Food Poisoning Disease

BASICS

DESCRIPTION

A variety of related illnesses resulting from ingestion of food contaminated with bacteria capable of causing disease. The illness may be produced by bacterial infection itself (salmonellosis, shigellosis) or by toxins produced by the bacteria (Staphylococcus aureus, Clostridium perfringens, Bacillus cereus).

System(s) affected: Gastrointestinal
Genetics: N/A
Incidence/Prevalence in USA: Poor reporting overall. Estimated 6 million cases/year. 1 in 10 Americans with foodborne diarrhea/year. Approximate incidence is 2,500/100,000. Most commonly reported cause in the US are C. jejuni, Salmonella, C. perfringens, S. aureus - accounting for 90% of cases, totaling approximately 45,000 hospitalizations and 2,700 deaths in U.S.
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Suspect when multiple persons become ill after eating the same meal. Timing and type of clinical presentation can aid in establishing etiology.

Fever more suggestive of invasive organisms (Shigella, Salmonella, Campylobacter)
Nausea, vomiting 1-6 hours after meal (S. aureus, B. cereus)
Cramps, diarrhea 8-16 hours after meal (C. perfringens, B. cereus)
Fever, cramps, diarrhea 18-72 hours after meal (Campylobacter jejuni, Yersinia enterocolitica, E. coli, Vibrio parahaemolyticus, Shigella and Salmonella species)
Bloody diarrhea without fever 3-5 days after meal (verotoxigenic E. coli, occasionally C. jejuni)
Pseudoappendicitis (Y. enterocolitica)
Sepsis, meningitis (Listeria monocytogenes, Shigella and Salmonella species)
Occasional metastatic foci of infection (arthritis, L. monocytogenes, Salmonella, etc.)

CAUSES

S. aureus (preformed enterotoxin)
B. cereus (preformed enterotoxin)
C. perfringens (enterotoxin elaborated in gut)
C. jejuni (tissue invasion)
Y. enterocolitica (tissue invasion)
E. coli (enterotoxigenic, verotoxigenic [hemorrhagic], and tissue invasive forms), including E. coli O157:H7
V. parahaemolyticus (toxin elaboration, possibly invasion)
Shigella species (tissue invasion)
Salmonella species (tissue invasion), including Salmonella serotype Typhimurium Definitive Type 104
L. monocytogenes (tissue invasion)

RISK FACTORS

Ingestion of:

High protein foods: egg salad, cream-filled pastries, poultry, ham - S. aureus
Cereals, fried rice, dried foods and herbs, meats, vegetables - B. cereus
Meats, gravies, dried foods, vegetables - C. perfringens
Under-cooked poultry, meat, raw dairy products, contaminated water, mushrooms - C. jejuni
Under-cooked pork, other meat and dairy products - Y. enterocolitica
Raw vegetables, meats and other foods, contaminated water and juice - E. coli
Raw and cooked seafood - V. parahaemolyticus
Raw vegetables, egg salads, contaminated water - Shigella
Raw or under-cooked eggs, poultry, dairy products, meat - Salmonella
Under-cooked meat, dairy products, and many other foods - L. monocytogenes
Daycare contacts
Travel to developing regions
Exposure to asymptomatic animals harboring infections and spreading them through feces and milk - E. coli, Listeria, Salmonella

DIAGNOSIS

LABORATORY

Culture of stool most reliable. Routine cultures detect Shigella, Salmonella, Campylobacter and E. coli 0157:H7. Vibrio and most E. coli species require specific media and orders to laboratory.

Drugs that may alter lab results: Prior or concomitant antibiotic therapy may eliminate pathogen from stool
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Only present in invasive or colitic syndromes

SPECIAL TESTS

Sigmoidoscopy in persistent and unresponsive cases

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Stool culture - obtain if diarrhea is severe (patient is bedfast), temperature > 101.5°F (38.5°C), persistently bloody stools, presence of fecal leukocytes
Epidemiologic investigation
Culture of suspected food source if available

TREATMENT

APPROPRIATE HEALTH CARE

Usually outpatient management sufficient. Hospitalization for septicemias or focal infections, severe electrolyte imbalance or dehydration.

GENERAL MEASURES

Most are self-limited syndromes and do not require specific therapy
Oral solutions for rehydration. Sport drinks and diluted fruit juices with broth and crackers sufficient in mild cases.
For moderate cases, consider 8 oz orange or apple juice plus 1/2 teaspoon honey and a pinch of salt followed by 8 oz water with 1/4 teaspoon baking soda
Intravenous fluid and electrolyte replacement if necessary for more severe dehydration (particularly in the elderly)
For infants, rehydration products (e.g., Pedialyte) provides adequate fluid and electrolyte replacement. Don't use for more than 1 to 2 days without clinical reassessment of nutritional needs.

SURGICAL MEASURES

N/A

ACTIVITY

Bedrest for comfort if needed during the acute phase

DIET

Eliminate contaminated food. Bland diet during recovery. Nothing by mouth, if needed, for excessive vomiting or diarrhea.

PATIENT EDUCATION

Avoidance of raw or under-cooked foods
Proper food storage and preparation techniques such as refrigeration
Instruction on prevention if patient traveling to foreign countries
Avoid antidiarrheal drugs in most cases; they may prolong the carrier state

FOLLOW UP

PREVENTION/AVOIDANCE

No ingestion of raw seafood, meats, or poultry
Avoid any unpasteurized dairy products
Clean thoroughly any food preparation area in contact with causative items
Ensure proper cooling of any prepared foods not immediately consumed

POSSIBLE COMPLICATIONS

Cardiovascular collapse
Arrhythmias from electrolyte disturbance
Septicemias or other metastatic infections
Hypoglycemic seizures or coma

EXPECTED COURSE AND PROGNOSIS

Resolution of signs and symptoms over a few days in most cases
Chronic sequelae include Guillain-Barre syndrome, reactive arthritis

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric:

Day care center outbreaks may occur. Perhaps at higher risk of complications from antiperistaltic drugs.
Newborns and infants are a high risk for mortality and complications
Shigellosis is a rare cause of chronic vaginal discharge in young girls

Geriatric:

Nursing home outbreaks may occur
Significant cause of mortality

Others: N/A

PREGNANCY

Perinatal Salmonellosis, Listeriosis, and Campylobacteriosis may secondarily infect newborn with severe consequences of sepsis and meningitis

OTHER NOTES

C. jejuni antimicrobial therapy resistance is increasing

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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