II. Epidemiology

  1. Incidence increasing in United States
    1. Cases per year: 48 million
    2. Hospitalizations: 128,000
    3. Diarrheal related deaths per year: 3000
    4. Medical and associated costs per year: $4-14 billion
    5. Most cases are not seen by medical care
  2. Expanded fast food industry in part responsible
    1. Large scale food production affects many people
    2. More virulent organisms may be evolving
  3. Increased intake of raw and partially processed food
  4. Special backcountry camping risks (no refrigeration)
  5. Frequent sources of foodborne Diarrhea outbreaks
    1. Chicken (Most common)
    2. Mexican Food
    3. Chinese Food
    4. Finfish
    5. Shellfish
    6. Beef (least common)

III. Causes: Food Pathogens

  1. Most common Food Pathogens
    1. Staphylococcus aureus via pre-formed enterotoxin (onset 1-6 hours)
      1. Eggs
      2. Mayonnaise
      3. Cold meats
      4. Pork
      5. Chicken
      6. Beef
      7. Seafood
      8. Salads
      9. Cream-filled desserts
    2. Non-typhoid Salmonella (onset 6-48 hours)
      1. Raw poultry
      2. Shellfish
      3. Eggs
      4. Cheese
      5. Contaminated raw produce
      6. Unpasteurized milk or juice
    3. Campylobacter jejuni (onset 2-5 days)
      1. Raw chicken (66% infected)
      2. Unpasteurized milk
    4. Norovirus or Norwalk Virus (onset 12-48 hours)
      1. See Waterborne Illness
      2. Contaminated raw produce
      3. Shellfish from contaminated water
      4. Infected food preparer of uncooked foods
    5. Enterotoxigenic Escherichia coli (Traveler's Diarrhea, rapid onset 1-3 days)
      1. Food or water contaminated by human feces
  2. Other Common Food Pathogens
    1. Enterovirus
      1. Shellfish (47% infected)
    2. Aeromonas Hydrophila
      1. Poultry (95% infected)
      2. Fish (95% infected)
      3. Red Meat (95% infected)
      4. Produce: lettuce, celery (95% infected)
    3. Bacillus Cereus (onset 10-16 hours)
      1. Hamburger (45-63% infected)
      2. Raw rice (100% infected)
      3. Fried rice
      4. Meats, stews and gravy
      5. Vanilla sauce
    4. Hepatitis A (onset 15-50 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
    5. Listeria monocytogenes (onset 9-48 hours, invasive disease delayed for weeks)
      1. Meats (50-100% infected)
      2. Unpasteurized milk and soft cheeses
    6. Enterohemorrhagic E. coli (E. coli 0157:H7, onset 1-8 days)
      1. Hamburger and other red meat (undercooked)
      2. Contaminated raw produce (e.g. Seed sprouts)
      3. Unpasterurized juice or milk
    7. Shigella (Shigellosis, onset 4-7 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
    8. Vibrio vulnificus (onset 1-7 days)
      1. Raw oysters
  3. Less Common Food Pathogens
    1. Clostridium perfringens (onset 8-16 hours)
      1. Pre-cooked meats
      2. Dried foods
      3. Meats, gravy
      4. Poultry
    2. Clostridium botulinum (Botulism, onset 12-72 hours)
      1. Fermented fish
      2. Poor canning technique (especially home canned vegetables)
      3. Potatoes baked in aluminum foil
    3. Cyclospora cayetanensis (Cyclosporiasis, onset 7-14 days)
      1. Contaminated raw produce (lettuce, basil, imported berries)
    4. Vibrio parahaemolyticus, V. fluvialis, V. mimicus and non-toxigenic V. Cholerae (4-96 hours)
      1. Shellfish or raw seafood
      2. Typically only severe in immunocompromised patients
        1. Vibrio vulnificus is more significant (see above)
    5. Yersinia enterocolitica
    6. Toxoplasma gondii

IV. Causes: Common food sources of Foodborne Illness

  1. See Waterborne Illness
  2. Unpasteurized dairy products
    1. Salmonella
    2. Campylobacter
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Listeria
    5. Brucella
  3. Raw Beef or Pork
    1. Staphylococcus aureus
    2. Bacillus Cereus
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Clostridium perfringens
    5. Listeria monocytogenes
    6. Yersinia
    7. Toxoplasmosis
    8. Brucella
  4. Poultry
    1. Nontyphoidal Salmonella
    2. Campylobacter jejuni
    3. Listeria monocytogenes
  5. Fish or seafood
    1. Shellfish
      1. Vibrio parahaemolyticus (or Vibrio haemolyticus)
      2. Vibrio Cholera
    2. Raw Fish
      1. Salmonella
      2. Hepatitis A
      3. Aeromonas Hydrophila
    3. Raw Oysters
      1. Vibrio vulnificus (Similar to Vibrio Cellulitis)
    4. Fish with pre-formed toxins
      1. Ciguatera Poisoning (Reef fish ingestion)
      2. Scombroid Poisoning (Tuna, Mahi-mahi, Mackeral)
  6. Wild rabbit
    1. Tularemia

V. Causes: Presentation

  1. Acute symptoms in multiple people with same food exposure (Preformed toxins)
    1. Symptom onset within 6 hours (presents with Vomiting)
      1. Staphylococcus aureus (often from cold mayonnaise-based salads)
      2. Bacillus Cereus (meats, rice)
    2. Symptom onset within 8-16 hours (presents with Diarrhea)
      1. Clostridium perfringens (Cooked meats)
  2. Invasive or Inflammatory Diarrhea (Acute Abdominal Pain, fever, bloody Diarrhea)
    1. Nontyphoidal Salmonella
    2. Yersinia enterocolitica
    3. Shigella
    4. Vibrio parahaemolyticus (or Vibrio haemolyticus)
    5. Campylobacter jejuni
    6. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    7. Clostridium difficile
  3. Fever
    1. Campylobacter jejuni
    2. Norwalk Virus
    3. Salmonella
    4. Shigella
    5. Vibrio Cholerae (non-01)
    6. Vibrio parahaemolyticus
  4. Vomiting
    1. Bacillus cereus
    2. Clostridium botulinum
    3. Norwalk Virus
    4. Staphylococcus aureus
    5. Vibrio Cholerae (01)
    6. Vibrio parahaemolyticus
  5. Bloody Diarrhea (most common)
    1. See Invasive or inflammatory Diarrhea causes above
    2. Salmonella
    3. Shigella
    4. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
  6. Foul smelling Diarrhea
    1. Clostridium difficile
    2. Giardia lamblia

VI. Causes: Timing

  1. Preformed toxin (early onset Vomiting and Diarrhea after ingestion)
    1. Bacillus Cereus
    2. Staphylococcus aureus
  2. Diarrhea within 24 hours of ingestion
    1. Bacillus Cereus
    2. Clostridium perfringens
  3. Diarrhea within 24-48 hours of ingestion
    1. Campylobacter jejuni (individual cases)
    2. Salmonella (outbreaks)

VIII. Evaluation

  1. See Diarrhea

IX. Management

X. Prevention

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Ontology: Food Poisoning (C0016479)

Definition (CSP) any of several acute conditions ranging from mild to life-threatening that result from eating food containing toxins or pathogenic microorganisms.
Concepts Injury or Poisoning (T037)
MSH D005517
ICD9 005.9
SnomedCT 186086003, 186115009, 75258004
French INTOXICATION ALIMENTAIRE, Intoxication alimentaire, non précisée, Intoxication alimentaire SAI, Toxi-infection alimentaire, Intoxication alimentaire, Intoxication par les aliments, Empoisonnement alimentaire
German LEBENSMITTELVERGIFTUNG, Lebensmittelvergiftung, unspezifisch, Nahrungsmittelvergiftung NNB, Lebensmittel-Toxi-Infektion, Vergiftung, Lebensmittel-, Lebensmittelvergiftung, Nahrungsmittelvergiftung
English Food poisoning, unspecified, Food poisoning NOS, FOOD POISONING, food poisoning (diagnosis), food poisoning, Food toxi-infection, FOOD POIS, Food Poisonings, Poisoning, Food, Poisonings, Food, POIS FOOD, Food Poisoning, Poisoning;food, Food poisoning NOS (disorder), Food poisoning, FP - Food poisoning, Food poisoning (disorder), food; intoxication, food; poisoning, intoxication; food, poisoning; food, Food poisoning, NOS
Dutch voedselvergiftiging, niet-gespecificeerd, voedselvergiftiging NAO, voedseltoxi-infectie, intoxicatie; voedsel, vergiftiging; voedsel, voedsel; intoxicatie, voedsel; vergiftiging, voedselvergiftiging
Italian Intossicazione alimentare, NAS, Intossicazione alimentare non specificata, Infezione tossica da cibo, Intossicazione alimentare
Portuguese Intoxicação alimentar NE, ENVENENAMENTO ALIMENTAR, Toxinfecção alimentar, Intoxicação Alimentar, Intoxicação alimentar
Spanish Intoxicación por alimentos NEOM, Intoxicación alimentaria no especificada, Toxinfección alimentaria, Intoxicación Alimentaria, intoxicación por alimentos, SAI, intoxicación por alimentos, SAI (trastorno), intoxicación alimentaria, intoxicación por alimentos (trastorno), intoxicación por alimentos, Intoxicación alimentaria
Japanese 食中毒, 食中毒NOS, 食中毒、詳細不明, ショクチュウドクNOS, ショクチュウドク, ショクチュウドクショウサイフメイ, ドクソガタショクチュウドク, 毒素型食中毒
Czech Otrava jídlem, blíže neurčená, Otrava jídlem NOS, Otrava jídlem, Infekce otravou z potravy, alimentární otrava, otrava potravou
Hungarian Ételmérgezés, Étel toxin-fertőzés, Ételmérgezés, nem meghatározott, Ételmérgezés k.m.n.
Norwegian Matforgiftninger