Food Poisoning, Bacterial was found in 5-Minute Clinical Consult which helps you diagnose, treat, and follow up on over 900 medical conditions seen in everyday practice.
To view this entire topic, please sign in or purchase a subscription.
Explore 5-Minute Clinical Consult - view these FREE monographs:
-- The first section of this topic is shown below --
Basics
Description
- Food poisoning (aka foodborne infection) is an illness resulting from the consumption of contaminated food.
- The illness may be produced by bacterial infection or by toxins produced by the bacteria.
- The most commonly recognized foodborne infections acquired in the US are those caused by the bacteria Salmonella, Campylobacter, and Clostridium perfringens. Adding in traveler's diarrhea, Escherichia coli enters this group.
- Vibrio incidence rare, but increasing substantially in last 10 years
Epidemiology
Incidence
- In the US, an estimated 48 million cases of foodborne poisoning annually (majority due to viral etiology), resulting in 128,000 hospitalizations and 3,000 deaths. ~1 of 6 Americans will have an episode.
- >1/2 of water-borne bacterial food poisoning in the US occurs in water not intended for drinking—untreated or inadequately treated ground water.
Risk Factors
- Travel to developing countries
- Improper food storage/handling
- Cross-contamination during preparation of food
- Weakened immune system, pregnancy, very young, elderly, and those with chronic diseases
- Underlying GI disorders
- Patients taking antacids, H2 blockers, and proton pump inhibitors
General Prevention
- When preparing food at home:
- Clean:
- Wash hands, cutting boards, and surfaces before food preparation and after preparing each food item.
- Wash fresh produce thoroughly before eating.
- Separate:
- Keep raw meat, poultry, fish, and their juices away from other food that will not be cooked (e.g., salad).
- Place cooked meat on clean platter.
- Cook: Thoroughly cook meat to the following internal temperature:
- Fresh beef, veal, pork, and lamb: 145°F
- Ground meats and egg dishes: 160°F
- Poultry: 165°F. Cook chicken eggs thoroughly until the yolk is firm.
- Chill:
- Refrigerate leftovers within 2–3 hours in clean, shallow, covered containers. If the temperature is >90°F, refrigerate within 1 hour.
- Clean:
- When traveling to underdeveloped countries:
- Eat only freshly prepared foods.
- Avoid beverages diluted with nonpotable water, such as ice and milk.
- Avoid food washed in nonpotable water, like salads.
- Other risky foods include raw or undercooked meat and seafood, unpeeled raw fruits and vegetables.
- In developing nations: “Boil it, Cook it, Peel it, or Forget it.”
- Bottled, carbonated, and boiled beverages are generally safe to drink.
- Bismuth subsalicylate (Pepto-Bismol), two 262-mg tablets q.i.d. has been shown to protect travelers to developing countries ∼60% of the time. However, it is not recommended for persons taking anticoagulants or other salicylates.
Etiology
- Short incubation period (1–6 hours): Likely preformed toxin-induced:
- Bacillus cereus:
- Food sources: Improperly cooked rice/fried rice and red meats
- Causes sudden onset of severe nausea and vomiting. Diarrhea may be present.
- Staphylococcus aureus:
- Food sources: Nonrefrigerated or improperly refrigerated meats and potato and egg salads
- Causes sudden onset of severe nausea and vomiting. Abdominal cramps and fever may be present.
- Bacillus cereus:
- Medium incubation period (8–16 hours):
- Bacillus cereus (toxin):
- Food sources: Meat, stew gravy, vanilla sauce
- Causes watery diarrhea, abdominal cramps, nausea
- C. perfringens:
- Food sources: Dry/Precooked meats and poultry
- Causes watery diarrhea, nausea, abdominal cramps
- Bacillus cereus (toxin):
- Long incubation period (>16 hours):
- Toxin-producing organisms:
- Clostridium botulinum: Source is commercially canned or improperly home-canned foods. Causes vomiting, diarrhea, slurred speech, diplopia, dysphagia, and descending muscle weakness/flaccid paralysis.
- Enterohemorrhagic E. coli (e.g., 0157:H7): Food sources are undercooked beef, especially hamburger, unpasteurized milk, raw fruits and vegetables, and contaminated water. Causes severe diarrhea that often becomes bloody, abdominal pain, vomiting. More common in children <4 years of age.
- Enterotoxigenic E. coli: Food sources are foods or water contaminated by human feces. Causes watery diarrhea, abdominal cramps, and vomiting.
- Vibrio cholerae: Food sources are contaminated water, fish, and shellfish, especially food sold by street vendors. Causes profuse watery diarrhea and vomiting, which can lead to severe dehydration and death within hours.
- Invasive organisms: Often bloody stool and fever:
- Salmonella: Food sources are contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruits and vegetables, contaminated peanut butter. Causes watery diarrhea, fever, abdominal cramps, vomiting.
- Campylobacter jejuni: Food sources are raw and undercooked poultry, unpasteurized milk, contaminated meats. Causes diarrhea (may be bloody), cramps, vomiting, fever.
- Shigella: Food sources are food or water contaminated by human fecal material. Causes abdominal cramps, fever, diarrhea.
- Vibrio parahaemolyticus: Food source is raw shellfish. Causes nausea, vomiting, diarrhea, abdominal pain.
- Vibrio vulnificus: Food source is undercooked and raw seafood; wounds exposed to sea water. Causes vomiting, diarrhea, abdominal pain, bacteremia, wound infections. Can be fatal in patients with liver disease or those who are immunocompromised.
- Yersinia enterocolitica and Y. pseudotuberculosis: Food sources are undercooked pork, unpasteurized milk, tofu, contaminated water. Causes appendicitislike symptoms: Abdominal pain, fever, diarrhea, vomiting; occurs primarily in older children and younger adults.
- Listeria: Sources include unpasteurized/contaminated milk, soft cheese, processed/delicatessen meats. Causes nausea, vomiting, fever, watery diarrhea.
- Toxin-producing organisms:
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
