Food Poisoning, Bacterial

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Basics

Description

  • Results from the consumption of contaminated food or water
  • Symptoms commonly include vomiting, diarrhea, dehydration, abdominal discomfort, and fever (1).
  • Foodborne illness may be caused by bacterial, parasitic, or viral infection (2).

Epidemiology

  • Roughly 1 in 6 Americans (48 million) become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases annually (3).
  • 80% of foodborne illness is due to unclear agents (3).
  • Bacterial pathogens most commonly contributing to foodborne illness are Salmonella (nontyphoidal), Campylobacter, Clostridium perfringens, Staphylococcus aureus, Listeria monocytogenes, and Escherichia coli (1,3).
  • Norovirus is the most common viral cause of foodborne illness in the United States (4).

Etiology and Pathophysiology

  • Short incubation period (1 to 6 hours)
    • Bacillus cereus toxin
      • Food sources: improperly cooked rice/fried rice and red meats (2)
      • Symptoms: sudden onset of severe nausea and vomiting. Diarrhea may be present.
    • S. aureus (1)
      • Food sources: nonrefrigerated or improperly refrigerated meats and potato and egg salads
      • Symptoms: sudden onset of severe nausea and vomiting. Abdominal cramps and fever may be present.
  • Medium incubation period (8 to 16 hours)
    • B. cereus (1)
      • Food sources: meat, stews, gravy, vanilla sauce
      • Symptoms: watery diarrhea, abdominal cramps, nausea
    • C. perfringens (1,2)
      • Food sources: dry/precooked or undercooked meats, home-canned goods
      • Symptoms: watery diarrhea, nausea, abdominal cramps
  • Long incubation period (>16 hours)
    • Toxin-producing organisms:
      • Clostridium botulinum (1)
        • Food source: commercially canned or improperly home-canned foods
        • Symptoms: vomiting, diarrhea, slurred speech, diplopia, dysphagia, and descending muscle weakness/flaccid paralysis
      • Enterohemorrhagic E. coli (e.g., 0157:H7) (1,2)
        • Food sources: undercooked ground beef, juice, unpasteurized milk; raw produce; and contaminated water
        • Risk factors: daycare centers, nursing homes, extremes of age
        • Symptoms: severe diarrhea that often becomes bloody, abdominal pain, vomiting
      • Enterotoxigenic E. coli (“traveler’s diarrhea”) (5)
        • Food sources: food or water contaminated by human feces
        • Symptoms: watery diarrhea, abdominal cramps, tenesmus, fecal urgency, and vomiting
      • Vibrio cholerae (2)
        • Food sources: contaminated water, fish, and shellfish, especially food sold by street vendors
        • Symptoms: profuse watery “rice water” diarrhea and vomiting, which can lead to severe dehydration and rapid death
    • Invasive organisms
      • Salmonella, nontyphoidal (1,2,4)
        • Food sources: contaminated eggs, poultry; unpasteurized milk or juice, cheese; contaminated raw fruit and vegetables; and contaminated peanut butter
        • Risk factors: contact with animals
        • Symptoms: small volume, mucopurulent and possibly bloody diarrhea; fever; abdominal cramps; vomiting
      • Campylobacter jejuni (1,2)
        • Food sources: raw and undercooked poultry, unpasteurized milk, and contaminated meats
        • Symptoms: diarrhea (possibly bloody), cramps, vomiting, fever
      • Shigella (1,2)
        • Food sources: contaminated water, raw produce, uncooked foods, foods handled by infected food worker
        • Risk factors: MSM
        • Symptoms: abdominal cramps, fever, mucopurulent and bloody diarrhea
      • Vibrio parahaemolyticus (1,2)
        • Food source: undercooked or raw seafood, especially shellfish
        • Risk factors: cirrhosis
        • Symptoms: nausea, vomiting, diarrhea, abdominal pain
      • Vibrio vulnificus (1,2)
        • Food source: undercooked or raw seafood, particularly oysters
        • Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, wound infections; can be fatal in patients with liver disease or those who are immunocompromised
      • Yersinia enterocolitica (2)
        • Food sources: undercooked beef and pork, unpasteurized milk, tofu, contaminated water
        • Risk factors: cirrhosis, hemochromatosis, blood transfusion
        • Symptoms: abdominal pain, fever, diarrhea (possibly bloody), vomiting
      • L. monocytogenes (1)
        • Food sources: unpasteurized/contaminated milk, soft cheese, and processed deli meats
        • Risk factors: pregnancy
        • Symptoms: nausea, vomiting, fever, watery diarrhea; pregnant women may have a flu-like illness leading to premature delivery or stillbirth; immunocompromised patients may develop meningitis and bacteremia.

Risk Factors

  • Recent travel to a developing country (4)
  • Food handlers, daycare attendees, nursing home residents, and recently hospitalized patients (2)
  • Altered immunity due to underlying disease or use of certain medications, including antacids, H2 blockers, and proton pump inhibitors (4)
  • Cross-contamination and subsequent ingestion of improperly prepared and stored foods

General Prevention

  • When preparing food:
    • Wash hands, cutting boards, and food preparation surfaces before and after preparing each item.
    • Wash fresh produce thoroughly before eating.
    • Keep raw meat, poultry, fish, and their juices away from other food (e.g., salad). Wear gloves when handling raw meats (6).
    • Do not put cooked protein or washed produce into containers or on surfaces where unwashed or raw food was stored.
    • 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 eggs thoroughly until the yolk is firm.
      • Seafood: 145°F
    • Refrigerate leftovers within 2 to 3 hours in clean, shallow, covered containers. If the temperature is >90°F, refrigerate within 1 hour.
  • When traveling to underdeveloped countries:
    • Eat only freshly prepared foods.
    • Avoid beverages and foods prepared with nonpotable water.
    • Other risky foods include raw or undercooked meat and seafood, unpeeled raw fruits, and vegetables.
    • Bottled, carbonated, and boiled beverages are generally safe to drink.
  • Improved hygiene and sanitation reduces the risk of traveler’s diarrhea. The prevention strategy “Boil it, Cook it, Peel it, or Forget it” has inconsistent and limited evidence (5).
  • Chemoprophylaxis for traveler’s diarrhea is recommended for high-risk travelers (e.g., immunocompromised) (5).

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