Food Poisoning, Bacterial
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- 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.
- Bacillus cereus toxin
- Medium incubation period (8 to 16 hours)
- 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 beef, especially hamburger; unpasteurized milk; raw produce; and contaminated water
- 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 death within hours
- Salmonella, nontyphoidal (1,2,4)
- Food sources: contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruit and vegetables, and contaminated peanut butter
- 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
- Symptoms: abdominal cramps, fever, mucopurulent and bloody diarrhea
- Vibrio parahaemolyticus (1,2)
- Food source: undercooked or raw seafood, especially shellfish
- 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
- Symptoms: abdominal pain, fever, diarrhea (possibly bloody), vomiting
- L. monocytogenes (1)
- Food sources: unpasteurized/contaminated milk, soft cheese, and processed deli meats
- 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.
- Clostridium botulinum (1)
- 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
- 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).
- 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).