Food Poisoning

  • Food poisoning is a common infectious condition that affects millions of people in the United States each year.
  • Most commonly, people complain of
    • vomiting,
    • diarrhea, and
    • cramping abdominal pain.
  • People should seek medical care if they have an associated fever, blood in their storol (rectal bleeding), signs and symptoms of dehydration, or if their symptoms do not resolve after a couple of days.
  • Treatment for food poisoning focuses on keeping the affected person well hydrated.
  • Most cases of food poisoning resolve on their own.
  • Prevention is key and depends upon keeping food preparation areas clean, proper hand washing, and cooking foods thoroughly.

What is food poisoning?

Food poisoning is a food borne disease. Ingestion of food that contains a toxin, chemical or infectious agent (like a bacterium, virus, parasite, or prion) may cause adverse symptoms in the body. Those symptoms may be related only to the gastrointestinal tract causing vomiting or diarrhea or they may involve other organs such as the kidney, brain, or muscle.

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Food poisoning most commonly causes:

  • stomach cramps,
  • vomiting, and
  • diarrhea.

This can cause significant amounts of fluid loss and diarrhea along with nausea and vomiting may make it difficult to replace lost fluid, leading to dehydration. In developing countries where infectious epidemics cause diarrheal illnesses, thousands of people die because of dehydration.

As noted in the section above, other organ systems may be infected and affected by food poisoning. Symptoms will depend upon what organ system is involved (for example, encephalopathy due to brain infection).

Most cases of food poisoning last about 1 to 2 days and symptoms resolve on their own. If symptoms persist longer than that, the affected person should contact their health-care professional.

Cyclospora infections may be difficult to detect and diarrhea may last for weeks. Health-care professionals may consider this parasite as the potential cause of food poisoning in patients with prolonged symptoms.

There many causes of food poisoning. Sometimes they are classified by how quickly the symptoms begin after eating potentially contaminated food. Think of this as the incubation time from when food enters the body until symptoms begin. The following are examples of how this time classification can be arranged:

Short incubation of less than 16 to 24 hours

Chemical causes

  • Scrombroid poisoning usually is due to poorly cooked or stored fish. The affected person will experience flushing, shortness of breath, and difficulty swallowing within 1 to 2 hours of eating.
  • Ciguatera poisoning is another fish toxin that occurs after eating fish such as grouper, snapper, and barracuda. Symptoms include vomiting and diarrhea, muscle aches, and neurologic complaints including headache, numbness and tingling, hallucinations, and difficulty with balance (ataxia).
  • Mushroom ingestion can cause initial symptoms like vomiting and diarrhea. Eating Amanita mushrooms can cause liver and kidney failure leading to death.

Bacterium Causes

  • Staphylococcus aureus poisoning is due to a toxin that is pre-formed in food before it is eaten. It causes vomiting within 1 to 6 hours after eating the contaminated food.
  • Bacillus cereus is an infection that occurs after eating poorly cooked or raw rice.
  • Clostridium perfringens produces a spore that may germinate in cooked meat that has been stored in an environment that was too warm. Within 8 to 12 hours, it may cause profuse diarrhea.

Intermediate incubation from about 1 to 3 days

Infections of the large intestine or colon can cause bloody, mucousy diarrhea associated with crampy abdominal pain.

  • Campylobacter, according to CDC data, is the number one cause of food-borne disease in the United States.
  • Shigella spp contaminate food and water and cause dysentery (severe diarrhea often containing mucus and blood).
  • Salmonella infections often occur because of poorly or undercooked cooked and/or poor handling of the chicken and eggs. In individuals with weakened immune systems, including the elderly, the infection can enter the bloodstream and cause potentially life-threatening infections.
  • Vibrio parahaemolyticus can contaminate saltwater shellfish and cause a watery diarrhea.

Diarrhea due to small bowel infection tends not to be bloody, but infections may affect both the small and large intestine at the same time.

  • E. coli (enterotoxigenic) is the most common cause of traveler's diarrhea. It lacks symptoms such as fever or bloody diarrhea.
  • Vibrio cholerae, often from contaminated drinking, water produces a voluminous watery diarrhea resembling rice-water.
  • Viruses such as Norwalk, rotavirus and adenovirus tend to have other symptoms associated with an infection including fever, chills, headache, and vomiting.
  • Botulism is caused by Clostridium botulinum toxin and may present with fever, vomiting, mild diarrhea, numbness, and weakness leading to paralysis.

Long incubation of 3 to 5 days

  • Hemorrhagic E. coli (mainly E. coli 0157:H7) can cause inflammation of the colon leading to bloody stools. In some children, about a week after infection, it can progress to hemolytic uremic syndrome (HUS). Elderly individuals may contract thrombotic thrombocytopenic purpura (TTP). Toxins from the bacteria enter the blood stream and hemolyze or destroy red blood cells. In addition, the toxins cause kidney failure and uremia, where waste products build up in the body.
  • Yersinia enterocolitica may cause inflammation of lymph nodes in the lining of the abdomen and may mimic appendicitis.

Very long incubation of up to a month

Parasites

  • Giardiasis may occur after drinking water from lakes or rivers that have been contaminated by beavers, muskrats, or sheep that have been grazing. It also can be passed from person to person, for example in day care settings.
  • Amoebiasis is encountered in contaminated drinking water, usually in tropical or semitropical climates and can be passed person to person.
  • Trichinosis is due to an infection from eating undercooked pork or wild game such as bear meat. Aside from fever and gastrointestinal complaints, symptoms include muscle pain, facial swelling, and bleeding around the eyes and under the fingernails.
  • Cysticercosis is often seen in developing countries where water is contaminated with pork tapeworms and the person swallows the ova form the tapeworm. The infection can invade the brain (neurocysticercosis) causing seizures.
  • Cyclospora is a one-celled parasite that infects the small intestine causing explosive, watery bowel movements. Cyclospora infection is contracted by eating contaminated food or drinking water. Cyclospora infection usually does not spread from person to person. Symptoms may also include headache, body aches, and malaise and can mimic a viral type infection. Without antibiotic treatment, Cyclospora infection will gradually resolve over the course of many weeks, but may come and go (relapse) over that period.

Bacteria

  • Listeriosis usually occurs after foods contaminated with Listeria bacteria are ingested. These include unpasteurized, raw milk, soft cheeses, and processed meats and poultry. Vegetables and fruits may also become infected with Listeria. The bacteria may lay dormant in or on the surface of the food products for weeks.
  • Brucellosis occurs by ingesting raw or unpasteurized milk and cheese, especially goat's milk contaminated with Brucella spp

Virus

  • Hepatitis A is spread by poor food handling, and not due to blood exposure such as in hepatitis B and C.

Protozoans

  • Toxoplasmosis is usually transmitted to humans from cat feces containing Toxoplasmaparasites; most infections are asymptomatic, but people who have diminished immune systems can develop systemic disease symptoms.

Prion

  • Bovine Spongiform encephalopathy (mad cow disease) is acquired by eating foods containing prions (transmissible agents that induce abnormal folding of brain protein) contaminating brain or spinal cord from infected cows.

 

Anyone can come down with food poisoning. Statistically speaking, nearly everyone will come down with food poisoning at least once in their lives.

There are some populations that are more at risk than others. Anyone with a suppressed immune system or an auto-immune disease may have a greater risk of infection and a greater risk of complications resulting from food poisoning.

If you have food poisoning, chances are it won’t go undetected. Symptoms can vary depending on the source of the infection. The length of time it takes for symptoms to appear also depends on the source of the infection, but it can range from as little as 1 hour to as long as 28 days. Common cases of food poisoning will typically include at least three of the following symptoms:

  • abdominal cramps
  • diarrhea
  • vomiting
  • loss of appetite
  • mild fever
  • weakness
  • nausea
  • headaches

Symptoms of potentially life-threatening food poisoning include:

  • diarrhea persisting for more than three days
  • a fever higher than 101.5°F
  • difficulty seeing or speaking
  • symptoms of severe dehydration, which may include dry mouth, passing little to no urine, and difficulty keeping fluids down
  • bloody urine

If you experience any of these symptoms, you should contact your doctor immediately.

Most times, the diagnosis of food poisoning is made by history and physical examination. Often, the patient volunteers the diagnosis when they come for medical care. For example, "I got sick after eating potato salad at a picnic," or, "I drank a raw egg protein shake."

The health-care professional may ask questions about the symptoms, when they started, and how long they have lasted. A review of systems may help give direction as to what type of infection is present. For example, a patient with numbness of their feet and weakness may be asked about whether they have opened any home canned food recently.

Travel history may be helpful to see if the patient had been camping near a stream or lake and the potential for drinking contaminated water, or if they have traveled out of the country recently and have eaten different foods than they normally do, such as raw eggs or wild game.

Physical examination begins with taking the vital signs of the patient (blood pressure, pulse rate, and temperature). Clinical signs of dehydration include dry, tenting skin, sunken eyes, dry mouth, and lack of sweat in the armpits and groin. In infants, in addition to the above, subtle signs of dehydration may include poor muscle tone, poor suckling, and sunken fontanelle.

Routine blood tests are not usually ordered unless there is concern about something more than the vomiting and diarrhea. In patients with significant dehydration, the health-care professional may want to check electrolyte levels in the blood as well as kidney function. If there is concern about hemolytic uremic syndrome, a complete blood count (hemogram, CBC) to check the red blood cells, white blood cells, and platelet count may be ordered. If there is concern about hepatitis, liver function tests may be ordered.

Stool samples may be useful especially if there is concern about infections caused by Salmonella, Shigella, and Campylobacter, the common non traveler's diarrhea. This is especially true when the patient presents with bloody diarrhea, thought to be due to infection. If there is concern about a parasite infection, stool samples can be examined also for the presence of parasites. Some parasites may be very difficult to see under the microscope, including Cyclospora, because it is so tiny.

Depending on the suspected cause of the food poisoning, there are some immunological tests (for example, detection of Shiga toxins) that the CDC recommends. Cyclospora DNA may be detected in the stool using molecular testing called polymerase chain reaction (PCR). Other methods may be used (for example, detection of prions in tissue samples).

Food poisoning can usually be treated at home, and most cases will resolve within three to five days.

If you have food poisoning, it’s crucial to remain properly hydrated. Sports drinks high in electrolytes can be helpful with this. Fruit juice and coconut water can restore carbohydrates and help with fatigue.

Avoid caffeine, which may irritate the digestive tract. Decaffeinated teas with soothing herbs like chamomile, peppermint, and dandelion may calm an upset stomach. 

Over-the-counter medications like Imodium and Pepto-Bismol can help control diarrhea and suppress nausea. However, you should check with your doctor before using these medications, as the body uses vomiting and diarrhea to rid the system of the toxin. Also, using these medications could mask the severity of the illness and cause you to delay seeking expert treatment.

It’s also important for those with food poisoning to get plenty of rest.

In severe cases of food poisoning, individuals may require hydration with intravenous (IV) fluids at a hospital. In the very worst cases of food poisoning, a longer hospitalization may be required while the individual recovers.

Food safety tips

Prevention of food borne illness begins at home with proper food preparation technique.

  • Foods should be cooked thoroughly. This especially applies to raw meat, eggs, and poultry. A meat thermometer can be used to measure the internal temperature of a meat dish.
  • Leftovers should be refrigerated immediately so bacteria and viruses do not have time to start growing.
  • Wash fruits and vegetables well before eating. This removes dirt, pesticides, chemicals, or other infectious agents used on, or exposed to, the foods in the fields or storage facilities.
  • Wash hands routinely before and after handling food to help prevent the spread of infection.
  • Thoroughly clean counters and other areas that are used to clean, prepare, and assemble foods. Cross contamination of food is common and can cause food poisonings. For example, a cutting board and knife used to cut raw chicken should be washed thoroughly before cutting up fruit and vegetables to prevent the spread of Salmonella.
  • In restaurants, meals are prepared by others. Health inspectors check restaurants routinely and their reports on sanitary practices are usually available online. Make certain the food ordered is thoroughly cooked, especially meats such hamburger.
  • Pregnant women and people who have compromised immune systems, such as those undergoing chemotherapy or who are taking medication such as prednisone, should avoid eating soft cheeses like camembert, brie, blue, and feta because of the risk of contracting Listeria. Be very sure all fruits and vegetables are cleaned thoroughly prior to eating, no matter the source.

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