II. Epidemiology
-
Incidence increasing in United States
- Cases per year: 48 million
- Hospitalizations: 128,000
- Diarrheal related deaths per year: 3000
- Medical and associated costs per year: $4-14 billion
- Most cases are not seen by medical care
- Expanded fast food industry in part responsible
- Large scale food production affects many people
- More virulent organisms may be evolving
- Highly processed foods (including ground meats which distribute contamination throughout food)
III. Risk Factors
- Increased intake of raw and partially processed food
- Special backcountry camping risks (no refrigeration)
- Improperly stored, cooked or reheated foods
- Frequent sources of foodborne Diarrhea outbreaks
- Chicken (Most common)
- Mexican Food
- Chinese Food
- Fin fish
- Shellfish
- Beef (least common)
IV. Causes: Food Pathogens
- Most common Food Pathogens in U.S.
- Norovirus or Norwalk Virus (onset 12-48 hours)
- See Waterborne Illness
- Incidence (U.S.): 5.5 Million cases with 15,000 hospitalizations and 150 deaths (0.0027% mortality) per year
- Worldwide, Norovirus is responsivble for 200,000 deaths per year in developing countries
- Contaminated raw produce
- Shellfish from contaminated water
- Infected food preparer of uncooked foods
- Non-typhoid Salmonella (onset 6-48 hours)
- Incidence (U.S.): 1 Million cases with 19,000 hospitalizations and 380 deaths (0.38% mortality) per year
- Raw poultry
- Shellfish
- Eggs
- Cheese
- Contaminated raw produce
- Unpasteurized milk or juice
- Clostridium perfringens via in-vivo toxin production (onset 6-16 hours, self-resolves by 24 hours)
- Campylobacter jejuni (onset 2-5 days)
- Incidence (U.S.): 850,000 cases with 8500 hospitalizations and 76 deaths (0.0089% mortality) per year
- Raw chicken (66% infected)
- Unpasteurized milk
- Staphylococcus Aureus via pre-formed Enterotoxin (onset 1-6 hours)
- Incidence (U.S.): 240,000 cases with 1100 hospitalizations and 6 deaths (0.0025% mortality) per year
- Resolves in 1-2 days without treatment
- Nausea, Vomiting and abdominal cramping are most common
- Diarrhea is less prominent and may persist for 3 days after onset)
- Eggs
- Mayonnaise
- Cold meats
- Pork
- Chicken
- Beef
- Seafood
- Salads
- Cream-filled desserts
- Shigella (Shigellosis, onset 4-7 days)
- Similar Waterborne Illness sources as Norovirus (see above)
- Incidence (U.S.): 130,000 cases with 1500 hospitalizations and 10 deaths (0.0077% mortality) per year
- Enterotoxigenic Escherichia coli (Traveler's Diarrhea, rapid onset 1-3 days)
- Food or water contaminated by human feces
- Incidence (U.S.): 110,000 cases with 270 hospitalizations and 1 death (rare mortality) per year
- Norovirus or Norwalk Virus (onset 12-48 hours)
- Less Common Food Pathogens in U.S.
- Yersinia enterocolitica
- Incidence (U.S.): 98,000 cases with 530 hospitalizations and 29 deaths (0.03% mortality) per year
- Waterborne Illness
- Toxoplasma gondii (Toxoplasmosis)
- Incidence (U.S.): 87,000 cases with 4400 hospitalizations and 330 deaths (0.38% mortality) per year
- Raw or under-cooked meat (pork, mutton, wild game)
- Ingested items contaminated with cat feces
- Enterohemorrhagic E. coli (E. coli 0157:H7, onset 1-8 days)
- Incidence (U.S.): 63,000 cases with 2100 hospitalizations and 20 deaths (0.032% mortality) per year
- Hamburger and other red meat (undercooked)
- Contaminated raw produce (e.g. Seed sprouts)
- Unpasterurized juice or milk
- Bacillus Cereus (onset 10-16 hours)
- Incidence (U.S.): 63,000 cases with 20 hospitalizations and 0 deaths per year
- Causes 2 syndromes
- Toxin-mediated with acute Vomiting (similar to staph aureus) esp. after fried rice ingestion
- Diarrheal illness similar to Clostridium perfringens
- Hamburger (45-63% infected)
- Raw rice (100% infected)
- Fried rice
- Meats, stews and gravy
- Vanilla sauce
- Vibrio parahaemolyticus, V. fluvialis, V. mimicus and non-toxigenic V. Cholerae (4-96 hours)
- Incidence (U.S.): 35,000 cases with 100 hospitalizations and 4 deaths (0.011 mortality) per year
- Shellfish or raw seafood
- Typically only severe in Immunocompromised patients
- Vibrio vulnificus is more significant (see below)
- Yersinia enterocolitica
- Rare Food Pathogens in U.S.
- Listeria monocytogenes (onset 9-48 hours, invasive disease delayed for weeks)
- Meats (50-100% infected)
- Deli Meats
- Uncooked hot dogs
- Cantaloupe
- Unpasteurized milk and soft cheeses
- Vibrio vulnificus (onset 1-7 days)
- Raw oysters
- Clostridium botulinum (Botulism, onset 12-72 hours)
- Fermented fish
- Poor canning technique (especially home canned vegetables)
- Potatoes baked in aluminum foil
- Hepatitis A (onset 15-50 days)
- Similar Waterborne Illness sources as Norovirus (see above)
- Enterovirus
- Shellfish (47% infected)
- Cyclospora cayetanensis (Cyclosporiasis, onset 7-14 days)
- Contaminated raw produce (lettuce, basil, imported berries)
- Aeromonas Hydrophila
- Poultry (95% infected)
- Fish (95% infected)
- Red Meat (95% infected)
- Produce: lettuce, celery (95% infected)
- Listeria monocytogenes (onset 9-48 hours, invasive disease delayed for weeks)
V. Causes: Common food sources of Foodborne Illness
- See Waterborne Illness
- Improperly stored, cooked or reheated foods (e.g. buffets, picnics)
- Staphylococcus Aureus
- Bacillus Cereus
- Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
- Unpasteurized dairy products
- Salmonella
- Campylobacter
- Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
- Listeria monocytogenes
- Brucella
- Yersinia enterocolitica
- Raw Beef or Pork
- Pigs or Pork
- Yersinia
- Trichinella
- Poultry
- Nontyphoidal Salmonella
- Campylobacter jejuni
- Listeria monocytogenes
- Reptile Exposure
- Cat Exposure
- Fish or seafood
- Shellfish
- Vibrio parahaemolyticus (or Vibrio haemolyticus)
- Vibrio Cholera
- Raw Fish
- Raw Oysters
- Vibrio vulnificus (Similar to Vibrio Cellulitis)
- Fish with pre-formed toxins
- Ciguatera Poisoning (Reef fish ingestion such as grouper, snapper, barracuda)
- Scombroid Poisoning (Tuna, Mahi-mahi, Mackeral, Swordfish)
- Tetrodotoxin (pufferfish, porcupinefish, ocean sunfish, or triggerfish)
- Shellfish
- Wild rabbit
VI. Symptoms: Gastrointestinal by Cause
- Acute symptoms in multiple people with same food exposure (Preformed toxins)
- Symptom onset within 6 hours (presents with Vomiting)
- Staphylococcus Aureus (often from cold mayonnaise-based salads)
- Bacillus Cereus (meats, rice)
- Symptom onset within 8-16 hours (presents with Diarrhea)
- Clostridium perfringens (Cooked meats)
- Symptom onset within 6 hours (presents with Vomiting)
- Watery Diarrhea (noninvasive osmotic dysfunction)
- Enterotoxigenic Escherichia coli
- Vibrio Cholerae
- Cryptosporidium
- Cyclospora
- Enteric Viruses
- Invasive or Inflammatory Diarrhea (Acute Abdominal Pain, fever, tenesmus, bloody Diarrhea)
- Nontyphoidal Salmonella
- Yersinia enterocolitica
- Shigella
- Vibrio parahaemolyticus (or Vibrio haemolyticus)
- Campylobacter jejuni
- Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
- Clostridium difficile
- Bloody Diarrhea
- See Invasive or Inflammatory Diarrhea causes above
- Salmonella
- Shigella
- Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
- Campylobacter
- Vibrio parahaemolyticus
- Yersinia
- Entamoeba histolytica
- Foul smelling Diarrhea
-
Vomiting
- Preformed toxins (onset within 6-12 hours) typically cause significant non-bilious, non-bloody Emesis
- Bacillus Cereus
- Clostridium botulinum
- Norwalk Virus
- Staphylococcus Aureus
- Vibrio Cholerae (01)
- Vibrio parahaemolyticus
VII. Symptoms: Systemic by Cause
- Fever
- Neurologic Symptoms
- Amatoxin Mushrooms (encephalopathy)
- Campylobacter (Guillain-Barre Syndrome)
- Ciguatera Poisoning (perioral Paresthesias, cold Allodynia)
- Clostridium botulinum (Diplopia, descending paralysis)
- Listeria monocytogenes (Nuchal Rigidity, confusion, myalgias)
- Muscarine Mushrooms (Cholinergic Toxicity)
- Psilocybin mushrooms (Hallucinations)
- Tetrodotoxin such as pufferfish, porcupinefish, ocean sunfish, or triggerfish (Paresthesias, numbness)
- Paralytic Shellfish Poisoning (Saxitoxin) in clams and mussels (numbness, paralysis)
- Toxoplasmosis (Headaches, Blurred Vision)
- Scombroid Fish Poisoning (perioral Paresthesias, Urticaria, facial Flushing)
-
Jaundice
- Amatoxin Mushrooms
- Hepatitis A
- Hemorrhagic or necrotic Bullae
VIII. Symptoms: Onset Timing
- Preformed Toxin with immediate onset (<1 hour)
- Tetrodotoxin (pufferfish, porcupinefish, ocean sunfish, or triggerfish)
- Scombroid Fish Poisoning
- Preformed toxin with 1-6 hour onset (early onset Vomiting and Diarrhea after ingestion)
- Bacillus Cereus
- Staphylococcus Aureus
- Norovirus
- Ciguatera Poisoning (Reef fish ingestion such as grouper, snapper, barracuda)
- Onset within 6-48 hours of ingestion
- Bacillus Cereus
- Clostridium perfringens
- Nontyphoidal Salmonella
- Vibrio species
- Listeria monocytogenes
- Enterotoxigenic Escherichia coli (Traveler's Diarrhea)
- Onset within 2-7 days of ingestion
- Campylobacter jejuni
- Shigella
- Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
- Yersinia enterocolitica
- Onset >7 days from ingestion
- Prolonged duration of Diarrhea
IX. Differential Diagnosis
X. Evaluation
- See Diarrhea
XI. Management
XII. Prevention
XIII. Resources
- CDC Foodborne Illness Index
- CDC Foodbourne Outbreaks
- CDC Foodborne Illness Statistics
- CDC Foodbourne Illness
XIV. References
- Glauser and Schafer (2020) Crit Dec Emerg Med 34(1):3-12
- Barr (2014) Am Fam Physician 89(3): 180-9 [PubMed]
- Scallen (2011) Emerg Infect Dis 17(1): 7-15 [PubMed]
- Switaj (2015) Am Fam Physician 92(5): 358-65 [PubMed]
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Related Studies
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 |
Ontology: Foodborne Disease (C0679360)
Definition (MSH) | Acute illnesses, usually affecting the GASTROINTESTINAL TRACT, brought on by consuming contaminated food or beverages. Most of these diseases are infectious, caused by a variety of bacteria, viruses, or parasites that can be foodborne. Sometimes the diseases are caused by harmful toxins from the microbes or other chemicals present in the food. Especially in the latter case, the condition is often called food poisoning. |
Definition (MEDLINEPLUS) |
Each year, 48 million people in the U.S. get sick from contaminated food. Common culprits include bacteria, parasites and viruses. Symptoms range from mild to serious. They include
Harmful bacteria are the most common cause of foodborne illness. Foods may have some bacteria on them when you buy them. Raw meat may become contaminated during slaughter. Fruits and vegetables may become contaminated when they are growing or when they are processed. But it can also happen in your kitchen if you leave food out for more than 2 hours at room temperature. Handling food safely can help prevent foodborne illnesses. The treatment in most cases is increasing your fluid intake. For more serious illness, you may need treatment at a hospital. NIH: National Institute of Diabetes and Digestive and Kidney Diseases |
Concepts | Injury or Poisoning (T037) |
MSH | D005517 |
Swedish | Matförgiftning |
Finnish | Ruokamyrkytys |
Italian | Avvelenamento alimentare, Malattie trasmesse da alimenti |
Russian | PISHCHEVYE OTRAVLENIIA, ПИЩЕВЫЕ ИНФЕКЦИИ И ИНТОКСИКАЦИИ, ПИЩЕВОГО ПРОИСХОЖДЕНИЯ БОЛЕЗНИ, БОЛЕЗНИ ПИЩЕВОГО ПРОИСХОЖДЕНИЯ, PISHCHEVOGO PROISKHOZHDENIIA BOLEZNI, ПИЩЕВЫЕ ОТРАВЛЕНИЯ, BOLEZNI PISHCHEVOGO PROISKHOZHDENIIA, PISHCHEVYE INFEKTSII I INTOKSIKATSII |
English | food borne disorder, Diseases, Foodborne, Food-borne Disease, Food borne Illnesses, Food-borne Illnesses, Illnesses, Food-borne, Food-borne Diseases, Diseases, Food-borne, Food borne Diseases, Foodborne Diseases, Foodborne Illnesses, Disease, Foodborne, Illnesses, Foodborne, Disease, Food-borne, Foodborne Diseases [Disease/Finding], Foodborne Disease, borne diseases food, food borne disease, Foodborne Illness, Foodborne diseases |
French | Maladies d'origine alimentaire, Toxi-infections alimentaires |
German | Erkrankungen durch Lebensmittel, Lebensmittelbedingte Erkrankungen |
Portuguese | Doenças Transmitidas por Alimentos, Envenenamento por Alimento, Envenenamento Alimentar, Intoxicação por Alimentos |
Spanish | Enfermedades Transmitidas por los Alimentos, Envenenamiento Alimentario, Envenenamiento por Alimento, Intoxicación por Alimentos, Enfermedades Transmitidas por Alimentos |
Croatian | OTROVANJE HRANOM |
Czech | nemoci přenášené potravou |
Polish | Choroby przenoszonę drogą pokarmową, Zatrucia i zakażenia pokarmowe, Choroby przenoszone przez żywność, Zatrucie pokarmowe, Choroby szerzące się drogą pokarmową |
Japanese | 中毒-食物性, 食中毒, 食あたり, 食品中毒 |
Norwegian | Matbårne sykdommer |