II. Epidemiology

  1. Incidence increasing in United States
    1. Cases per year: 48 million
    2. Hospitalizations: 128,000
    3. Diarrheal related deaths per year: 3000
    4. Medical and associated costs per year: $4-14 billion
    5. Most cases are not seen by medical care
  2. Expanded fast food industry in part responsible
    1. Large scale food production affects many people
    2. More virulent organisms may be evolving
    3. Highly processed foods (including ground meats which distribute contamination throughout food)

III. Risk Factors

  1. Increased intake of raw and partially processed food
  2. Special backcountry camping risks (no refrigeration)
  3. Improperly stored, cooked or reheated foods
  4. Frequent sources of foodborne Diarrhea outbreaks
    1. Chicken (Most common)
    2. Mexican Food
    3. Chinese Food
    4. Fin fish
    5. Shellfish
    6. Beef (least common)

IV. Causes: Food Pathogens

  1. Most common Food Pathogens in U.S.
    1. Norovirus or Norwalk Virus (onset 12-48 hours)
      1. See Waterborne Illness
      2. Incidence (U.S.): 5.5 Million cases with 15,000 hospitalizations and 150 deaths (0.0027% mortality) per year
      3. Worldwide, Norovirus is responsivble for 200,000 deaths per year in developing countries
      4. Contaminated raw produce
      5. Shellfish from contaminated water
      6. Infected food preparer of uncooked foods
    2. Non-typhoid Salmonella (onset 6-48 hours)
      1. Incidence (U.S.): 1 Million cases with 19,000 hospitalizations and 380 deaths (0.38% mortality) per year
      2. Raw poultry
      3. Shellfish
      4. Eggs
      5. Cheese
      6. Contaminated raw produce
      7. Unpasteurized milk or juice
    3. Clostridium perfringens via in-vivo toxin production (onset 6-16 hours, self-resolves by 24 hours)
      1. Incidence (U.S.): 970,000 cases with 440 hospitalizations and 26 deaths (0.0027% mortality) per year
      2. Associated with fever and Headache
      3. Pre-cooked meats
      4. Dried foods
      5. Meats or gravy
      6. Poultry
    4. Campylobacter jejuni (onset 2-5 days)
      1. Incidence (U.S.): 850,000 cases with 8500 hospitalizations and 76 deaths (0.0089% mortality) per year
      2. Raw chicken (66% infected)
      3. Unpasteurized milk
    5. Staphylococcus aureus via pre-formed enterotoxin (onset 1-6 hours)
      1. Incidence (U.S.): 240,000 cases with 1100 hospitalizations and 6 deaths (0.0025% mortality) per year
      2. Eggs
      3. Mayonnaise
      4. Cold meats
      5. Pork
      6. Chicken
      7. Beef
      8. Seafood
      9. Salads
      10. Cream-filled desserts
    6. Shigella (Shigellosis, onset 4-7 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
      2. Incidence (U.S.): 130,000 cases with 1500 hospitalizations and 10 deaths (0.0077% mortality) per year
    7. Enterotoxigenic Escherichia coli (Traveler's Diarrhea, rapid onset 1-3 days)
      1. Food or water contaminated by human feces
      2. Incidence (U.S.): 110,000 cases with 270 hospitalizations and 1 death (rare mortality) per year
  2. Less Common Food Pathogens in U.S.
    1. Yersinia enterocolitica
      1. Incidence (U.S.): 98,000 cases with 530 hospitalizations and 29 deaths (0.03% mortality) per year
      2. Waterborne Illness
    2. Toxoplasma gondii (Toxoplasmosis)
      1. Incidence (U.S.): 87,000 cases with 4400 hospitalizations and 330 deaths (0.38% mortality) per year
      2. Raw or under-cooked meat (pork, mutton, wild game)
      3. Ingested items contaminated with cat feces
    3. Enterohemorrhagic E. coli (E. coli 0157:H7, onset 1-8 days)
      1. Incidence (U.S.): 63,000 cases with 2100 hospitalizations and 20 deaths (0.032% mortality) per year
      2. Hamburger and other red meat (undercooked)
      3. Contaminated raw produce (e.g. Seed sprouts)
      4. Unpasterurized juice or milk
    4. Bacillus Cereus (onset 10-16 hours)
      1. Incidence (U.S.): 63,000 cases with 20 hospitalizations and 0 deaths per year
      2. Causes 2 syndromes
        1. Toxin-mediated with acute Vomiting (similar to staph aureus) esp. after fried rice ingestion
        2. Diarrheal illness similar to Clostridium perfringens
      3. Hamburger (45-63% infected)
      4. Raw rice (100% infected)
      5. Fried rice
      6. Meats, stews and gravy
      7. Vanilla sauce
    5. Vibrio parahaemolyticus, V. fluvialis, V. mimicus and non-toxigenic V. Cholerae (4-96 hours)
      1. Incidence (U.S.): 35,000 cases with 100 hospitalizations and 4 deaths (0.011 mortality) per year
      2. Shellfish or raw seafood
      3. Typically only severe in Immunocompromised patients
        1. Vibrio vulnificus is more significant (see above)
  3. Rare Food Pathogens in U.S.
    1. Listeria monocytogenes (onset 9-48 hours, invasive disease delayed for weeks)
      1. Meats (50-100% infected)
      2. Deli Meats
      3. Uncooked hot dogs
      4. Cantaloupe
      5. Unpasteurized milk and soft cheeses
    2. Vibrio vulnificus (onset 1-7 days)
      1. Raw oysters
    3. Clostridium botulinum (Botulism, onset 12-72 hours)
      1. Fermented fish
      2. Poor canning technique (especially home canned vegetables)
      3. Potatoes baked in aluminum foil
    4. Hepatitis A (onset 15-50 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
    5. Enterovirus
      1. Shellfish (47% infected)
    6. Cyclospora cayetanensis (Cyclosporiasis, onset 7-14 days)
      1. Contaminated raw produce (lettuce, basil, imported berries)
    7. Aeromonas Hydrophila
      1. Poultry (95% infected)
      2. Fish (95% infected)
      3. Red Meat (95% infected)
      4. Produce: lettuce, celery (95% infected)

V. Causes: Common food sources of Foodborne Illness

  1. See Waterborne Illness
  2. Improperly stored, cooked or reheated foods (e.g. buffets, picnics)
    1. Staphylococcus aureus
    2. Bacillus Cereus
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
  3. Unpasteurized dairy products
    1. Salmonella
    2. Campylobacter
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Listeria monocytogenes
    5. Brucella
    6. Yersinia enterocolitica
  4. Raw Beef or Pork
    1. Staphylococcus aureus
    2. Bacillus Cereus
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Clostridium perfringens
    5. Listeria monocytogenes
    6. Toxoplasmosis
    7. Brucella
  5. Pigs or Pork
    1. Yersinia
    2. Trichinella
  6. Poultry
    1. Nontyphoidal Salmonella
    2. Campylobacter jejuni
    3. Listeria monocytogenes
  7. Reptile Exposure
    1. Salmonella
  8. Cat Exposure
    1. Toxoplasmosis
  9. Fish or seafood
    1. Shellfish
      1. Vibrio parahaemolyticus (or Vibrio haemolyticus)
      2. Vibrio Cholera
    2. Raw Fish
      1. Salmonella
      2. Hepatitis A
      3. Aeromonas Hydrophila
    3. Raw Oysters
      1. Vibrio vulnificus (Similar to Vibrio Cellulitis)
    4. Fish with pre-formed toxins
      1. Ciguatera Poisoning (Reef fish ingestion such as grouper, snapper, barracuda)
      2. Scombroid Poisoning (Tuna, Mahi-mahi, Mackeral, Swordfish)
      3. Tetrodotoxin (pufferfish, porcupinefish, ocean sunfish, or triggerfish)
  10. Wild rabbit
    1. Tularemia

VI. Symptoms: Gastrointestinal by Cause

  1. Acute symptoms in multiple people with same food exposure (Preformed toxins)
    1. Symptom onset within 6 hours (presents with Vomiting)
      1. Staphylococcus aureus (often from cold mayonnaise-based salads)
      2. Bacillus Cereus (meats, rice)
    2. Symptom onset within 8-16 hours (presents with Diarrhea)
      1. Clostridium perfringens (Cooked meats)
  2. Watery Diarrhea (noninvasive osmotic dysfunction)
    1. Enterotoxigenic Escherichia coli
    2. Vibrio Cholerae
    3. Cryptosporidium
    4. Cyclospora
    5. Enteric Viruses
  3. Invasive or Inflammatory Diarrhea (Acute Abdominal Pain, fever, tenesmus, bloody Diarrhea)
    1. Nontyphoidal Salmonella
    2. Yersinia enterocolitica
    3. Shigella
    4. Vibrio parahaemolyticus (or Vibrio haemolyticus)
    5. Campylobacter jejuni
    6. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    7. Clostridium difficile
  4. Bloody Diarrhea
    1. See Invasive or Inflammatory Diarrhea causes above
    2. Salmonella
    3. Shigella
    4. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    5. Campylobacter
    6. Vibrio parahaemolyticus
    7. Yersinia
    8. Entamoeba histolytica
  5. Foul smelling Diarrhea
    1. Clostridium difficile
    2. Giardia lamblia
  6. Vomiting
    1. Preformed toxins (onset within 6-12 hours) typically cause significant non-bilious, non-bloody Emesis
    2. Bacillus cereus
    3. Clostridium botulinum
    4. Norwalk Virus
    5. Staphylococcus aureus
    6. Vibrio Cholerae (01)
    7. Vibrio parahaemolyticus

VII. Symptoms: Systemic by Cause

  1. Fever
    1. Campylobacter jejuni
    2. Norwalk Virus
    3. Salmonella
    4. Shigella
    5. Vibrio Cholerae (non-01)
    6. Vibrio parahaemolyticus
  2. Neurologic Symptoms
    1. Amatoxin Mushrooms (encephalopathy)
    2. Campylobacter (Guillain-Barre Syndrome)
    3. Ciguatera Poisoning (perioral Paresthesias, cold Allodynia)
    4. Clostridium botulinum (Diplopia, descending paralysis)
    5. Listeria monocytogenes (Nuchal Rigidity, confusion, myalgias)
    6. Muscarine Mushrooms (Cholinergic Toxicity)
    7. Psilocybin mushrooms (Hallucinations)
    8. Tetrodotoxin such as pufferfish, porcupinefish, ocean sunfish, or triggerfish (Paresthesias, numbness)
    9. Paralytic Shellfish Poisoning (Saxitoxin) in clams and mussels (numbness, paralysis)
    10. Toxoplasmosis (Headaches, Blurred Vision)
    11. Scombroid Fish Poisoning (perioral Paresthesias, Urticaria, facial Flushing)
  3. Jaundice
    1. Amatoxin Mushrooms
    2. Hepatitis A
  4. Hemorrhagic or necrotic Bullae
    1. Vibrio vulnificus

VIII. Symptoms: Onset Timing

  1. Preformed Toxin with immediate onset (<1 hour)
    1. Tetrodotoxin (pufferfish, porcupinefish, ocean sunfish, or triggerfish)
    2. Scombroid Fish Poisoning
  2. Preformed toxin with 1-6 hour onset (early onset Vomiting and Diarrhea after ingestion)
    1. Bacillus Cereus
    2. Staphylococcus aureus
    3. Norovirus
    4. Ciguatera Poisoning (Reef fish ingestion such as grouper, snapper, barracuda)
  3. Onset within 6-48 hours of ingestion
    1. Bacillus Cereus
    2. Clostridium perfringens
    3. Nontyphoidal Salmonella
    4. Vibrio species
    5. Listeria monocytogenes
    6. Enterotoxigenic Escherichia coli (Traveler's Diarrhea)
  4. Onset within 2-7 days of ingestion
    1. Campylobacter jejuni
    2. Shigella
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Yersinia enterocolitica
  5. Onset >7 days from ingestion
    1. Cyclospora
    2. Cryptosporidium
    3. Toxoplasmosis
    4. Hepatitis A
    5. Salmonella typhi
    6. Entamoeba histolytica
  6. Prolonged duration of Diarrhea
    1. See Chronic Diarrhea
    2. Parasitic Infections (see Serious Parasitic Gastrointestinal Complications)
    3. Noninfectious Chronic Diarrhea
      1. Diarrhea due to Malabsorption (Chronic Fatty Diarrhea)
      2. Chronic Watery Diarrhea (including Drug-Induced Diarrhea)

X. Evaluation

  1. See Diarrhea

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Related Studies

Ontology: Food Poisoning (C0016479)

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

  • Upset stomach
  • Abdominal cramps
  • Nausea and vomiting
  • Diarrhea
  • Fever
  • Dehydration

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
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
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