Diarrhea

Food-borne Diarrheal Infection

search

Food-borne Diarrheal Infection, Foodborne Illness, Food-Borne Disease, Food Poisoning

  • 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. Increased intake of raw and partially processed food
  4. Special backcountry camping risks (no refrigeration)
  5. Frequent sources of foodborne Diarrhea outbreaks
    1. Chicken (Most common)
    2. Mexican Food
    3. Chinese Food
    4. Finfish
    5. Shellfish
    6. Beef (least common)
  • Causes
  • Food Pathogens
  1. Most common Food Pathogens
    1. Staphylococcus aureus via pre-formed enterotoxin (onset 1-6 hours)
      1. Eggs
      2. Mayonnaise
      3. Cold meats
      4. Pork
      5. Chicken
      6. Beef
      7. Seafood
      8. Salads
      9. Cream-filled desserts
    2. Non-typhoid Salmonella (onset 6-48 hours)
      1. Raw poultry
      2. Shellfish
      3. Eggs
      4. Cheese
      5. Contaminated raw produce
      6. Unpasteurized milk or juice
    3. Campylobacter jejuni (onset 2-5 days)
      1. Raw chicken (66% infected)
      2. Unpasteurized milk
    4. Norovirus or Norwalk Virus (onset 12-48 hours)
      1. See Waterborne Illness
      2. Contaminated raw produce
      3. Shellfish from contaminated water
      4. Infected food preparer of uncooked foods
    5. Enterotoxigenic Escherichia coli (Traveler's Diarrhea, rapid onset 1-3 days)
      1. Food or water contaminated by human feces
  2. Other Common Food Pathogens
    1. Enterovirus
      1. Shellfish (47% infected)
    2. Aeromonas Hydrophila
      1. Poultry (95% infected)
      2. Fish (95% infected)
      3. Red Meat (95% infected)
      4. Produce: lettuce, celery (95% infected)
    3. Bacillus Cereus (onset 10-16 hours)
      1. Hamburger (45-63% infected)
      2. Raw rice (100% infected)
      3. Fried rice
      4. Meats, stews and gravy
      5. Vanilla sauce
    4. Hepatitis A (onset 15-50 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
    5. Listeria monocytogenes (onset 9-48 hours, invasive disease delayed for weeks)
      1. Meats (50-100% infected)
      2. Unpasteurized milk and soft cheeses
    6. Enterohemorrhagic E. coli (E. coli 0157:H7, onset 1-8 days)
      1. Hamburger and other red meat (undercooked)
      2. Contaminated raw produce (e.g. Seed sprouts)
      3. Unpasterurized juice or milk
    7. Shigella (Shigellosis, onset 4-7 days)
      1. Similar Waterborne Illness sources as Norovirus (see above)
    8. Vibrio vulnificus (onset 1-7 days)
      1. Raw oysters
  3. Less Common Food Pathogens
    1. Clostridium perfringens (onset 8-16 hours)
      1. Pre-cooked meats
      2. Dried foods
      3. Meats, gravy
      4. Poultry
    2. Clostridium botulinum (Botulism, onset 12-72 hours)
      1. Fermented fish
      2. Poor canning technique (especially home canned vegetables)
      3. Potatoes baked in aluminum foil
    3. Cyclospora cayetanensis (Cyclosporiasis, onset 7-14 days)
      1. Contaminated raw produce (lettuce, basil, imported berries)
    4. Vibrio parahaemolyticus, V. fluvialis, V. mimicus and non-toxigenic V. Cholerae (4-96 hours)
      1. Shellfish or raw seafood
      2. Typically only severe in immunocompromised patients
        1. Vibrio vulnificus is more significant (see above)
    5. Yersinia enterocolitica
    6. Toxoplasma gondii
  • Causes
  • Common food sources of Foodborne Illness
  1. See Waterborne Illness
  2. Unpasteurized dairy products
    1. Salmonella
    2. Campylobacter
    3. Shiga-toxin producing E. coli (e.g. E. coli 0157:H7, Enterohemorrhagic E. coli)
    4. Listeria
    5. Brucella
  3. 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. Yersinia
    7. Toxoplasmosis
    8. Brucella
  4. Poultry
    1. Nontyphoidal Salmonella
    2. Campylobacter jejuni
    3. Listeria monocytogenes
  5. 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)
      2. Scombroid Poisoning (Tuna, Mahi-mahi, Mackeral)
  6. Wild rabbit
    1. Tularemia
  • Causes
  • Presentation
  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. Invasive or Inflammatory Diarrhea (Acute Abdominal Pain, fever, 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
  3. Fever
    1. Campylobacter jejuni
    2. Norwalk Virus
    3. Salmonella
    4. Shigella
    5. Vibrio Cholerae (non-01)
    6. Vibrio parahaemolyticus
  4. Vomiting
    1. Bacillus cereus
    2. Clostridium botulinum
    3. Norwalk Virus
    4. Staphylococcus aureus
    5. Vibrio Cholerae (01)
    6. Vibrio parahaemolyticus
  5. Bloody Diarrhea (most common)
    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)
  6. Foul smelling Diarrhea
    1. Clostridium difficile
    2. Giardia lamblia
  • Causes
  • Timing
  1. Preformed toxin (early onset Vomiting and Diarrhea after ingestion)
    1. Bacillus Cereus
    2. Staphylococcus aureus
  2. Diarrhea within 24 hours of ingestion
    1. Bacillus Cereus
    2. Clostridium perfringens
  3. Diarrhea within 24-48 hours of ingestion
    1. Campylobacter jejuni (individual cases)
    2. Salmonella (outbreaks)
  • Evaluation
  1. See Diarrhea
  • Management