Food Poisoning or Foodborne Illness

Food Poisoning or Foodborne Illness: Excerpt from The 5-Minute Pediatric Consult

Christina B. Bales, MD

Food Poisoning or Foodborne Illness - BASICS

Food Poisoning or Foodborne Illness - description

Any illness resulting from the ingestion of food or drink contaminated with an infectious organism or associated toxin

Food Poisoning or Foodborne Illness - general prevention

• Parenteral vaccination:
  • Pentavalent rotavirus vaccine
  • Inactivated hepatitis A vaccine
• Preventative strategies:
  • Hand washing
  • Proper food handling (adequate cooking and refrigeration)
  • Avoidance of unpasteurized dairy products and juices
  • Avoidance of raw or undercooked eggs, meat, and shellfish
  • Avoidance of honey in children <1 year old

Food Poisoning or Foodborne Illness - epidemiology

Food Poisoning or Foodborne Illness - incidence

• 1,200–1,400 outbreaks of foodborne disease reported each year in the US
• Estimated 76 million illnesses in the US annually
• Estimated 5,000 deaths in the US annually

Food Poisoning or Foodborne Illness - pathophysiology

• Bacteria (often causes secretory diarrhea):
  • Invades intestinal epithelium
  • Elaborates toxin into the GI tract
  • Elaborates toxin into food (performed toxin is ingested)
• Virus (often causes osmotic diarrhea): Invasion of subsequent lysis of intestinal epithelial cells, leaving predominantly immature cells with inadequate disaccharidase activity

Food Poisoning or Foodborne Illness - etiology

• Bacteria and/or associated toxins. Most common (in descending order):
  • Salmonella (nontyphoid)
  • Clostridium perfringens
  • Escherichia coli
  • Staphylococcus aureus
  • Campylobacter
• Viruses including calciviruses (noro and astro)
• Parasites

Food Poisoning or Foodborne Illness - DIAGNOSIS

Food Poisoning or Foodborne Illness - signs & symptoms

• GI illness:
  • Nausea and vomiting
  • Diarrhea (watery vs. mucoid vs. bloody)
  • Abdominal pain or cramping
  • Constitutional symptoms (fever, malaise, myalgias)
  • Jaundice (may be present in hepatitis A)
• Botulism:
  • Impaired cranial nerve activity (sluggish or fixed pupils, ptosis, diminished corneal and oculovestibular reflexes, facial weakness, diminished gag, weak cry)
  • Constipation
  • Hypotonia with progressive symmetric descending paralysis
  • Absent deep tendon reflexes
  • Apnea

Food Poisoning or Foodborne Illness - history

• Similarly exposed persons with related symptoms
• Timing of illness in relation to ingestion
• Type of food ingested

Food Poisoning or Foodborne Illness - physical exam

• Detailed neurologic examination
• Assessment of dehydration status (examination of mucous membranes, skin turgor)
• Assessment of potential liver involvement (hepatomegaly, jaundice, icterus)
• Careful abdominal examination

Food Poisoning or Foodborne Illness - tests

Food Poisoning or Foodborne Illness - lab

• Organism culture within:
  • Stool
  • Vomitus
  • Food (10⁵ organisms/g)
  • Hand lesions of food handlers
  • Intestinal tissue
• Toxin identification in stool
• Serum antibody identification (e.g., HAV IgM in hepatitis A)
• Polymerase chain reaction (PCR) identification of viral RNA (e.g., norovirus) in stool or vomitus
• Virus identification via electron microscopy (e.g., norovirus)
• Latex agglutination tests (e.g., Brucella)

Food Poisoning or Foodborne Illness - diag proced-surgery

Food Poisoning or Foodborne Illness - differencial diagnosis

• Non-foodborne infection:
  • GI
  • Urinary tract
  • Upper respiratory (e.g., otitis media)
• Food intolerance or allergy:
  • Cow’s milk (protein allergy)
  • Carbohydrate intolerance (e.g., lactose)
• Dietary manipulations:
  • Hyperosmolar formulas
  • Food additives (dyes, processing materials, coloring)
  • Caffeine
  • Overfeeding
  • Low fat intakes
  • Excessive fluids
• Miscellaneous:
  • Antibiotic induced
  • Malnutrition

Food Poisoning or Foodborne Illness - TREATMENT

Food Poisoning or Foodborne Illness - general measures

• Gastroenteritis:
  • Treat dehydration with Oral Rehydration Solution (ORS):
    • Standard ORS contains 75–90 mEq of sodium and 74–111 mmol/L of glucose.
    • Alternative ORS, including rice-based carbohydrate or amylase-based solutions, may be more effective for Vibrio cholerae infections.
  • Transition rapidly (after 3–4 hours of ORS tolerance) to regular diet (see below).
  • Continue breastfeeding infants if possible.
• Botulism:
  • Continuous cardiac and respiratory monitoring
  • Endotracheal intubation and assisted ventilation in cases of respiratory insufficiency
  • Naso- or orogastric tube feeding

Food Poisoning or Foodborne Illness - diet

• BRATT diet (bananas, rice, applesauce, toast, tea): Inappropriate due to low calorie, protein, and fat contents
• Balanced, varied diet, providing easily digestible, complex carbohydrates will promote increased stool consistency.

Food Poisoning or Foodborne Illness - special therapy

Botulism:

• Foodborne: Equine-derived immunoglobulin
• Infant: Human-derived immunoglobulin (BABY BIG) reduces hospital stay, duration of ventilation, duration of tube feeding, and cost.

Food Poisoning or Foodborne Illness - iv fluids

• If patient unable to be rehydrated via oral route (because of ileus, circulatory failure, CNS complications) or
• If >10% dehydration

Food Poisoning or Foodborne Illness - comp alt-medicine

• Probiotics (especially lactobacillus) have been shown to reduce duration of diarrhea and hospital stays.
• Zinc supplementation may be beneficial in malnourished children.

Food Poisoning or Foodborne Illness - medication

Use of antibiotics is:

• Always indicated:
  • Shigella
  • Brucella
  • Listeria monocytogenes
  • Salmonella typhi
• Sometimes indicated:
  • E. coli (prolonged enterotoxigenic escherichia coli)
  • V. cholerae (moderate to severe cases)
  • Campylobacter (Early treatment limits duration, prevents relapse, and shortens duration of shedding.)
  • Non-typhi Salmonella (Only patients who are <3 months old, are immunocompromised, have hemoglobinopathy, or have chronic GI conditions should be treated. Other patients should not be treated as antibiotics prolong organism shedding in the stool and promote disease spread.)
  • Yersinia (sepsis)
• Contraindicated: Clostridium botulinum (aminoglycosides potentiate paralytic effects)

Food Poisoning or Foodborne Illness - FOLLOW UP

Food Poisoning or Foodborne Illness - prognosis

• Most gastroenteritis secondary to food poisoning is mild and self-limited.
• Recovery is complete in 2–5 days in most individuals.
• In the very young, prognosis is more guarded because these patients can become dehydrated quickly.
• After the patient has survived the paralytic phase of botulism, the outlook for complete recovery is excellent.

Foodborne diseases and conditions designated as notifiable at the national level

• Notifiable bacterial foodborne diseases and conditions:
  • Botulism
  • Brucellosis
  • Cholera
  • Enterohemorrhagic E. coli
  • Hemolytic uremic syndrome
  • Listeriosis
  • Salmonellosis (other than S. typhi)
  • Shigellosis
  • Typhoid fever (S. typhi and S. paratyphi infections)
  • Notifiable viral foodborne diseases and conditions:
    • Hepatitis A
  • Notifiable parasitic foodborne diseases and conditions:
    • Cryptosporidiosis
    • Cyclosporiasis
    • Trichinellosis
• In the US, additional reporting requirements may be mandated by state and territorial laws and regulations. Details on specific state reporting requirements are available from state health departments and from the Council of State and Territorial Epidemiologists (http://www.cste.org/nndss/reportingrequirements.htm or phone 770-458-3811)

Food Poisoning or Foodborne Illness - bibliography

Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics: 2006.
1. Stefano G. Probiotics for children: Use in diarrhea. J Clin Gastroenterol. 2006;40(3):244–248.
2. Davidson G, Barnes G, Bass D, et al. Infectious diarrhea in children: Working group report of the first world congress of pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr. 2002;25:143–150.
3. Centers for Disease Control and Prevention (CDC). Surveillance for Foodborne Disease Outbreaks – United States, 1998-2002. Morb Mortal Wkly Rep. 2006;55(10)1–42.

Food Poisoning or Foodborne Illness - CODES

Food Poisoning or Foodborne Illness - icd9

005.9 Food poisoning, unspecified

Food Poisoning or Foodborne Illness - FAQ

• Q: What are the most common causes of food poisoning?
• A: Bacteria (non-typhi, Salmonella, C. perfringens, E. coli, S. aureus, and Campylobacter jejeuni), although viral causes are playing an increasingly greater role as methods of viral detection become more available
• Q: How are the signs and symptoms of food poisoning different from those of a viral gastroenteritis?
• A: The signs and symptoms of food poisoning and gastroenteritis are similar in that the patient displays diarrhea, vomiting, and fever. Historically, food poisoning is distinguished by its association with a common food that affects multiple individuals who consumed it.
• Q: Which foods are most likely to be contaminated?
• A: Dairy products that are not handled properly (e.g., unpasteurized or inadequately heated or cooked) and meat that is not thoroughly cooked at high enough temperatures.

Book Source Details

• Book Title: The 5-Minute Pediatric Consult
• Author(s): M. William Schwartz MD; et al.
• Year of Publication: 2008
• Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 5-Minute Pediatric Consult Authors: M. William Schwartz MD; et al. Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7577-9

 » Next page: Sympathomimetic Poisoning (The 5-Minute Pediatric Consult)

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