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Food Poisoning and Enteric Pathogens


Food poisoning is characterized chiefly by acute gastroenteritis developing within hours or days of ingesting contaminated food. The food may contain either live organisms that grow within the host and can be designated infectious, or more often, preformed toxins produced by organisms growing in the food. In addition, foods such as mushrooms, fish, and mussels may contain poisonous components.

An estimated 38 to 78 million food poisonings occur annually in the United States, resulting in approximately 325,000 hospitalizations and 2000 to 5000 deaths, influenced by comorbidities. This chapter emphasizes gastroenteritis, but other foodborne illnesses affecting other organ systems exist. Depending on the area and the outbreak, about 50% of foodborne poisonings can be attributed to bacteria and 50% to viral agents (importantly norovirus; Box 111.1 and Table 111.1 ).

Box 111.1
Organisms That Cause Food Poisoning

Bacteria

  • Brucella spp.

  • Campylobacter spp.

  • Escherichia coli, O157:H7

  • E. coli, non-O157:H7

  • Listeria monocytogenes

  • Salmonella typhi

  • Nontyphoidal Salmonella spp.

  • Shigella spp.

  • Vibrio cholerae

  • Noncholera Vibrio spp.

  • Vibrio vulnificus

  • Yersinia enterocolitica

Bacterial Toxins Produced by:

  • Bacillus cereus

  • Clostridium botulinum

  • Clostridium perfringens

  • Staphylococcus aureus

  • Streptococcus spp.

Parasites

  • Cryptosporidium parvum

  • Cyclospora cayetanensis

  • Giardia lamblia

  • Toxoplasma gondii

  • Trichinella spiralis

Viruses

  • Norwalklike virus

  • Rotavirus

  • Astrovirus

  • Hepatitis A virus

TABLE 111.1
Foodborne Illness-Causing Organisms in the United States a
From U.S. Food and Drug Administration. https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM187482.pdf (Accessed April 2018).
Organism Common Name of Illness Onset Time After Ingesting Signs and Symptoms Duration Food Sources
Bacillus cereus B. cereus food poisoning 10–16 h Abdominal cramps, watery diarrhea, nausea 24–48 h Meats, stews, gravies, vanilla sauce
Campylobacter jejuni Campylobacteriosis 2–5 days Diarrhea, cramps, fever, and vomiting; diarrhea may be bloody 2–10 days Raw and undercooked poultry, unpasteurized milk, contaminated water
Clostridium botulinum Botulism 12–72 h Vomiting, diarrhea, blurred vision, double vision, difficulty in swallowing, muscle weakness. Can result in respiratory failure and death Variable Improperly canned foods, especially home-canned vegetables, fermented fish, baked potatoes in aluminum foil
Clostridium perfringens Perfringens food poisoning 8–16 h Intense abdominal cramps, watery diarrhea Usually 24 h Meats, poultry, gravy, dried or precooked foods, time and/or temperature-abused foods
Cryptosporidium Intestinal cryptosporidiosis 2–10 days Diarrhea (usually watery), stomach cramps, upset stomach, slight fever May be remitting and relapsing over weeks to months Uncooked food or food contaminated by an ill food handler after cooking, contaminated drinking water
Cyclospora cayetanensis Cyclosporiasis 1–14 days, usually at least 1 week Diarrhea (usually watery), loss of appetite, substantial loss of weight, stomach cramps, nausea, vomiting, fatigue May be remitting and relapsing over weeks to months Various types of fresh produce (imported berries, lettuce, basil)
Escherichia coli producing toxin E. coli infection (common cause of “travelers' diarrhea”) 1–3 days Watery diarrhea, abdominal cramps, some vomiting 3–7 or more days Water or food contaminated with human feces
E. coli O157:H7 Hemorrhagic colitis or E. coli O157:H7 infection 1–8 days Severe (often bloody) diarrhea, abdominal pain and vomiting. Usually, little or no fever is present. More common in children 4 years or younger. Can lead to kidney failure 5–10 days Undercooked beef (especially hamburger), unpasteurized milk and juice, raw fruits and vegetables (e.g., sprouts), and contaminated water
Hepatitis A Hepatitis 28 days average (15–50 days) Diarrhea, dark urine, jaundice, and flulike symptoms (i.e., fever, headache, nausea, and abdominal pain) Variable, 2 weeks–3 months Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters
Listeria monocytogenes Listeriosis 9–48 h for gastrointestinal symptoms, 2–6 weeks for invasive disease Fever, muscle aches, and nausea or diarrhea. Pregnant women may have mild flulike illness, and infection can lead to premature delivery or stillbirth. The elderly or immunocompromised patients may develop bacteremia or meningitis. Variable Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats
Noroviruses Variously called viral gastroenteritis, winter diarrhea, acute nonbacterial gastroenteritis, food poisoning, and food infection 12–48 h Nausea, vomiting, abdominal cramping, diarrhea, fever, headache. Diarrhea is more prevalent in adults; vomiting more common in children. 12–60 h Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters
Salmonella Salmonellosis 6–48 h Diarrhea, fever, abdominal cramps, vomiting 4–7 days Eggs, poultry, meat, unpasteurized milk or juice, cheese, contaminated raw fruits and vegetables
Shigella Shigellosis or Bacillary dysentery 4–7 days Abdominal cramps, fever, and diarrhea. Stools may contain blood and mucus. 24–48 h Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler
Staphylococcus aureus Staphylococcal food poisoning 1–6 h Sudden onset of severe nausea and vomiting. Abdominal cramps. Diarrhea and fever may be present. 24–48 h Unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries
Vibrio parahaemolyticus V. parahaemolyticus 4–96 h Watery (occasionally bloody) diarrhea, abdominal cramps, nausea, vomiting, fever 2–5 days Undercooked or raw seafood, such as shellfish
Vibrio vulnificus V. vulnificus infection 1–7 days Vomiting, diarrhea, abdominal pain, bloodborne infection. Fever, bleeding within the skin, ulcers requiring surgical removal. Can be fatal to persons with liver disease or weakened immune systems. 2–8 days Undercooked or raw seafood, such as shellfish (especially oysters)

a While the American food supply is among the safest in the world, the federal government estimates that there are about 48 million cases of foodborne illness annually—the equivalent of 1 in 6 Americans each year. And each year these illnesses result in an estimated 128,000 hospitalizations and 3000 deaths. The chart includes foodborne disease-causing organisms that frequently cause illness in the United States. As the chart shows, the threats are numerous and varied, with symptoms ranging from relatively mild discomfort to very serious, life-threatening illness. While the very young, the elderly, and persons with weakened immune systems are at greatest risk of serious consequences from most foodborne illnesses, some of the organisms shown pose grave threats to all persons.

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