Aetiology

Ingestion of food or water contaminated with bacteria and/or their toxins, viruses, parasites, or chemicals. Contamination usually arises from improper handling, preparation, or storage of food or drinks.[1]

Pathophysiology

Diarrhoea results from the action of enterotoxins (preformed before ingestion or produced after ingestion) on the secretory mechanisms of the mucosa of the small intestine, without invasion (non-inflammatory), or in the large intestine, with invasion and destruction (inflammatory).[1]​[14]​[15]​[16]​[17]​

In some types of food poisoning (e.g., staphylococci, Bacillus cereus), a toxin acting on the central nervous system results in vomiting.[1]​

The clinical syndrome of botulism results when the botulinum toxin inhibits acetylcholine release in nerve endings.

The pathophysiological mechanisms that result in acute gastrointestinal symptoms from some of the non-infectious causes of food poisoning (naturally occurring substances such as mushrooms and toadstools and heavy metals such as arsenic, mercury, and lead) are not well known.[4]​

Classification

Biological and non-biological agents[1]

  • Bacterial:

    • Bacillus: B anthracis; B cereus (preformed enterotoxin and diarrhoeal toxin)

    • Brucella: B abortus, B melitensis, B suis

    • Campylobacter jejuni

    • Clostridium: C botulinum, C perfringens

    • Escherichia coli subtypes enterohaemorrhagic (EHEC), enteroinvasive (EIEC), enteroaggregative (EAEC), enterotoxic (ETEC), enteropathogenic (EPEC)

    • Listeria monocytogenes

    • Salmonella species

    • Shigella species, including Shiga toxin and Shiga-like ribosome inactivating proteins

    • Staphylococcus aureus, including staphylococcal enterotoxins

    • Vibrio: V cholerae, V parahaemolyticus; V vulnificus

    • Yersinia: Y enterocolitica, Y pseudotuberculosis.

  • Viral:

    • Hepatitis A and E

    • Noroviruses and other caliciviruses

    • Rotavirus

    • Other: astroviruses, adenoviruses, parvoviruses.

  • Parasitic:

    • Angiostrongylus cantonensis

    • Cryptosporidium

    • Cyclospora cayetanensis

    • Cystoisospora

    • Entamoeba histolytica

    • Giardia lamblia

    • Toxoplasma

    • Trichinella

    • Trematoda (flukes).

  • Non-infectious:

    • Antimony

    • Arsenic

    • Cadmium

    • Ciguatera fish poisoning (ciguatera toxin)

    • Copper

    • Mercury

    • Mushroom toxins (short- and long-acting)

    • Nitrite poisoning

    • Pesticides (organophosphates or carbamates)

    • Puffer fish (tetrodotoxin)

    • Scombroid (histamine)

    • Shellfish toxin

    • Sodium fluoride

    • Thallium

    • Tin

    • Zinc.

Incubation period[1]

  • Hours: preformed toxins (S aureus, B cereus, C perfringens) and non-infectious toxins; Salmonella (up to 72 hours)

  • Days: most viruses (except hepatitis A and E), Campylobacter, Shigella, parasites

  • Weeks: hepatitis A and E, chronic exposure to heavy metals.

Duration of illness[1]

  • Self-limited/days: most foodborne illnesses

  • Weeks to months: parasites.

Associated foods[1]

  • Undercooked, uncooked, or raw foods: particularly meats (hamburger and stews), poultry, raw and unpasteurised milk and cheese, shellfish (oysters), and fish

  • Improper storage: improperly refrigerated or canned and home-canned foods

  • Water or food contaminated with faeces

  • Fresh produce

  • Mushrooms

  • Toxin contaminated seafood (e.g., mercury, cadmium, histamine).

Notifiable foodborne disease

Some foodborne diseases are notifiable to public health agencies. In the UK, food poisoning itself is a notifiable condition. Specific notifiable causes of food poisoning in the US and UK include:

  • Bacterial: anthrax, botulism, brucellosis, cholera, enterohaemorrhagic (Shiga toxin-producing) E coli, haemolytic uraemic syndrome, listeriosis, salmonellosis (other than Salmonella typhi), shigellosis, typhoid fever (S typhi and S paratyphi infections)

  • Viral: hepatitis A, hepatitis E

  • Parasitic: cryptosporidiosis, cyclosporiasis (US only), giardiasis, trichinellosis (US only).

Local policies on reportable conditions should be sought and followed. UK Health Security Agency: ​notifiable diseases and causative organisms: how to report Opens in new window CDC: how to report a foodborne illness - healthcare professionals Opens in new window​

Diarrhoea[1]

  • Acute: <14 days

  • Persistent: >14 days

  • Chronic: >6 weeks

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