Etiology
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
Diarrhea 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 (noninflammatory), 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 pathophysiologic mechanisms that result in acute gastrointestinal symptoms from some of the noninfectious 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 nonbiological agents[1]
Bacterial:
Bacillus: B anthracis; B cereus (preformed enterotoxin and diarrheal toxin)
Brucella: B abortus, B melitensis, B suis
Campylobacter jejuni
Clostridium: C botulinum, C perfringens
Escherichia coli subtypes enterohemorrhagic (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
Entameba histolytica
Giardia lamblia
Toxoplasma
Trichinella
Trematoda (flukes).
Noninfectious:
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 noninfectious 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 unpasteurized milk and cheese, shellfish (oysters), and fish
Improper storage: improperly refrigerated or canned and home-canned foods
Water or food contaminated with feces
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, enterohemorrhagic (Shiga toxin-producing)E coli, hemolytic uremic 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
Diarrhea[1]
Acute: <14 days
Persistent: >14 days
Chronic: >6 weeks
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