Food Poisoning Overview

Food poisoning is a common, usually mild, but sometimes deadly illness. Typical
symptoms include nausea, vomiting, abdominal cramping, and diarrhea that occur
suddenly (within 48 hours) after consuming a contaminated food or drink. Depending on
the contaminant, fever and chills, bloody stools, dehydration, and nervous system damage
may follow. These symptoms may affect one person or a group of people who ate the
same thing (called an outbreak).

• The Centers for Disease Control and Prevention (CDC) estimates that in the
United States, food poisoning causes about 76 million illnesses, 325,000
hospitalizations, and up to 5,000 deaths each year. One of the most common
bacterial forms of infection, the salmonellae organisms, account for $1 billion in
medical costs and lost work time.

• Worldwide, diarrheal illnesses are among the leading causes of death. Travelers to
developing countries often encounter food poisoning in the form of traveler's
diarrhea or "Montezuma’s revenge." Additionally, there are possible new global
threats to the world's food supply through terrorist actions using food toxins as
weapons.

Food Poisoning Causes

More than 250 known diseases can be transmitted through food. The CDC estimates
unknown or undiscovered agents cause 81% of all food-borne illnesses and related
hospitalizations. Many cases of food poisoning are not reported because people suffer
mild symptoms and recover quickly. Also, doctors do not test for a cause in every
suspected case because it does not change the treatment or the outcome.

• The known causes of food poisoning can be divided into two categories:
infectious agents and toxic agents.

o Infectious agents include viruses, bacteria, and parasites.

o Toxic agents include poisonous mushrooms, improperly prepared exotic

foods (such as barracuda), or pesticides on fruits and vegetables.

• Food usually becomes contaminated from poor sanitation or preparation. Food

handlers who do not wash their hands after using the bathroom or have infections
themselves often cause contamination. Improperly packaged food stored at the
wrong temperature also promotes contamination.
Food Poisoning Symptoms

Symptoms of food poisoning depend on the type of contaminant and the amount eaten.
The symptoms can develop rapidly, within 30 minutes, or slowly, worsening over days to
weeks. Most of the common contaminants cause nausea, vomiting, diarrhea, and
abdominal cramping. Usually food poisoning is not serious, and the illness runs its course
in 24-48 hours.

• Viruses account for most food poisoning cases where a specific contaminant is
found.

o Noroviruses are a group of viruses that cause a mild illness (often termed
"stomach flu") with nausea, vomiting, diarrhea, abdominal pain, headache,
and low-grade fever. These symptoms usually resolve in two to three days.
It is the most common viral cause of adult food poisoning and is
transmitted from water, shellfish, and vegetables contaminated by feces, as
well as from person to person. Outbreaks are more common in densely
populated areas such as nursing homes, schools and cruise ships (hence
why the virus is also known as the "Cruise Ship Illness"). The term
norovirus has been approved as the official name for this group of viruses.
Several other names have been used for noroviruses, including Norwalk-
like viruses, caliciviruses (because they belong to the virus family
Caliciviridae), and small round structured viruses.

o Rotavirus: Causes moderate to severe illness with vomiting followed by

watery diarrhea and fever. It is the most common cause of food poisoning
in infants and children and is transmitted from person to person by fecal
contamination of food and shared play areas.

o Hepatitis A: Causes mild illness with sudden onset of fever, loss of

appetite, and feeling of tiredness followed by jaundice, which is a
yellowing of the eyes and skin. It is transmitted from person to person by
fecal contamination of food.

• Bacteria can cause food poisoning in two different ways. Some bacteria infect the
intestines, causing inflammation and difficulty absorbing nutrients and water,
leading to diarrhea. Other bacteria produce chemicals in foods (known as toxins)
that are poisonous to the human digestive system. When eaten, these chemicals
can lead to nausea and vomiting, kidney failure, and even death.
o Salmonellae: Salmonellae are bacteria that may cause food poisoning; the
illness itself is often referred to as Salmonella or Salmonella infection.
Salmonellae cause a moderate illness with nausea, vomiting, crampy
diarrhea, and headache, which may come back a few weeks later as
arthritis (joint pains). In people with impaired immune systems (such as
people with kidney disease or HIV/AIDS or those receiving chemotherapy
for cancer), Salmonellae can cause a life-threatening illness. The illness is
transmitted by undercooked foods such as eggs, poultry, dairy products,
and seafood.

o Campylobacter: Causes mild illness with fever, watery diarrhea,

headache, and muscle aches. Campylobacter is the most commonly
identified food-borne bacterial infection encountered in the world. It is
transmitted by raw poultry, raw milk, and water contaminated by animal
feces.

o Staphylococcus aureus: Causes moderate to severe illness with rapid

onset of nausea, severe vomiting, dizziness, and abdominal cramping.
These bacteria produce a toxin in foods such as cream-filled cakes and
pies, salads (most at risk are potato, macaroni, egg, and tuna salads, for
example) and dairy products. Contaminated salads at picnics are common
if the food is not chilled properly.

o Bacillus cereus: Causes mild illness with rapid onset of vomiting, with or
without diarrhea and abdominal cramping. It is associated with rice
(mainly fried rice) and other starchy foods such as pasta or potatoes. It has
been speculated that this bacteria may also be used as a potential terrorist
weapon.

o Escherichia coli (E coli): Causes moderate to severe illness that begins as

large amounts of watery diarrhea, which then turns into bloody diarrhea.
There are many different types of this bacteria. The worst strain can cause
kidney failure and death (about 3%-5% of all cases). It is transmitted by
eating raw or undercooked hamburger, unpasteurized milk or juices, or
contaminated well water. Outbreaks of food poisoning due to E. coli have
also occurred following ingestion of contaminated produce.
 o Shigella (traveler’s diarrhea): Causes moderate to severe illness with
fever, diarrhea containing blood or mucus or both, and the constant urge to
have bowel movements. It is transmitted in water polluted with human
wastes.

o Clostridium botulinum (botulism): Causes severe illness affecting the

nervous system. Symptoms start as blurred vision. The person then
develops problems talking and overall weakness. Symptoms then progress
to breathing difficulty and the inability to move arms or legs. Infants and
young children are particularly at risk. It is transmitted in foods such as
home-packed canned goods, honey, sausages, and seafood.

Because botulism can be released in the air, it is considered a potential

biological weapon for terrorists.

o Vibrio cholerae: Causes mild to moderate illness with crampy diarrhea,

headache, nausea, vomiting, and fever with chills. It strikes mostly in the
warmer months of the year and is transmitted by infected, undercooked, or
raw seafood.

• Parasites rarely cause food poisoning. When they do, they are usually swallowed
in contaminated or untreated water and cause long-lasting but mild symptoms.

o Giardia (beaver fever): Causes mild illness with watery diarrhea often
lasting one to two weeks. It is transmitted by drinking contaminated water,
often from lakes or streams in cooler mountainous climates.

The infection can also be spread from person to person by food or other
items contaminated with feces from an infected person.

o Cryptosporidium: Causes moderate illness with large amounts of watery

diarrhea lasting two to four days. May become a long-lasting problem in
people with poor immune systems (such as people with kidney disease or
HIV/AIDS or those on chemotherapy for cancer). It is transmitted by
contaminated drinking water.

• Toxic agents are the least common cause of food poisoning. Illness is often an
isolated episode caused by poor food preparation or selection (such as picking
wild mushrooms).
 o Mushroom toxins: Illness can range from mild to deadly depending on
the type of mushroom eaten. Often there is nausea, vomiting, and diarrhea.
Some types of mushrooms produce a nerve toxin, which causes sweating,
shaking, hallucinations, and coma.

o Ciguatera poisoning: Caused by eating fish that contains toxins produced

by a marine algae called Gambierdiscus toxicus. It can cause moderate to
severe illness with numbness of the area around the mouth and lips that
can spread to the arms and legs, nausea, vomiting, muscle pain and
weakness, headache, dizziness, and rapid heartbeat. The toxin may cause
sensory problems in which hot things feel cold and cold things feel hot. It
is transmitted by eating certain large game fish from tropical waters-most
specifically barracuda, grouper, snapper, and jacks. According to the
CDC, ciguatera has no cure. Symptoms may disappear in days or weeks,
but may persist for years.

o Scombroid: Causes mild to moderate illness with facial flushing, burning

around the mouth and lips, peppery-taste sensations, a red rash on the
upper body, dizziness, headache, and itchy skin. Severe symptoms may
include blurry vision, respiratory distress, and swelling of the tongue and
mouth. Symptoms typically last from four to six hours, and rarely more
than one or two days. It is transmitted in seafood, mostly mahi-mahi and
tuna, but can also be in Swiss cheese.

o Pesticides: Cause mild to severe illness with weakness, blurred vision,

headache, cramps, diarrhea, increased production of saliva, and shaking of
the arms and legs. Toxins are transmitted by eating unwashed fruits or
vegetables contaminated with pesticides.

When to Seek Medical Care

Contact your doctor if any of the following situations occur:

• Nausea, vomiting, or diarrhea lasts for more than two days.

• The ill person is younger than three years.

• The abdominal symptoms are associated with a low-grade fever.

• Symptoms begin after recent foreign travel.

 • Other family members or friends who ate the same thing are also sick.

• The ill person cannot keep any liquids down.

• The ill person does not improve within two days even though they are drinking
large amounts of fluids.

• The ill person has a disease or illness that weakens their immune system (for
example, HIV/AIDS, cancer and undergoing chemotherapy, kidney disease).

• The ill person cannot take their normal prescribed medications because of
vomiting.

• The ill person has any nervous system symptoms such as slurred speech, muscle
weakness, double vision, or difficulty swallowing.

Go to the nearest hospital's emergency department if any of the following situations

occur:

• The ill person passes out or collapse, become dizzy, lightheaded, or have
problems with vision.

• A fever higher than 101°F occurs with the abdominal symptoms.

• Sharp or cramping pains do not go away after 10-15 minutes.

• The ill person's stomach or abdomen swells.

• The skin and/or eyes turn yellow.

• The ill person is vomiting blood or having bloody bowel movements.

• The ill person stops urinating, have decreased urination, or have urine that is dark
in color.

• The ill person develops problems with breathing, speaking, or swallowing.

• One or more joints swell or a rash breaks out on your skin.

• The ill person or caretaker considers the situation to be an emergency.

xams and Tests

If the patient visits a doctor or a hospital emergency department because they think they
may have food poisoning, a thorough examination will be performed, including
measurements of blood pressure, pulse, breathing rate, and temperature. The doctor will
perform a physical exam, which screens for outward signs and symptoms of the illness.
They will assess how dehydrated the patient is and examine the abdominal area to make
sure the illness is not serious.

• The doctor may need to do a rectal examination. The doctor performs this test by
inserting a lubricated and gloved finger gently into the rectum. The purpose is to
make sure there are no breaks in the rectal wall. A sample of stool is taken and
tested for blood and mucus. In some cases, a sample of stool or vomit can be sent
to the laboratory for further testing to find out which toxin caused the illness. In a
majority of cases, a specific cause is not found.

• A urine sample helps assess how dehydrated the patient is and may indicate
possible kidney damage.

• Blood tests may be performed to determine the seriousness of the illness. An x-

ray of the abdomen or a CT scan may be taken if the doctor suspects your
symptoms may be caused by another illness.

Food Poisoning Treatment

Self-Care at Home

Short episodes of vomiting and small amounts of diarrhea lasting less than 24 hours can
usually be cared for at home.

• Do not eat solid food while nauseous or vomiting but drink plenty of fluids.

o Small, frequent sips of clear liquids (those you can see through) are the
best way to stay hydrated.

o Avoid alcoholic, caffeinated, or sugary drinks. Over-the-counter

rehydration products made for children such as Pedialyte and Rehydralyte
are expensive but good to use if available.

o Sports drinks such as Gatorade and Powerade are fine for adults if they are
diluted with water because at full strength they contain too much sugar,
which can worsen diarrhea.

• After successfully tolerating fluids, eating should begin slowly, when nausea and
vomiting have stopped. Plain foods that are easy on the stomach should be started
 in small amounts. Consider eating rice, wheat, breads, potatoes, low-sugar cereals,
lean meats, and chicken (not fried) to start. Milk can be given safely, although
some people may experience additional stomach upset due to lactose intolerance.

• Most food poisonings do not require the use of over-the-counter medicines to stop
diarrhea, but they are generally safe if used as directed. It is not recommended
that these medications be given to children. If there is a question or concern, you
should always check with a doctor.

Medical Treatment

The main treatment for food poisoning is putting fluids back in the body (rehydration)
through an IV and by drinking. The patient may need to be admitted to the hospital. This
depends on the severity of the dehydration, response to therapy, and ability to drink fluids
without vomiting. Children, in particular, may need close observation.

• Anti-vomiting and diarrhea medications may be given.

• The doctor may also treat any fever to make the patient more comfortable.

• Antibiotics are rarely needed for food poisoning. In some cases, antibiotics
worsen the condition. Only a few specific causes of food poisoning are improved
by using these medications. The length of illness with traveler's diarrhea
(shigellae) can be decreased with antibiotics, but this specific illness usually runs
its course and improves without treatment.

• With mushroom poisoning or eating foods contaminated with pesticides,

aggressive treatment may include pumping the stomach (lavage) or giving
medications as antidotes. These poisonings are very serious and may require
intensive care in the hospital.

Follow-up

After visiting your doctor or the emergency department, follow any

specific instructions and take any medications prescribed exactly as
directed. Continue to drink extra fluids until the diarrhea stops
completely. You may need to miss one to two days of work or
schPrevention

Safe steps in food handling, cooking, and storage are essential to avoiding food-borne
illness. Bacteria cannot be seen, smelled, or tasted, which may be on any food.

Follow the CDC food safety guidelines to keep contaminants away.

• Safe shopping
 o Buy cold foods last during your shopping trip. Get them home fast.

o Never choose torn or leaking packages.

o Do not buy foods past their "sell-by" or expiration dates.

o Keep raw meat and poultry separate from other foods.

o
• Safe storage of foods

o Keep it safe; refrigerate.

o Unload perishable foods first and immediately refrigerate them. Place raw
meat, poultry, or fish in the coldest section of your refrigerator.

o Check the temperature of your appliances. To slow bacterial growth, the

refrigerator should be at 40°F, the freezer at 0°F.

o Cook or freeze fresh poultry, fish, ground meats, and variety meats within
two days.
o

• Safe food preparation

o Keep everything clean!

o Wash hands before and after handling raw meat and poultry.
 o Sanitize cutting boards often in a solution of one teaspoon chlorine bleach
in one quart of water.

o Do not cross-contaminate. Keep raw meat, poultry, fish, and their juices
away from other food. After cutting raw meats, wash hands, cutting board,
knife, and counter tops with hot, soapy water.

o Marinate meat and poultry in a covered dish in the refrigerator. Discard

any uncooked/unused marinade.
o

• Thawing food safely

o Refrigerator: Allows slow, safe thawing. Make sure thawing juices do not
drip on other foods.

o Cold water: For faster thawing, place food in a leak-proof plastic bag and
submerge in cold tap water.

o Microwave: Cook meat and poultry immediately after microwave

thawing.
o
• Safe cooking

o Use a meat thermometer.

o Cook ground meats to 160°F; ground poultry to 165°F. Beef, veal, and
lamb steaks, roasts and chops may be cooked to 145°F; all cuts of fresh
pork, 160°F. Whole poultry should reach 180°F in the thigh; breasts
170°F.

o Keep hot foods hot and cold foods cold.

 o Never leave food out more than two hours (or more than one hour in
temperatures above 90°F).

o Bacteria that cause food poisoning grow rapidly at room temperature.

o Use cooked leftovers within four days.

ool to let your body recover. If any symptoms change or worsen, contact your doctor.

Some of the most severe food poisoning can result in long-term illness and death.
However, most food poisoning is not serious. Most people begin feeling better within 24-
48 hours. Queasiness or nausea and slight diarrhea may stay for one to two days longer.

What is Salmonella?

Salmonella are bacteria that can live in the intestinal tracts of humans and other animals.
There are many different kinds of these bacteria; the most common types in the U.S. are
Salmonella typhimurium and Salmonella enteritidis. Any raw food of animal origin and
some fruits and vegetables may carry salmonella bacteria, as can non-food sources.

Shown here is a color-enhanced and magnified view of salmonella invading human cells.
Food Sources of Salmonella

Any raw food of animal origin -- such as meat, poultry, milk and dairy products, eggs,
and seafood -- and some fruits and vegetables may carry salmonella bacteria. People
should avoid eating raw or undercooked meat, poultry or eggs, along with unpasteurized
dairy products. The list also includes homemade foods made with raw eggs, such as
mayonnaise, cookie dough, and ice cream.

Can Cooking or Washing Help?

Thorough cooking can kill salmonella. While it's always a good idea to rinse fruits and
vegetables, it may not get rid of salmonella, particularly during an outbreak -- it's best
just to throw any suspect produce away. Further, when health officials warn people not to
eat potentially contaminated food during an outbreak, that means you shouldn't eat that
food, cooked or not.

Food Sources of Salmonella

Food Safety Tips

The FDA recommends these practices for all fruits and vegetables to prevent food
poisoning:

• Wash hands with soap and warm water before and after handling them.
• Wash produce thoroughly under running water, not in a tub or sink.
• Use a clean cutting board and utensils. Don't let produce come into contact with
other raw foods or surfaces they have touched.

Non-Food Sources of Salmonella

Pets may carry salmonella bacteria in their intestines, so their feces are a potential
concern. Certain pets, such as turtles, snakes and other reptiles, and chicks and other birds
are more likely to carry it. But always wash your hands thoroughly with soap and warm
water after coming into contact with any pet or their droppings.

Salmonella Symptoms and Treatments

Symptoms of salmonellosis include abdominal cramps, diarrhea, and fever that develop
12 to 72 hours after infection. Most people recover in four to seven days and don't require
treatment other than drinking plenty of fluids. People with severe diarrhea may require
rehydration with intravenous fluids. Antibiotics are usually not used unless the
salmonella infection has spread beyond the intestines. Serious -- and potentially fatal --
cases are more likely in young children, frail or elderly people, and people with weak
immune systems.
Foodborne illness (also foodborne disease and colloquially referred to as food
poisoning)[1] is any illness resulting from the consumption of contaminated food.

There are two types of food poisoning: infectious agent and toxic agent. Food infection
refers to the presence of bacteria or other microbes which infect the body after
consumption. Food intoxication refers to the ingestion of toxins contained within the
food, including bacterially produced exotoxins, which can happen even when the microbe
that produced the toxin is no longer present or able to cause infection. In spite of the
common term food poisoning, most cases are caused by a variety of pathogenic bacteria,
viruses, or parasites that contaminate food,[2] rather than chemical or natural toxins

Signs and symptoms

Symptoms typically begin several hours to several days after consumption and depending
on the agent involved, can include one or more of the following: nausea, abdominal pain,
vomiting, diarrhea, gastroenteritis, fever, headache or fatigue.

In most cases the body is able to permanently recover after a short period of acute
discomfort and illness. However, foodborne illness can result in permanent health
problems or even death, especially for people at high risk, including babies, young
children, pregnant women (and their fetuses), elderly people, sick people and others with
weak immune systems.

Foodborne illness due to campylobacter, yersinia, salmonella or shigella infection is a

major cause of reactive arthritis, which typically occurs 1–3 weeks after diarrheal illness.
Similarly, people with liver disease are especially susceptible to infections from Vibrio
vulnificus, which can be found in oysters or crabs.

Tetrodotoxin poisoning from reef fish and other animals manifests rapidly as numbness
and shortness of breath, and is often fatal.

Causes

Foodborne illness usually arises from improper handling, preparation, or food storage.
Good hygiene practices before, during, and after food preparation can reduce the chances
of contracting an illness. There is a general consensus in the public health community
that regular hand-washing is one of the most effective defenses against the spread of
foodborne illness. The action of monitoring food to ensure that it will not cause
foodborne illness is known as food safety. Foodborne disease can also be caused by a
large variety of toxins that affect the environment. For foodborne illness caused by
chemicals, see Food contaminants.

Foodborne illness can also be caused by pesticides or medicines in food and naturally
toxic substances like poisonous mushrooms or reef fish.

[edit] Bacteria
Bacteria are a common cause of foodborne illness. In the United Kingdom during 2000
the individual bacteria involved were as follows: Campylobacter jejuni 77.3%,
Salmonella 20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.1%.[3] In
the past, bacterial infections were thought to be more prevalent because few places had
the capability to test for norovirus and no active surveillance was being done for this
particular agent. Symptoms for bacterial infections are delayed because the bacteria need
time to multiply. They are usually not seen until 12–72 hours or more after eating
contaminated food.

Most common bacterial foodborne pathogens are:

• Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome and

periodontitis[4]
• Clostridium perfringens, the "cafeteria germ"[5]
• Salmonella spp. – its S. typhimurium infection is caused by consumption of eggs
that are not adequately cooked or by other interactive human-animal pathogens[6]
[7][8]

• Escherichia coli O157:H7 enterohemorrhagic (EHEC) which causes hemolytic-

uremic syndrome

Other common bacterial foodborne pathogens are:

• Bacillus cereus
• Escherichia coli, other virulence properties, such as enteroinvasive (EIEC),
enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroaggregative (EAEC or
EAgEC)
• Listeria monocytogenes
• Shigella spp.
• Staphylococcus aureus
• Streptococcus
• Vibrio cholerae, including O1 and non-O1
• Vibrio parahaemolyticus
• Vibrio vulnificus
• Yersinia enterocolitica and Yersinia pseudotuberculosis

Less common bacterial agents:

• Brucella spp.
• Corynebacterium ulcerans
• Coxiella burnetii or Q fever
• Plesiomonas shigelloides
[edit] Exotoxins

In addition to disease caused by direct bacterial infection, some foodborne illnesses are
caused by exotoxins which are excreted by the cell as the bacterium grows. Exotoxins
can produce illness even when the microbes that produced them have been killed.
Symptoms typically appear after 1–6 hours depending on the amount of toxin ingested.

• Clostridium botulinum
• Clostridium perfringens
• Staphylococcus aureus
• Bacillus cereus

For example Staphylococcus aureus produces a toxin that causes intense vomiting. The
rare but potentially deadly disease botulism occurs when the anaerobic bacterium
Clostridium botulinum grows in improperly canned low-acid foods and produces botulin,
a powerful paralytic toxin.

Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some

other bacteria, produce the lethal tetrodotoxin, which is present in the tissues of some
living animal species rather than being a product of decomposition.

[edit] Mycotoxins and alimentary mycotoxicoses

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins

through food consumption. Mycotoxins sometimes have important effects on human and
animal health. For example, an outbreak which occurred in the UK in 1960 caused the
death of 100,000 turkeys which had consumed aflatoxin-contaminated peanut meal. In
the USSR in World War II, 5000 people died due to Alimentary Toxic Aleukia (ALA).[9]
The common foodborne Mycotoxins include:

• Aflatoxins – originated from Aspergillus parasiticus and Aspergillus flavus. They

are frequently found in tree nuts, peanuts, maize, sorghum and other oilseeds,
including corn and cottonseeds. The pronounced forms of Aflatoxins are those of
B1, B2, G1, and G2, amongst which Aflatoxin B1 predominantly targets the liver,
which will result in necrosis, cirrhosis, and carcinoma.[10][11] In the US, the
acceptable level of total aflatoxins in foods is less than 20 μg/kg, except for
Aflatoxin M1 in milk, which should be less than 0.5 μg/kg.[12] The official
document can be found at FDA's website.[13][14]
• Altertoxins – are those of Alternariol (AOH), Alternariol methyl ether (AME),
Altenuene (ALT), Altertoxin-1 (ATX-1), Tenuazonic acid (TeA) and Radicinin
(RAD), originated from Alternaria spp. Some of the toxins can be present in
sorghum, ragi, wheat and tomatoes.[15][16][17] Some research has shown that the
toxins can be easily cross-contaminated between grain commodities, suggesting
that manufacturing and storage of grain commodities is a critical practice.[18]
• Citrinin
• Citreoviridin
• Cyclopiazonic acid
• Cytochalasins
• Ergot alkaloids / Ergopeptine alkaloids – Ergotamine
• Fumonisins – Crop corn can be easily contaminated by the fungi Fusarium
moniliforme, and its Fumonisin B1 will cause Leukoencephalomalacia (LEM) in
horses, Pulmonary edema syndrome (PES) in pigs, liver cancer in rats and
Esophageal cancer in humans.[19][20] For human and animal health, both the FDA
and the EC have regulated the content levels of toxins in food and animal feed.[21]
[22]

• Fusaric acid
• Fusarochromanone
• Kojic acid
• Lolitrem alkaloids
• Moniliformin
• 3-Nitropropionic acid
• Nivalenol
• Ochratoxins – In Australia, The Limit of Reporting (LOR) level for Ochratoxin A
(OTA) analyses in 20th Australian Total Diet Survey was 1 µg/kg,[23] whereas the
EC restricts the content of OTA to 5 µg/kg in cereal commodities, 3 µg/kg in
processed products and 10 µg/kg in dried vine fruits.[24]
• Oosporeine
• Patulin – Currently, this toxin has been advisably regulated on fruit products. The
EC and the FDA have limited it to under 50 µg/kg for fruit juice and fruit nectar,
while limits of 25 µg/kg for solid-contained fruit products and 10 µg/kg for baby
foods were specified by the EC.[24][25]
• Phomopsins
• Sporidesmin A
• Sterigmatocystin
• Tremorgenic mycotoxins – Five of them have been reported to be associated with
molds found in fermented meats. These are Fumitremorgen B, Paxilline, Penitrem
A, Verrucosidin, and Verruculogen.[26]
• Trichothecenes – sourced from Cephalosporium, Fusarium, Myrothecium,
Stachybotrys and Trichoderma. The toxins are usually found in molded maize,
wheat, corn, peanuts and rice, or animal feed of hay and straw.[27][28] Four
trichothecenes, T-2 toxin, HT-2 toxin, diacetoxyscirpenol (DAS) and
deoxynivalenol (DON) have been most commonly encountered by humans and
animals. The consequences of oral intake of, or dermal exposure to, the toxins
will result in Alimentary toxic aleukia, neutropenia, aplastic anemia,
thrombocytopenia and/or skin irritation.[29][30][31] In 1993, the FDA issued a
document for the content limits of DON in food and animal feed at an advisory
level.[32] In 2003, US published a patent that is very promising for farmers to
produce a trichothecene-resistant crop.[33]
• Zearalenone
• Zearalenols
[edit] Emerging foodborne pathogens

Many foodborne illnesses remain poorly understood. Approximately sixty percent of

outbreaks are caused by unknown sources.[citation needed]

• Aeromonas hydrophila, Aeromonas caviae, Aeromonas sobria

Preventing bacterial food poisoning

Proper storage and refrigeration of food help in the prevention of food poisoning

Prevention is mainly the role of the state, through the definition of strict rules of hygiene
and a public services of veterinary surveying of animal products in the food chain, from
farming to the transformation industry and delivery (shops and restaurants). This
regulation includes:

• traceability: in a final product, it must be possible to know the origin of the

ingredients (originating farm, identification of the harvesting or of the animal) and
where and when it was processed; the origin of the illness can thus be tracked and
solved (and possibly penalized), and the final products can be removed from the
sale if a problem is detected;
• enforcement of hygiene procedures like HACCP and the "cold chain";
• power of control and of law enforcement of veterinarians.

In August 2006, the United States Food and Drug Administration approved Phage
therapy which involves spraying meat with viruses that infect bacteria, and thus
preventing infection. This has raised concerns, because without mandatory labelling
consumers wouldn't be aware that meat and poultry products have been treated with the
spray. [1]

At home, prevention mainly consists of good food safety practices. Many forms of
bacterial poisoning can be prevented even if food is contaminated by cooking it
sufficiently, and either eating it quickly or refrigerating it effectively[citation needed]. Many
toxins, however, are not destroyed by heat treatment.

[edit] Viruses
Viral infections make up perhaps one third of cases of food poisoning in developed
countries. In the US, more than 50% of cases are viral and noroviruses are the most
common foodborne illness, causing 57% of outbreaks in 2004. Foodborne viral infection
are usually of intermediate (1–3 days) incubation period, causing illnesses which are self-
limited in otherwise healthy individuals, and are similar to the bacterial forms described
above.

• Enterovirus
• Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week)
incubation period and its ability to spread beyond the stomach and intestines, into
the liver. It often induces jaundice, or yellowing of the skin, and rarely leads to
chronic liver dysfunction. The virus has been found to cause the infection due to
the consumption of fresh-cut produce which has fecal contamination.[34][35]
• Hepatitis E
• Norovirus
• Rotavirus

Rotavirus

[edit] Parasites

Most foodborne parasites are zoonoses.

• Platyhelminthes:
o Diphyllobothrium sp.
o Nanophyetus sp.
o Taenia saginata
o Taenia solium
 The scolex of Taenia solium

o Fasciola hepatica

See also: Tapeworm and Flatworm

• Nematode:
o Anisakis sp.
o Ascaris lumbricoides
o Eustrongylides sp.
o Trichinella spiralis
o Trichuris trichiura
• Protozoa:
o Acanthamoeba and other free-living amoebae
o Cryptosporidium parvum
o Cyclospora cayetanensis
o Entamoeba histolytica
o Giardia lamblia

Giardia lamblia

o Sarcocystis hominis
o Sarcocystis suihominis
o Toxoplasma gondii

[edit] Natural toxins

Several foods can naturally contain toxins, many of which are not produced by bacteria.
Plants in particular may be toxic; animals which are naturally poisonous to eat are rare. In
evolutionary terms, animals can escape being eaten by fleeing; plants can use only
passive defenses such as poisons and distasteful substances, for example capsaicin in
chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons
are not synthesised by the animal, but acquired by eating poisonous plants to which the
animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish
poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning and
ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)

Some plants contain substances which are toxic in large doses, but have therapeutic
properties in appropriate dosages.

• Foxglove contains cardiac glycosides.

• Poisonous hemlock (conium) has medicinal uses.

[edit] Other pathogenic agents

• Prions, resulting in Creutzfeldt-Jakob disease

[edit] "Ptomaine poisoning"

An early theory on the causes of food poisoning involved ptomaines (from Greek ptōma,
"fall, fallen body, corpse"), alkaloids found in decaying animal and vegetable matter.
While some alkaloids do cause poisoning, the discovery of bacteria left the ptomaine
theory obsolete and the word ptomaine is no longer used scientifically.

[edit] Mechanism

[edit] Incubation period

The delay between consumption of a contaminated food and appearance of the first
symptoms of illness is called the incubation period. This ranges from hours to days (and
rarely months or even years, such as in the case of Listeriosis or Creutzfeldt-Jacob
disease), depending on the agent, and on how much was consumed. If symptoms occur
within 1–6 hours after eating the food, it suggests that it is caused by a bacterial toxin or a
chemical rather than live bacteria.

The long incubation period of many foodborne illnesses tends to cause sufferers to
attribute their symptoms to "stomach flu".

During the incubation period, microbes pass through the stomach into the intestine, attach
to the cells lining the intestinal walls, and begin to multiply there. Some types of
microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream,
and some can directly invade the deeper body tissues. The symptoms produced depend on
the type of microbe.[36]

[edit] Infectious dose

The infectious dose is the amount of agent that must be consumed to give rise to
symptoms of foodborne illness, and varies according to the agent and the consumer's age
and overall health. In the case of Salmonella a relatively large inoculum of 1 million to 1
billion organisms is necessary to produce symptoms in healthy human volunteers [2], as
Salmonellae are very sensitive to acid. An unusually high stomach pH level (low acidity)
greatly reduces the number of bacteria required to cause symptoms by a factor of between
10 and 100.

Clostridium Botulinum (Botulism)

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by
the bacterium Clostridium botulinum. Clostridium botulinum is the name of a group of
bacteria commonly found in soil. The bacteria are anaerobic, gram-positive, spore-
forming rods that produce a potent neurotoxin. These rod-shaped organisms grow best in
low oxygen conditions. The bacteria form spores that allow them to survive in a dormant
state until exposed to conditions that can support their growth. The organism and its
spores are widely distributed in nature. They occur in both cultivated and forest soils,
bottom sediment of streams, lakes, and coastal waters, in the intestinal tracts of fish and
mammals, and in the gills and viscera of crabs and other shellfish.

Foodborne botulism is a severe type of food poisoning caused by the ingestion of foods
containing the potent neurotoxin formed during growth of the organism. The incidence
of the disease is low, but the disease is of considerable concern because of its high
mortality rate if not treated immediately and properly. Most of the 10 to 30 outbreaks
that are reported annually in the United States are associated with inadequately
processed, home-canned foods, but occasionally commercially produced foods are
implicated as the source of outbreaks. Sausages, meat products, canned vegetables, and
seafood products have been the most frequent vehicles for foodborne botulism.
Symptoms of Botulism

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids,
slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with
botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor
muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial
toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs,
trunk, and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to
36 hours after consuming contaminated food, but they can occur as early as 6 hours or as
late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the
myoneural junction. The flaccid paralysis progresses symmetrically downward, usually
starting with the eyes and face, then moving to the throat, chest, and extremities. When
the diaphragm and chest muscles become fully involved, respiration is inhibited and
unless the patient receives treatment in time, death from asphyxia results.

Detection and Treatment of Botulism

Although botulism can be diagnosed by clinical symptoms alone, differentiation from

other diseases may be difficult. The most direct and effective way to confirm the clinical
diagnosis of botulism in the laboratory is to demonstrate the presence of toxin in the
serum or feces of the patient or in the food the patient consumed. Currently, the most
sensitive and widely used method for detecting toxin is the mouse neutralization test,
which involves injecting serum or stool into mice and looking for signs of botulism. This
test typically takes 48 hours. Culturing of specimens takes 5-7 days. Some cases of
botulism may go undiagnosed because symptoms are transient or mild, or are
misdiagnosed as Guillain-Barre Syndrome.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the
action of toxin circulating in the blood. This can prevent patients from worsening, but
recovery still takes many weeks. Physicians may try to remove contaminated food still in
the gut by inducing vomiting or using enemas.

While botulism has been known to cause death due to respiratory failure, in the past 50
years the proportion of patients with botulism who die has fallen from about 50% to 8%.
The respiratory failure and paralysis that occur with severe botulism may require a
patient to be on a ventilator for weeks, plus intensive medical and nursing care. After
several weeks, the paralysis slowly improves.

Preventing Botulism

The types of foods implicated in botulism outbreaks vary according to food preservation
and eating habits in different regions. Any food that is conducive to outgrowth and toxin
production, that when processed allows spore survival, and is not subsequently heated
before consumption, can be associated with botulism. Almost any type of food that is not
very acidic (pH above 4.6) can support growth and toxin production by C. botulinum.
Botulinal toxin has been demonstrated in a considerable variety of foods, such as canned
corn, peppers, green beans, soups, beets, asparagus, mushrooms, ripe olives, spinach,
tuna fish, chicken and chicken livers and liver pate, and luncheon meats, ham, sausage,
stuffed eggplant, lobster, and smoked and salted fish.

Botulinum toxin is heat-labile, or unstable if heated to a certain temperature, and can be

destroyed if heated and held at 80 degrees Centigrade (176 degrees Fahrenheit) for ten
minutes or longer.

Botulism Food Poisoning: An Overview

Botulism is a rare but serious illness that is caused by toxins (poisons) produced by
specific bacteria (Clostridium botulinum). In severe cases, botulism can lead to paralysis
or death. Botulism food poisoning (also known as foodborne botulism) is one form of the
illness (see Botulism Types).

Common Causes
Botulism food poisoning is caused by eating foods that contain the botulism toxin. A
common source is improperly preserved home-processed foods with low acid content,
such as corn, green beans, and beets. Less likely sources include fish products and other
commercially processed foods.

Ideal Environment for Botulism Food Poisoning

Certain conditions allow Clostridium botulinum spores to germinate and the botulinum
toxin to be produced. These conditions include:

• Absence of oxygen
• Low acidity levels
• Temperatures between 40 and 120°F (4.5 to 49°C).

The potential for food poisoning can easily develop in improperly stored home-cooked or
commercial foods, as well as in canned foods that have not been prepared with proper
canning procedures.

The Botulism Incubation Period

The time between a person becoming infected with botulism bacteria and the beginning
of symptoms is called the "incubation period." For food poisoning related to botulism, the
incubation period is between 18 to 36 hours, but can occur as early as 6 hours after eating
contaminated food or as late as 10 days.
Food Poisoning From Commercial Foods
Commercial foods have been involved in botulism outbreaks. Some outbreaks have been
attributed to improperly handled food, such as potato salad, served in restaurants. But
many commercial food outbreaks are due to consumer mishandling, such as disregarding
labels that indicate the food should be refrigerated.

Some food companies acidify their products or lower their moisture content as an extra
precautionary measure in case the refrigeration warning is not heeded. Consumers can
best protect themselves by reading the labels and following the storage instructions and
by discarding rusty, swollen, or otherwise damaged cans.

Preventing Botulism Food Poisoning

Botulism food poisoning has often been caused by home-canned foods with low acid
content, such as asparagus, green beans, beets, and corn. However, outbreaks have also
originated from more unusual sources, such as:

• Chopped garlic in oil

• Chile peppers
• Tomatoes
• Improperly handled baked potatoes wrapped in aluminum foil
• Home-canned or fermented fish.

People who do home canning should follow strict hygienic procedures to reduce
contamination of foods. Some suggestions include:

• Refrigerating oils containing garlic or herbs.

• Keeping baked potatoes cooked in aluminum foil hot until they are served, or
refrigerating them.

• Boiling home-canned foods for 10 minutes before eating them (to ensure safety).

• Cooking food to be canned in pressure cookers for 10 minutes because such

cookers can maintain temperatures high enough (above 212°F, or 100°C) to kill
the spores, which are remarkably heat-resistant.
 • Not leaving foods cooked at home at temperatures between 40 and 140°F (4.5 to
60°C) for more than four hours. (Toxins that may have formed can readily be
destroyed by boiling the food for 10 minutes.)

Instructions on safe home canning can be obtained from county extension services or
from the U.S. Department of Agriculture.

How Common Is Food Poisoning With Botulism?

The actual number of cases of botulism due to food poisoning in the United States is
small -- approximately 9 outbreaks per year, with an average of 2.4 cases per outbreak.

Salmonellosis
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Salmonellosis
Classification and external resources
ICD-10 A02.0
ICD-9 003.0

Salmonellosis is an infection with Salmonella bacteria. Most people infected with

Salmonella develop diarrhea, fever, vomiting, and abdominal cramps 8 to 72 hours after
infection. In most cases, the illness lasts 4 to 7 days and most people recover without
treatment.[1] However, in some persons the diarrhea may be so severe that the patient
becomes dangerously dehydrated and must be taken to a hospital. At the hospital, the
patient may receive intravenous fluids to treat the dehydration, and medications may be
given to provide symptomatic relief, such as fever reduction. In severe cases, the
Salmonella infection may spread from the intestines to the blood stream, and then to
other body sites, and can cause death unless the person is treated promptly with
antibiotics. The elderly, infants, and those with impaired immune systems are more likely
to develop severe illness. Some people afflicted with salmonellosis later experience
reactive arthritis, which can have long-lasting, disabling effects.

The type of Salmonella usually associated with infections in humans is nontyphoidal

Salmonella. It is usually contracted from sources such as:

• Poultry, pork, and cattle, if the meat is prepared incorrectly or is infected with the
bacteria after preparation.[1]
• Infected eggs, egg products, and milk when not prepared, handled, or refrigerated
properly.[1]
 • Reptiles such as turtles, lizards, and snakes, which may carry the bacteria on their
skin.
• Pet rodents.
• Tainted fruits and vegetables.[1]

A rarer form of Salmonella named typhoidal Salmonella can lead to typhoid fever. It is
carried only by humans and is usually contracted through direct contact with the fecal
matter of an infected person. Typhoidal Salmonella therefore mainly occurs in lesser
developed countries where unsanitary conditions are more likely to occur.

Etymology

Both Salmonellosis and the Salmonella genus of microorganisms derive their names from
a modern Latin coining after Daniel E. Salmon (1850–1914), an American veterinary
surgeon. He had help from Theobald Smith, and together they found the bacterium in
pigs.

[edit] Symptoms

The bacterium induces responses in the animal that it is infecting, and this is what
typically causes the symptoms, rather than any direct toxin produced[2]. Symptoms are
usually gastrointestinal, including nausea, vomiting, abdominal cramps and bloody
diarrhea with mucus. Headache, fatigue and rose spots are also possible. These symptoms
can be severe, especially in young children and the elderly. Symptoms last generally up
to a week, and can appear 8 to 72 hours after ingesting the bacterium.

After bacterial infections, reactive arthritis (a.k.a. Reiters syndrome) can develop.[3] In
sickle-cell anemia, osteomyelitis due to Salmonella infection is much more common than
in the general population. Note however, salmonella infection is more frequently the
cause of osteomyelitis in sickle-cell anemia patients, not the most common cause. The
most common cause of osteomyelitis remains due to Staphylococcus infection.

Salmonella
Salmonella is one of the most common enteric (intestinal) infections in the United States.
Salmonellosis – the disease caused by Salmonella – is the second most common bacterial
foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of
salmonellosis occur each year in the U.S.; 95 percent of those cases are related to
foodborne causes.

Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000
cases result in death. About 500 to 1,000 deaths - 31 percent of all food-related deaths -
are caused by Salmonella infections each year. Salmonellosis is more common in the
warmer months of the year.
Salmonella infection occurs when bacteria are ingested, typically from food derived from
infected animals, but infection can also occur by ingesting the feces of an infected animal
or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw
milk products, contaminated water, meat and meat products, and poultry. Raw fruits and
vegetables contaminated during slicing have been implicated in several foodborne
outbreaks, as have foods contaminated by food handlers who did not adhere to proper
hygienic standards and practice proper handwashing techniques.

Symptoms of Salmonella infection

The acute symptoms of Salmonella gastroenteritis include the sudden onset of nausea,
abdominal cramping, and bloody diarrhea with mucous. Fever is almost always a
symptom. Vomiting is less common than diarrhea. Headaches, myalgias (muscle pain),
and arthralgias (joint pain) are often reported as well. The onset of symptoms usually
occurs within 6 to 72 hours after the ingestion of Salmonella bacteria. The infectious dose
is small, probably from 15 to 20 cells.

Reiter’s Syndrome, which includes and is sometimes referred to as “reactive arthritis,” is

an uncommon, but debilitating, result of Salmonella infection. The symptoms of Reiter’s
Syndrome usually occur between one and three weeks after infection, and include at least
two of three seemingly unrelated symptoms: reactive arthritis, conjunctivitis (eye
irritation), and urinary tract infection.

The arthritis associated with Reiter’s Syndrome typically affects the knees, ankles, and
feet, causing pain and swelling. Wrists, fingers and other joints can be affected, though
with less frequency. With Reiter’s Syndrome, the affected person commonly develops
inflammation where the tendon attaches to the bone, a condition called enthesopathy.
Some people also develop heel spurs—bony growths in the heel that cause chronic or
long-lasting foot pain. Arthritis from Reiter’s Syndrome can also affect the joints of the
back and cause spondylitis—inflammation of the vertebrae in the spinal column. The
duration of reactive arthritis symptoms can vary greatly. Most of the literature suggests
that the majority of affected persons recover within a year. The condition, can, however,
be permanent.

Detection and treatment of Salmonella infection

Salmonella bacteria are discovered in stool cultures. Although blood cultures are rarely
positive, bacteremia (bacteria in the blood stream) does occur in 5 percent of adults with
Salmonella gastroenteritis and can result in spread to the heart (endocarditis), spleen,
bone (osteomyelitis), and joints (Reiter’s Syndrome or reactive arthritis).

Generally, blood cultures are not performed and in most cases the blood stream is not
infected. In the stool, the laboratory is challenged to pick out Salmonella from many
other similar bacteria that are normally present. In addition, many persons submit
samples for testing after they have started antibiotics, which may make it even more
difficult for a microbiology lab to grow Salmonella. So, the diagnosis of salmonellosis
may be problematic and many mild cases are culture-negative.

Salmonella infections usually resolve in five to seven days, and many times require no
treatment, unless the affected person becomes severely dehydrated or the infection
spreads from the intestines. Persons with severe diarrhea may require re-hydration, often
with intravenous fluids. Treatment with antibiotics is not usually necessary, unless the
infection spreads from the intestines or otherwise persists, in which case the infection can
be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin.
Some Salmonella bacteria have become resistant to antibiotics, possibly as a result of the
use of antibiotics to promote the growth of feed animals.

For those persons who develop Reiter’s Syndrome, symptomatic treatment with high
doses of a nonsteroidal anti-inflammatory drug and steroid injections into affected joints
can be helpful in reactive arthritis. For people with severe joint inflammation, injections
of corticosteroids directly into the affected joint may reduce inflammation. A small
percentage of patients with reactive arthritis have severe symptoms that cannot be
controlled with these treatments, in which case medicine that suppresses the immune
system, such as sulfasalazine or methotrexate, may be effective. Exercise, when
introduced gradually, may help improve joint function. Topical corticosteroids can be
applied directly on the skin lesions associated with reactive arthritis.

Consult a physician for treatment options if you suspect you have become ill with
Salmonellosis or a complication of Salmonella infection such as Reiter’s Syndrome.

Preventing Salmonella infection

To prevent salmonellosis, cook poultry, ground beef, and eggs thoroughly before eating.
In order to ensure that eggs do not contain viable Salmonella they must be cooked at least
until the yoke is solid. Meat and poultry must reach 160ºF or higher throughout. Be
particularly careful with foods prepared for infants, the elderly, and those with a
compromised immune system, including diabetics, pregnant women, HIV/AIDS patients,
cancer patients, and transplant recipients.

Do not eat or drink foods containing raw eggs, such as homemade eggnog and
hollandaise sauce. Avoid drinking raw (unpasteurized) milk or products made from raw
milk.

Wash hands, kitchen work surfaces, and utensils with soap and water immediately after
they have been in contact with foods of animal origin. Also, wash hands with soap after
handling reptiles, amphibians, or birds, or after contact with pet feces. Infants and
immune-compromised persons should have no direct or indirect contact with such pets.