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7/29/2019 Food-Water Borne Dses
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Food-borne and Water-borne
Diseases
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Definition
Food-borne illness two or more cases of asimilar illness resulting from the ingestion of a
common food Water-borne illness an illness that occurs afterconsumption or use of water intended fordrinking or as illness associated with recreational
water such as swimming pools, whirlpools, hottubs, spas, water parks, and naturally occurringfresh and marine surface waters
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Epidemiology - Food-borne
List of most common bacterial food-borneillness, listed in order of occurrence
1) Campylobacter2) Salmonella
3) Shigella
4) E. Coli
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Epidemiology - Food-borne
List of most common viral food-borne illness1) Norwalk virus
2) Astroviruses
3) Rotaviruses
4) Enteric adenoviruses
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Physical Examination
Determine hydration statusPresence of blood in the stoolExclude other diarrheal illness
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Diagnostic Tests
Blood cultures suspect bateremia Gram stain - identifies campylobacter with
66-99% sensitivity Fecal leukocytes - if positive = higher
culture yield
Ova and parasites - done in the ER
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Diagnostic Tests
Stool cultures only if pt1) febrile
2) bloody diarrhea
3) severe abdominal pain
4) clinically severe or persistent
5) significant historical risk factors for
food-borne illness
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Treatment
Most episodes are self-limiting and fluidreplacement with supportive care is all that isneeded.
If determined that a severe case of bacterialinfectious diarrhea has occurred then antibioticof choice is either:
Ciprofloxacin 500mg PO BID x3-5 days
Ciprofloxacin 1 gm PO x 1 dose
Bactrim DS PO BID x 3-5 days
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Bacillus anthracis
Incubation period2d-weeks Signs and symptoms nausea, vomiting,
bloody diarrhea, abdominal pain Duration weeks Food Sourcecontaminated meat
Lab testingblood Treatmentpenicillin, ciprofloxacin
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Bacillus cereus
Enterotoxin Incubation period1-6h
Signs and symptomssudden fever, nausea,vomiting, may have diarrhea
Duration 24h
Food Sourcerice, meat Lab testing none Treatmentsupportive only
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Bacillus cereus
Diarrheal toxin Incubation period - 10-16h
Signs and symptoms - watery diarrhea,nausea, cramps
Duration - 24-28h
Food Source meat, stew, gravy, vanilla sauce Lab testing none Treatmentsupportive only
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Brucella spp.
Incubation period7-21d Signs and symptoms fever, chills, headache,
myalgias, arthralgias, bloody diarrhea Duration weeks Food Source raw milk, goat cheese, meats
Lab testingblood, serology Treatmentrifampin and doxycycline
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Clostridium botulinum
Adults, children Incubation period12-72h Signs and symptoms vomiting, diarrhea, diplopia,
dysphagia, descending muscle weakness Duration variable, can end in death Food Sourceimproperly canned foods, fermented
fish, garlic, herb-infused oils, baked potato in foil, foodskept in a warm oven for hours
Lab testingstool, serum, and food assayed for toxinat CDC or state labs Treatmentbotulinum antitoxin
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Clostridium botulinum
Infants Incubation period3-30d
Signs and symptomslethargy, poorfeeding, hypotonia Duration variable Food Sourcehoney, home-canned foods
Lab testingstool, serum, and food assayedfor toxin at CDC or state lab
Treatmentbotulinum immune globulin
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Campylobacter
Incubation period2-5d Signs and symptomsbloody or watery
diarrhea, cramps, fever Duration 2-10d Food SourcePoultry, milk, water
Lab testingspecial stool culture Treatmenterythromycin or ciprofloxacin-antibiotic for severe cases only
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Clostridium perfringens
Incubation period8-16h Signs and symptoms watery diarrhea, nausea,
cramps Duration 24-48h Food Source meat, poultry, gravy, dried or
precooked foods
Lab testingquantitative culture of stool Treatmentsupportive only
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Enterohemorrhagic E. coli
Incubation period1-8d Signs and symptomsbloody diarrhea,
abdominal pain, vomiting
Duration 5-10d Food Source undercooked meat,
unpasteurized dairy products, milk, raw fruit and
vegetables, salami, contaminated water, saladdressing, yogurt, acidic foods
Lab testingspecific stool culture Treatmentsupportive only
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Enterotoxigenic E. coli
(travelers diarrhea) Incubation period1-3d Signs and symptomswatery diarrhea,
vomiting, cramps Duration 3-10d Food Sourcefecal contamination of food
Lab testingspecific stool culture Treatmentciprofloxacin-antibiotic forsevere cases only or TMP-SMX
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Listeria monocytogenes
Incubation period9-48h for GI, 2-6 weeks forinvasive disease
Signs and symptoms fever, myalgias, nausea, diarrheain pregnant women, flu-like illness, can lead topremature delivery, elderly orimmunocompromised can have sepsis ormeningitis
Duration variable Food Source soft cheese, unpasteurized milk, deli
meat, and hot dogs Lab testingblood or CSF cultures TreatmentIV ampicillin or TMP-SMX. Antibiotics
for severe cases only
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Salmonella spp.
Incubation period1-3d Signs and symptoms diarrhea, fever, cramps, vomiting,
s. typhi and paratyphi cause chills, myalgia,
headache, with rare diarrhea Duration 4-7d Food Sourceeggs, poultry, unpasteurized milk or
juice, raw fruits and vegetables, street venders, fecalwater contamination
Lab testingstool cultures Treatmentciprofloxacin or TMP-SMX. Antibiotics
for severe cases only
Necessitates typhoid immunization for travelers
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Shigella spp.
Incubation period24-48h Signs and symptomsbloody diarrhea, fever,
cramps
Duration 4-7d Food Sourcefecal food or water
contamination, person-person spread by
fecal-oral contamination Lab testingstool cultures TreatmentTMP-SMX if susceptible
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S. Aureus
Incubation period1-6h Signs and symptomssudden severe
nausea, vomiting, diarrhea Duration 24-48h Food Sourceunrefrigerated meats,
potato and egg salad, cream pastries Lab testing none Treatment supportive only
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Vibrio cholerae
Incubation period24-72h Signs and symptomssevere watery
diarrhea and vomiting
Duration 3-7d death from dehydration Food Sourcecontaminated water, fish,
shellfish, street vendors
Lab testingspecific stool cultures Treatmentciprofloxacin in adults, TMP-SMX in children
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Vibrio vulnificus
Incubation period1-7d Signs and symptoms vomiting, diarrhea, abdominal
pain, sepsis, wound infections, liver disease, and
elderly can have skin bullae Duration 2-8d death can result Food Sourceraw shellfish, open wound exposure
to seawater
Lab testingspecific wound or blood cultures Treatmentdoxycycline or ceftazidime
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Yersinia spp.
Incubation period24-48h Signs and symptomsmimics appendicitis,
can have a rash
Duration 1-3 weeks Food Source undercooked pork, unpasteurized
milk, contaminated water Lab testingspecific stool or blood cultures
Treatmentciprofloxacin, doxycycline,ceftriaxone, or gentamycin. Antibiotics forsevere cases only
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Chronic sequelae
Occurs in 2-3% of pts Seronegative reactive arthritis &
salmonella, shigella & campylobacter GBS & campylobacter HUS & E. coli 0157:H7