J Korean Med Assoc.  2011 Jun;54(6):617-626. 10.5124/jkma.2011.54.6.617.

Food poisoning

• Ryu CB
• Lee MS

• KMID: 2190747
• DOI: http://doi.org/10.5124/jkma.2011.54.6.617

Abstract

This article aims to help physicians to make a differential diagnosis of food poisoning by introducing the incubation period, clinical symptoms of each causative agent according to the mode of manifestation. Etiologic agents for food poisoning are classified as bacterial, viral, natural toxin, and chemical toxin. Bacterial food poisoning is classified as infectious type, toxin type and other type according to the pathogenesis. Natural toxin food poisoning are classified as plant and animal food poisoning according to causative food. Many of the diagnoses are made clinically, without confirmative laboratory tests. However, some of food poisonings require the confirmative etiologic diagnoses, because they have rapid life-threatening courses and need proper speedy therapies. When incubation period is 1-6 hours, natural toxin type food poisoning should be suspected such as Staphylococcus aureus, Bacillus cereus vomiting type. When it is 7 to 12 hours, Clostridium perfringens and Bacillus cereus diarrheal type should be suspected. When it is 12 to 72 hours, Enterotoxigenic Echerichia coli, Salmonella spp., Vibrio parahemolyticus and Norovirus should be suspected. Before the result of confirmative laboratory test, a probable diagnosis for the etiology of food poisoning should be based upon the combination of their clinical manifestations, food histories, and pathogenic mechanisms.

Keyword

Food poisoning; Differential dignosis; Etiology

MeSH Terms

Animals
Bacillus cereus
Clostridium perfringens
Diagnosis, Differential
Foodborne Diseases
Norovirus
Plants
Salmonella
Staphylococcus aureus
Vibrio
Vomiting

Reference

1. Fry AM, Braden CR, Griffin PM, Hughes JM. Mandell GL, Bennett JE, Dolin R, editors. Foodborne diseases. Princi-ples and practice of infectious diseases. 2005. 6th ed. Philadelphia: Elsevier;1286–1301.

2. Murray PR, Rosenthal KS, Kobayashi GS, Pfaller MA. Medical microbiology. 2002. 4th ed. St. Louis: Mosby.

3. Morris JG Jr. Cholera and other types of vibriosis: a story of human pandemics and oysters on the half shell. Clin Infect Dis. 2003. 37:272–280.

4. Qadri F, Svennerholm AM, Faruque AS, Sack RB. Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. Clin Microbiol Rev. 2005. 18:465–483.

5. American Medical Association. Centers for Disease Control and Prevention. Center for Food Safety and Applied Nutrition, Food and Drug Administration. Food Safety and Inspection Service, US Department of Agriculture. Diagnosis and management of foodborne illnesses: a primer for physicians. MMWR Recomm Rep. 2001. 50(RR-2):1–69.

6. Allen SD, Emery CL, Lyerly DM. Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH, editors. Clostridium. Manual of clinical microbiology. 2003. 8th ed. Washington, DC: American Society for Microbiology Press;835–856.

7. Smedley JG 3rd, Fisher DJ, Sayeed S, Chakrabarti G, McClane BA. The enteric toxins of Clostridium perfringens. Rev Physiol Biochem Pharmacol. 2004. 152:183–204.

8. Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, Hennessy T, Griffin PM, DuPont H, Sack RB, Tarr P, Neill M, Nachamkin I, Reller LB, Osterholm MT, Bennish ML, Pickering LK. Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001. 32:331–351.

9. Pegues DA, Hohmann EL, Miller SI. Blaster MJ, Smith PD, Ravdin PD, Ravdin JI, Greenberg HB, Guerrant RL, editors. Salmonella including S.typhi. Infections of the gastrointestinal tract. 1995. New York: Raven Press;785–809.

10. Ebel E, Schlosser W. Estimating the annual fraction of eggs contaminated with Salmonella enteritidis in the United States. Int J Food Microbiol. 2000. 61:51–62.

11. Saphra I, Winter JW. Clinical manifestations of salmonellosis in man: an evaluation of 7779 human infections identified at the New York Salmonella Center. N Engl J Med. 1957. 256:1128–1134.

12. Buchwald DS, Blaser MJ. A review of haman salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella. Rev Infect Dis. 1984. 6:345–356.

13. Szanton VL. Epidemic salmonellosis: a 30-month study of 80 cases of Salmonella Oranienburg infection. Pediatrics. 1957. 20(5, Part 1):794–808.

14. Kramer JM, Frost JA, Bolton FJ, Wareing DR. Campylobacter contamination of raw meat and poultry at retail sale: identification of multiple types and comparison with isolates from human infection. J Food Prot. 2000. 63:1654–1659.

15. Tulloch EF Jr, Ryan KJ, Formal SB, Franklin FA. Invasive enteropathic Escherichia coli dysentery. An outbreak in 28 adults. Ann Intern Med. 1973. 79:13–17.

16. Schmitt M, Schuler-Schmid U, Schmidt-Lorenz W. Temperature limits of growth, TNase and enterotoxin production of Staphylococcus aureus strains isolated from foods. Int J Food Microbiol. 1990. 11:1–19.

17. Saunders GC, Bartlett ML. Double-antibody solid-phase enzyme immunoassay for the detection of staphylococcal enterotoxin A. Appl Environ Microbiol. 1977. 34:518–522.

18. Sobel J, Malavet M, John S. Outbreak of clinically mild botulism type E illness from home-salted fish in patients presenting with predominantly gastrointestinal symptoms. Clin Infect Dis. 2007. 45:e14–e16.

19. Jo SH, Kim HJ, Choi EJ, Ha SD. Trends analysis of food-borne outbreaks in United States of America, Japan and Korea. Safe Food. 2009. 4:3–14.

20. Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol Rev. 1998. 11:142–201.

21. Paton JC, Paton AW. Pathogenesis and diagnosis of Shiga toxin-producing Escherichia coli infections. Clin Microbiol Rev. 1998. 11:450–479.

22. Kim MJ, Kim SH, Kim TS, Kee H, Seo J, Kim ES, Park JT, Chung JK, Lee J. Identification of Shiga toxin-producing E. coli isolated from diarrhea patients and cattle in Gwangju area, Korea. J Bacteriol Virol. 2009. 39:29–39.

23. Ehling-Schulz M, Fricker M, Scherer S. Bacillus cereus, the causative agent of an emetic type of food-borne illness. Mol Nutr Food Res. 2004. 48:479–487.

24. Mahler H, Pasi A, Kramer JM, Schulte P, Scoging AC, Bar W, Krahenbuhl S. Fulminant liver failure in association with the emetic toxin of Bacillus cereus. N Engl J Med. 1997. 336:1142–1148.

25. Food poisoning statistical system [Internet]. cited 2011 May 29. Cheongwon: Korea Food and Drug Administration;Available from: http://e-stat.kfda.go.kr/intro.jsp.

26. Yu JH, Kim NY, Koh YJ, Lee HJ. Epidemiology of foodborne Norovirus outbreak in Incheon, Korea. J Korean Med Sci. 2010. 25:1128–1133.

27. Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-related illness and death in the United States. Emerg Infect Dis. 1999. 5:607–625.

28. Kim WJ. Management of food poisoning and diarrheal disease. Korean J Med. 1999. 57:128–130.

29. Atmar RL, Estes MK. The epidemiologic and clinical importance of norovirus infection. Gastroenterol Clin North Am. 2006. 35:275–290.

30. Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med. 2005. 33:419–426.

31. Barceloux DG. Potatoes, tomatoes, and solanine toxicity (Solanum tuberosum L., Solanum lycopersicum L.). Dis Mon. 2009. 55:391–402.

32. Tambyah PA, Hui KP, Gopalakrishnakone P, Chin NK, Chan TB. Central-nervous-system effects of tetrodotoxin poisoning. Lancet. 1994. 343:538–539.

33. Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol. 2005. 4:219–228.

34. Borade PS, Ballary CC, Lee DK. A fish cause of sudden near fatal hypotension. Resuscitation. 2007. 72:158–160.