Description

Any illness resulting from the ingestion of food or drink contaminated with an infectious organism or associated toxin

Epidemiology

• Highest incidence in children <5 years
• Hospitalizations and death more common in persons >64 years
• See Appendix, Table 8 regarding epidemiologic aspects by organism.

General Prevention

• Vaccination
  • Oral rotavirus vaccine
  • Hepatitis A vaccine
• Preventive strategies
  • Hand washing (soap and water)
  • Avoidance of contaminated water and raw foods (seeded fruits and vegetables)
  • Proper food handling (adequate cooking and refrigeration)
  • Avoidance of unpasteurized dairy products and juices
  • Avoidance of raw or undercooked eggs, meat, and shellfish
  • Avoidance of honey in children <1 year old

Pathophysiology

• Gastroenteritis
  • Viral epithelial invasion/replication or ingestion of preformed elaborated toxin
• Noninflammatory diarrhea
  • Selective destruction of absorptive cells in mucosa, leaving secretory cells intact
  • Toxin elaboration (secretory diarrhea)
  • Impairment of brush border enzymes and lactose intolerance (osmotic diarrhea)
• Inflammatory diarrhea/dysentery
  • Direct mucosal invasion of intestinal epithelial cells (colon)
  • Toxin elaboration
  • Inflammatory infiltration destroys villous cells and transporters and leads to exudation of mucus/protein/blood into gut.
• Local/remote invasion (bacteremia, meningitis, hepatitis, septic arthritis, osteomyelitis)
• Immune-mediated extraintestinal manifestations (hemolytic uremic syndrome (HUS), reactive arthritis, Guillain-Barré syndrome [GBS])

Etiology

• Viruses
  • Most common cause of foodborne illness
  • Caliciviruses (norovirus, sapovirus)
  • Rotavirus (infant/child)
  • Astrovirus
  • Enteric adenovirus
  • Hepatitis A
• Bacteria
  • Salmonella typhi, Salmonella paratyphi, nontyphoidal Salmonella
  • Campylobacter jejuni, Campylobacter coli
  • Shigella sonnei, Shigella flexneri, Shigella boydii
  • Escherichia coli
    • Enterohemorrhagic E. coli (EHEC) including Shiga toxin–producing E. coli (STEC)
    • Enteropathogenic E. coli (EPEC)
    • Enterotoxigenic E. coli (ETEC)
    • Enteroinvasive E. coli (EIEC)
    • Enteroaggregative E. coli (EAEC)
  • Vibrio cholerae, Vibrio parahaemolyticus, Vibrio vulnificus
  • Listeria monocytogenes
  • Brucella spp.
  • Yersinia enterocolitica
• Toxin mediated
  • Clostridium perfringens
  • Staphylococcus aureus
  • Bacillus cereus
  • Clostridium botulinum
• Parasites
  • Entamoeba histolytica
  • Giardia intestinalis
  • Cryptosporidium
  • Cyclospora cayetanensis
  • Toxoplasma gondii
  • Trichinella spiralis