Food Poisoning or Foodborne Illness

Food Poisoning or Foodborne Illness is a topic covered in the 5-Minute Pediatric Consult.

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Basics

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

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