-IBIS-1.5.0-
tx
digestive system
food poisoning
diagnoses

definition and etiology

definition and etiology:
an acute syndrome of gastrointestinal distress caused by infection of or ingestion of toxins from micro-organisms or plants, including species of staphylococcus, clostridium, salmonella, vibrio, salmonella, campylobacter, yersinia and bacillus

signs and symptoms

staphylococcus
signs and symptoms:
• onset usually 2-4 hours after eating
• nausea and vomiting
• abdominal cramping
• prostration
• diarrhea
• headache
• fever
• may be subnormal temperature and lowered blood pressure

lab findings:
• (+) isolation of coagulase-(+) staph from suspected food
• enterotoxin-producing staph in stool
• increased WBCs in stool presumptive evidence for staph poisoning

clostridium perfringens:
signs and symptoms:
• onset usually 10-12 hours after ingestion
• sudden onset of colic followed by diarrhea
• nausea and vomiting
• fever usually absent

lab findings:
• culture of organism in food or stool

clostridium botulinum:
a. food botulism:
signs and symptoms:
• onset is typically abrupt, with neurologic symptoms starting 12-36 hours after ingestion of contaminated food
• diplopia
• blurred vision
• dry mouth
• loss of pupillary accommodation
• bulbar paresis
• decreased or absent pupillary light reflex
• GI illness: nausea, vomiting, diarrhea, abdominal cramping
• paralysis: symmetrical, descending (usually) or ascending (sometimes)
• fever is absent
• patients are alert and oriented, even with severe poisoning
• constipation, urinary retention, decreased saliva production
• sensory system is unchanged

b. infantile
signs and symptoms:
• constipation
• neuromuscular weakness
• paralysis

c. wound: similar neuromuscular symptoms appear without the gastrointestinal symptoms; this type of botulism is quite rare

d. unclassified: signs and symptoms are similar to the classic food poisoning although no source for the disease can be uncovered.

lab findings for all botulism:
• check food, stool, wound, and serum for toxin using mouse bioassay technique and special anaerobic cultures
• routine lab studies are not helpful in diagnosing botulism
• electrodiagnostic studies can differentiate botulism from other diseases causing paralysis

salmonella:
signs and symptoms: onset is sudden, usually 12-36 hours after ingestion
• headache
• abdominal pain
• diarrhea, occasional vomiting and nausea, anorexia (can last for days)
• dehydration can be severe, especially when infants are afflicted
• fever is often present
• rarely, the organism can localize in a body tissue and create abscesses, arthritis, pericarditis, pneumonia, endocarditis, cholecystitis or meningitis

lab findings:
• stool analysis for salmonella: when enterocolitis is present
• blood culture: when there is enteric fever and septicemia

vibrio parahaemolyticus:
signs and symptoms:
• onset usually 12-24 hours after ingestion
• watery diarrhea
• abdominal cramps
• occasional nausea, vomiting, headaches
• occasional dysentery-like clinical picture with mucous or bloody stools, high fever, and high WBC counts

lab findings:
• isolation of the bacteria from stool
• high WBC with dysentery

campylobacter jejuni and coli
signs and symptoms: the disease expression ranges from mild to severe
• onset usually 3-5 days after ingestion
• acute: diarrhea, abdominal pain, malaise, nausea/vomiting, fever
• liquid stools, often foul-smelling, with blood and mucous

lab findings:
• cultured organisms from the stool

yersinia enterocolitica:
signs and symptoms:
• onset 3-7 days after ingestion
• acute watery diarrhea
• acute mesenteric lymphadenitis
• fever, headache, pharyngitis
• anorexia, vomiting
• erythema nodosum, arthritis, iritis

lab findings:
• (+) blood cultures
• (+) fecal culture
• (+) serologic agglutination

bacillus cereus
signs and symptoms:
• nausea and vomiting (onset 1-6 hours after ingestion)
• cramping and diarrhea (onset 6-16 hours after ingestion)

lab findings:
• (+) identification in food and/or
• (+) identification in stool

course and prognosis

staphylococcus
:
Recovery from Staph poisoning is usually complete within a day or two. Fatalities are rare, and follow electrolyte and/or fluid imbalances, mostly affecting the very old, the very young, and the chronically ill. No treatment is usually needed, but occasional replacement of fluid and electrolytes by IV solution is helpful.

clostridium perfringens:
Usually mild and self-limiting within 24 hours in healthy persons.

clostridium botulinum:
Botulism is a medical emergency. Death occurs from respiratory failure, although with proper treatment and antitoxin administration, the fatality rate is < 10-15 % for food-borne poisonings and 2% for infantile botulism. Antitoxin including all three subtypes (A, B, and E) should be given as soon as possible after diagnosis. Treatment of the other individual symptoms may be needed (e.g. by catheterization, enemas). Recovery, while usually full, may be very protracted, with residual weakness, respiratory impairment and autonomic symptoms lasting up to one year after hospitalization.

salmonella:
Salmonellosis is rarely fatal. Death occurs primarily in infants, the elderly, and the infirm. However, the disease may be very intense, and require convalescence. Antibiotics may prolong the carrier state and encourage resistant strains.

vibrio parahemolyticus:
The disease is typically self-limiting, though with the dysentery-type, electrolyte and fluid IV replacement may be necessary. Death is rare.

campylobacter jejuni and coli:
The disease is typically self-limited, although 20% of patients may develop a prolonged clinical picture that requires medical attention. Relapses among recovered patients is not uncommon. Antibiotics may not shorten the course of the disease, but may shorten the 2-7 weeks that carriers shed organisms.

yersinia enterocolitica:
The disease is rarely fatal, but abdominal complications require antimicrobial therapy.

bacillus cereus:
The disease is generally self-limiting within 24 hours.

differential diagnosis

• most cases of food poisoning are mild and self-limiting, but in severe cases, a stool culture is indicated to differentiate the offending agent; food poisoning also must be differentiated from other infectious gastrointestinal complaints, disorders like ulcerative colitis and irritable bowel syndrome, and miscellaneous poisonings: e.g. shellfish, belladonna

clostridium botulinum
• Guillain-Barre syndrome: has mild sensory changes
• Fisher's syndrome: Guillain-Barre with ataxia, ophthalmoplegia, areflexia
• myasthenia gravis: has a more gradual onset
• tick paralysis: tick may be evident; paresthesias occur
• diphtheria
• poliomyelitis: spinal fluid is abnormal, paralysis and weakness is asymmetrical
• miscellaneous poisonings: e.g. shellfish, belladonna


footnotes