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CHAPTER 2-71: FOOD POISONING: BACTERIAL

Susan Kim-Katz

INTRODUCTION

Food-borne bacteria and bacterial toxins are a common cause of epidemic gastroenteritis. In general, the illness is relatively mild and self-limited, with recovery within 24 hours. However, severe and even fatal poisoning may occur with listeriosis, salmonellosis, or botulism and with certain strains of Escherichia coli. Poisoning after the consumption of fish and shellfish. Mushroom poisoning. Viruses such as the Norwalk virus and Norwalk-like caliciviruses, enteroviruses, and rotaviruses are the causative agent in as many as 80% of food-related illness. Other microbes that can cause food-borne illness include Cryptosporidium and Cyclospora, which can cause serious illness in immunocompromised patients. However, in over half of reported food-borne outbreaks, no microbiological pathogens are identified.

MECHANISM OF TOXICITY

Gastroenteritis may be caused by invasive bacterial infection of the intestinal mucosa or by a toxin elaborated by bacteria. Bacterial toxins may be preformed in food that is improperly prepared and improperly stored before use or may be produced in the gut by the bacteria after they are ingested (Table II–28).

TABLE II–28.BACTERIAL FOOD POISONING
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TABLE II–28. BACTERIAL FOOD POISONING
Organism Incubation Period Common Symptomsa and Mechanism Common Foods
Bacillus cereus

1–6 h (emetic)

8–16 h (diarrheal)

 V > D, S; toxins produced in food and gut Reheated fried rice, improperly refrigerated meats.
Campylobacter jejuni 1–8 d D+, F; invasive and possibly toxin produced in gut Poultry, water, milk; direct contact (eg, food handlers).
Clostridium perfringens 6–16 h D > V; toxin produced in food and gut Meats, gravy, dairy products.
Escherichia coli "enterotoxigenic" 12–72 h D > V; toxin produced in gut "Traveler's diarrhea": water, various foods; direct contact (eg, food handlers).
E. coli "enteroinvasive" 24–72 h D+; invasive infection Water, various foods; direct contact (eg, food handlers).
E. coli "enterohemorrhagic" (STEC, eg, 0157:H7) 1–8 d D+, S; toxin produced in gut Water, ground beef, salami and other meats, unpasteurized milk and juice, contaminated lettuce and sprouts; direct contact (eg, food handlers).
Listeria monocytogenes Varies D+, S; invasive infection Milk, soft cheeses, raw meat.
Salmonella spp 12–36 h D+, F; invasive infection Meat, dairy, eggs, water, sprouts; direct contact (eg, food handlers).
Shigella spp 1–7 d D+, S; invasive infection Water, fruits, vegetables; direct contact (eg, food handlers, contact with contaminated reptiles/frogs).
Staphylococcus aureus 1–6 h V > D; toxin preformed in food; heat-resistant Very common: meats, dairy, bakery foods; direct contact (eg, food handlers).
Vibrio parahemolyticus 8–30 h V, D+; invasive and toxin produced in gut Shellfish, water.
Yersinia enterocolitica 3–7 d D+; invasive infection Water, meats, dairy.

aD, diarrhea; D+, diarrhea with blood and/or fecal leukocytes; F, fever; S, systemic manifestations; V, vomiting.

TOXIC DOSE

The toxic dose depends on the type of bacteria or toxin and its concentration in the ingested food as well as individual susceptibility or resistance. Some of the ...

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