food poisoning

This usually refers to the often violent vomiting and diarrhea that can occur when a bacterial germ, often Staphylococcus, secrets a toxin while growing in your food. You ingest the toxin, which irritates your gastrointestinal tract, and you develop a violent gastroenteritis, typically lasting a few hours to a day or so, until the toxin is cleared from your system. Treatment is generally supportive, which is to say you mainly just wait it out. The body knows just what to do - get that toxin out of the system - which it does by violently purging everything from both ends of the GI tract. Other forms of food poisoning involve infection of the bowel with gastroenteritis-producing bacteria or the ingestion of toxins with other effects, chiefly on the nervous system.

Now for the more encyclopedic treatment. Three questions go a long way toward confirming a suspicion of common food poisoning:

When did the illness start?
What did the child eat?
When was it eaten?

Nausea, vomiting, and diarrhea - gastroenteritis - occurring less than 6 hours after eating indicate ingestion of a toxin, most commonly Staphylococcus aureus. Only toxin-related disease causes symptoms this rapidly, and almost never with fever. Common sources of the sudden, explosive gastroenteritis due to S. aureus might be described as "church picnic food poisoning," caused by dairy products, poultry, or meat left out in the sun or at room temperature for too long. Patients recover in 24-48 hours with symptomatic support for dehydration.

Gastroenteritis with paresthesias - nerve tingling - are the hallmarks of toxin-related seafood poisoning which also occurs without fever. Scombroid fish poisoning can be caused by tuna (including canned tuna), mackerel, bonito, skipjack, or mahi mahi. It is an explosive illness with flushing, headache, dizziness, nausea, cramps, and severe diarrhea. Symptoms usually resolve within 4 hours. Severe cases are treated with antihistamines or bronchodilators for wheezing or asthmatic patients.

Paralytic or neurotoxic poisoning from shellfish causes paresthesias of the mouth, tongue, and face, and often a feeling of floating. Weakness sets in rapidly, including cranial nerve paralysis. Most cases resolve within 24 hours with symptomatic care, but consuming a lot of tainted shellfish can produce respiratory failure.

Ciguatera poisoning from fish such as red snapper, barracuda, grouper, or amberjack -- all bottom feeders -- can cause sudden cramps, nausea, vomiting, and diarrhea with paresthesias of the lips, tongue, and extremities. Patients may complain of a metallic taste in the mouth, shooting limb pains, or reversed temperature perception. This is the most common form of food poisoning in Florida. With activated charcoal, a cathartic, and symptomatic therapy, acute symptoms may subside in 2-8 days, but weakness and sensory findings can last for months.

Cramps and profuse watery diarrhea within 6-16 hours of eating suggest "holiday food poisoning." This is most commonly caused by eating bacteria-containing turkey or other food left at room temperature for hours on end. The bacteria (Clostridium perfringens or Bacillus cereus) produce a toxin in the gut, causing delayed toxin-related symptoms that resolve in 20-36 hours.

Fever, cramps, and diarrhea within 12-72 hours suggest an infection of the gut. Illnesses associated with egg consumption, especially Salmonella, Shigella, or Campylobacter jejuni infection, have become much more common. Treatment depends on the severity of symptoms, because in general, antibiotic treatment prolongs the period that the patient sheds the germ in his or her stool. If the patient has bloody stools or fever, however, treatment with ampicillin or trimethoprim-sulfamethoxazole (Septra®, Bactrim®) will shorten the illness due to Salmonella or Shigella. Campylobacter responds to erythromycin-class antibiotics, but usually by the time the diagnosis can be made, it's too late to actually shorten the illness.

Children with fever and diarrhea 16-48 hours after eating in whom appendicitis is suspected could be having cramps due to Yersinia enterocolitica infection.

Acute and often bloody diarrhea 3-5 days after consuming undercooked hamburger or unpasteurized juices could be due to enterotoxigenic Escherichia coli. This produces fever and chills about half the time. Most cases resolve in 3-5 days with supportive care, but 10% develop severe hemorrhagic colitis, and this organism can rarely produce the very dangerous hemolytic-uremic syndrome. Order your hamburger well-done.

Of course, botulism (not infant botulism, discussed elsewhere in the Encyclopedia) in older children and adults is the extreme case of food poisoning - often fatal. It is the result of ingestion of the nerve-paralysing botulinum toxin secreted by the bacterium Clostridium botulinum in contaminated canned food. Again, that toxin is deactivated by thorough cooking. If any canned good ever smells funny, throw it away and do not taste it even in the slightest - you could die from just that little taste.

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