Pediatric emergency medicine trisk 3102 3102
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Most bacterial toxin-induced food poisoning leads to self-limited GI
symptoms, whereas foodborne botulism and ingestion of contaminated
seafood may also lead to neurologic and cardiorespiratory symptoms. In
addition to drugs and medications and household products and plants,
toxic ingestions may occur through normal diet when the ingested
product contains a toxin that is preformed by microorganisms.
Mycotoxins are important food contaminants worldwide. Major bacterial
enterotoxins include those produced by Shigella, Salmonella, Yersinia,
Escherichia coli, Staphylococcus, Bacillus cereus, Clostridium, Vibrio,
and Clostridium botulinum. After this large group of toxins, the next most
common cause of foodborne intoxications results from the ingestion of
contaminated marine life.
When similar GI symptoms occur in a group of persons who share the same meal
or the same food on separate occasions, the emergency physician may consider
the possibility of foodborne disease. Detailed epidemiologic investigations are
usually beyond the capacity of the ED setting, but the hospital infection control
officer and/or local health department can often be helpful.
TABLE 102.14
COMMON CAUSES OF DIARRHEAL FOOD POISONING IN THE
UNITED STATES
Organism
Onset (hours)
Effect of heat
Typical sources
Staphylococcal
1–6
Stable
Meats, potato/egg
salads, creamfilled desserts
Bacillus cereus
Emetic type
1–6
Stable
Fried rice
Diarrheal type
Clostridia
12–16
12–24
Labile
Spores, stable
Cooked meats
Meats/poultry a
12–24
Toxin labile
Toxin labile
Raw shellfish
Cholera/other
Vibrio spp.
a In
context of inadequate refrigeration.
