Food-borne and Water-borne Diseases

Definition
Food-borne illness two or more cases of a
similar illness resulting from the ingestion of a common food Water-borne illness an illness that occurs after consumption or use of water intended for drinking or as illness associated with recreational water such as swimming pools, whirlpools, hot tubs, spas, water parks, and naturally occurring fresh and marine surface waters

Epidemiology - Food-borne
List of most common bacterial food-borne
illness, listed in order of occurrence 1) Campylobacter 2) Salmonella 3) Shigella 4) E. Coli

Epidemiology - Food-borne
List of most common viral food-borne illness
1) 2) 3) 4) Norwalk virus Astroviruses Rotaviruses Enteric adenoviruses

Physical Examination

Determine hydration status Presence of blood in the stool Exclude other diarrheal illness

Diagnostic Tests
Blood cultures suspect bateremia Gram stain - identifies campylobacter with
66-99% sensitivity Fecal leukocytes - if positive = higher culture yield Ova and parasites - done in the ER

Diagnostic Tests
Stool cultures only if pt
1) 2) 3) 4) 5) febrile bloody diarrhea severe abdominal pain clinically severe or persistent significant historical risk factors for food-borne illness

Treatment
Most episodes are self-limiting and fluid

replacement with supportive care is all that is needed. If determined that a severe case of bacterial infectious diarrhea has occurred then antibiotic of choice is either: Ciprofloxacin 500mg PO BID x3-5 days Ciprofloxacin 1 gm PO x 1 dose Bactrim DS PO BID x 3-5 days

Bacillus anthracis
Incubation period 2d-weeks Signs and symptoms nausea, vomiting,
bloody diarrhea, abdominal pain Duration weeks Food Source contaminated meat Lab testing blood Treatment penicillin, ciprofloxacin

Bacillus cereus
Enterotoxin Incubation period 1-6h Signs and symptoms sudden fever, nausea,

vomiting, may have diarrhea Duration 24h Food Source rice, meat Lab testing none Treatment supportive only

Bacillus cereus
Diarrheal toxin Incubation period - 10-16h Signs and symptoms - watery diarrhea,

nausea, cramps Duration - 24-28h Food Source meat, stew, gravy, vanilla sauce Lab testing none Treatment supportive only

Brucella spp.
Incubation period 7-21d Signs and symptoms fever, chills, headache,
myalgias, arthralgias, bloody diarrhea Duration weeks Food Source raw milk, goat cheese, meats Lab testing blood, serology Treatment rifampin and doxycycline

Clostridium botulinum
Adults, children Incubation period 12-72h Signs and symptoms vomiting, diarrhea, diplopia,

dysphagia, descending muscle weakness Duration variable, can end in death Food Source improperly canned foods, fermented fish, garlic, herb-infused oils, baked potato in foil, foods kept in a warm oven for hours Lab testing stool, serum, and food assayed for toxin at CDC or state labs Treatment botulinum antitoxin

Clostridium botulinum
Infants Incubation period 3-30d Signs and symptoms lethargy, poor

feeding, hypotonia Duration variable Food Source honey, home-canned foods Lab testing stool, serum, and food assayed for toxin at CDC or state lab Treatment botulinum immune globulin

Campylobacter
Incubation period 2-5d Signs and symptoms bloody or watery

diarrhea, cramps, fever Duration 2-10d Food Source Poultry, milk, water Lab testing special stool culture Treatment erythromycin or ciprofloxacinantibiotic for severe cases only

Clostridium perfringens
Incubation period 8-16h Signs and symptoms watery diarrhea, nausea,
cramps Duration 24-48h Food Source meat, poultry, gravy, dried or precooked foods Lab testing quantitative culture of stool Treatment supportive only

Enterohemorrhagic E. coli
Incubation period 1-8d Signs and symptoms bloody diarrhea,

abdominal pain, vomiting Duration 5-10d Food Source undercooked meat, unpasteurized dairy products, milk, raw fruit and vegetables, salami, contaminated water, salad dressing, yogurt, acidic foods Lab testing specific stool culture Treatment supportive only

Enterotoxigenic E. coli (travelers diarrhea)

Incubation period 1-3d Signs and symptoms watery diarrhea,
vomiting, cramps Duration 3-10d Food Source fecal contamination of food Lab testing specific stool culture Treatment ciprofloxacin-antibiotic for severe cases only or TMP-SMX

Listeria monocytogenes
Incubation period 9-48h for GI, 2-6 weeks for

invasive disease Signs and symptoms fever, myalgias, nausea, diarrhea in pregnant women, flu-like illness, can lead to premature delivery, elderly or immunocompromised can have sepsis or meningitis Duration variable Food Source soft cheese, unpasteurized milk, deli meat, and hot dogs Lab testing blood or CSF cultures Treatment IV ampicillin or TMP-SMX. Antibiotics for severe cases only

Salmonella spp.
Incubation period 1-3d Signs and symptoms diarrhea, fever, cramps, vomiting,

s. typhi and paratyphi cause chills, myalgia, headache, with rare diarrhea Duration 4-7d Food Source eggs, poultry, unpasteurized milk or juice, raw fruits and vegetables, street venders, fecal water contamination Lab testing stool cultures Treatment ciprofloxacin or TMP-SMX. Antibiotics for severe cases only Necessitates typhoid immunization for travelers

Shigella spp.
Incubation period 24-48h Signs and symptoms bloody diarrhea, fever,

cramps Duration 4-7d Food Source fecal food or water contamination, person-person spread by fecal-oral contamination Lab testing stool cultures Treatment TMP-SMX if susceptible

S. Aureus
Incubation period 1-6h Signs and symptoms sudden severe

nausea, vomiting, diarrhea Duration 24-48h Food Source unrefrigerated meats, potato and egg salad, cream pastries Lab testing none Treatment supportive only

Vibrio cholerae
Incubation period 24-72h Signs and symptoms severe watery

diarrhea and vomiting Duration 3-7d death from dehydration Food Source contaminated water, fish, shellfish, street vendors Lab testing specific stool cultures Treatment ciprofloxacin in adults, TMPSMX in children

Vibrio vulnificus
Incubation period 1-7d Signs and symptoms vomiting, diarrhea, abdominal

pain, sepsis, wound infections, liver disease, and elderly can have skin bullae Duration 2-8d death can result Food Source raw shellfish, open wound exposure to seawater Lab testing specific wound or blood cultures Treatment doxycycline or ceftazidime

Yersinia spp.
Incubation period 24-48h Signs and symptoms mimics appendicitis,

can have a rash Duration 1-3 weeks Food Source undercooked pork, unpasteurized milk, contaminated water Lab testing specific stool or blood cultures Treatment ciprofloxacin, doxycycline, ceftriaxone, or gentamycin. Antibiotics for severe cases only

Chronic sequelae
Occurs in 2-3% of pts Seronegative reactive arthritis &

salmonella, shigella & campylobacter GBS & campylobacter HUS & E. coli 0157:H7