Signs of Food Poisoning

Food Poisoning

What Is Food Poisoning

Food poisoning is an infection or poisoning that people get from eating or touching contaminated food or water, or by being otherwise exposed to one of several harmful pathogens (bacteria, viruses, or parasites). It causes multiple symptoms including nausea, vomiting, abdominal cramps and diarrhea. According to the Centers for Disease Control and Prevention (CDC), food poisoning, also called, “foodborne illness,” affects 1 in 6 Americans each year. That means some 48 million Americans will become ill, with approximately 3,000 dying from the illness, this year.

Most people fully recover from food poisoning, but pregnant women and their unborn children, children younger than 5, the elderly and those with compromised immune systems are typically at greater risk for complications. Age group risk factors change slightly depending on the particular infection type.

Because the source of the infection is often related to poor food preparation practices, poor sanitation by food handlers, and other “farm to table” issues, food poisoning is viewed as a preventable public health issue.

There are many types of food poisoning, and more than 250 different foodborne diseases have been identified. New pathogens appear annually. While most of these diseases are the result of infections caused by bacteria or viruses, a few are straight poisonings (such as consuming poisonous mushrooms).

Some of the most frequently seen infections in the US are: Norovirus, Salmonella, Campylobacter, Listeria, E.coli 0157, and Clostridium Perfringens.

Norovirus is the most common infection that results in food poisoning, with some 20 million people each year being infected. It is very contagious and is usually passed from person to person as the source, usually through environmental surfaces (versus contact with food). Cruise ships, nursing homes and daycare facilities are often impacted by outbreaks of norovirus. Infected food workers using poor sanitation practices are responsible for an estimated 70% of reported norovirus outbreaks. Raw oysters can also be a source of norovirus due to sewage discharge into the ocean.
Salmonella is among the infections causing the most hospitalizations and fatalities each year. Salmonella is a bacterium that is found in the intestines and feces of birds, reptiles (such as pet turtles) and mammals, including humans. Infection is usually associated with poor food preparation relating to contaminated eggs, poultry, meat, seafood and produce. In particular, the drippings from infected raw meat or poultry are often the source of infection. Raw eggs in homemade foods such as cookie dough, ice-cream and mayonnaise have also been identified as a source. There are about a million Salmonella illnesses in the US each year, although infections of Salmonella have been on the decrease in the past few years. Salmonella is most often found in North American and European countries.
Campylobacter is bacteria that live in the intestines of perfectly healthy birds; most raw poultry has campylobacter on it. An infection is typically caused by eating or touching raw/undercooked poultry or juice drippings. Campylobacter is usually an individual or family infection versus an outbreak. It is the most commonly identified bacterial cause of diarrhea in the world. Campylobacter is very common in the developing world, so International travelers are at risk.
Listeria is a bacterial infection, tied to the consumption of ready to eat packaged meats, hotdogs, soft cheeses and raw milk. Listeria, unlike most bacteria, can grow while refrigerated; so foods that are not typically cooked can contain the bacteria. The bacteria can be found in the intestines and feces of animals; as well as in the soil, water and in decaying vegetation. Most cases are individual or family versus an outbreak; however, in 2011 cantaloupe from a single farm became the deadliest US based foodborne disease outbreak in almost 90 years. Listeria is the 3rd leading cause of death due to food poisoning.
E.coli 0157 is an infection that is most often caused by consuming or touching uncooked beef (especially ground beef), unpasteurized milk and fruit juices, and rawfruits and vegetables that have been infected. E.coli outbreaks are also found outside of the food chain; often in a day care center or health care facility, due to inadequate sanitation relating to employee hygiene, diapering, etc. The incidence rate of E.coli has been increasing in the past few years by some 16%.

Clostridium Perfringens is a bacterium that is usually found on poultry and raw meat that has been contaminated by feces of infected animals, and sometimes by people. The bacterium produces a toxin in the intestines of people who are infected which causes illness. A million people a year are estimated to be diagnosed with clostridium perfringens. It is most often found in situations where a large amount of food is prepared and kept warm for long periods of time, such as at catered events, hospitals, school cafeterias and prisons. The bacteria grow very quickly, even on cooked meats, poultry and gravies, if left out at warm temperatures too long.
Botulism, while not common, botulism is quite serious. It is most often found on surfaces of fruits and vegetables, and is often tied to poor home-based canning procedures. 1 in 5 households in the US do some form of canning. People canning fruits and vegetables at home may not have the necessary equipment or knowledge to adequately kill off existing bacteria. Botulism can be quite serious and cause neurological impairments (slurred speech, blurred vision) and even paralysis, as a neurotoxin is created from the infection. Botulism can also infect children under the age of one if they eat honey.

Bacteria-related food poisoning peaks in summer months as more people are participating in outside activities; this typically means less food safety is being utilized, a few examples being:
- Inadequate personal hygiene (no place to wash hands after going to the toilet, etc.)
- Inadequate refrigeration
- Lack of a thermostat for proper heating
- Cross-contamination of foods (raw meat juices inadvertently touching vegetables due to shared utensils, plates, or surfaces)
- Inadequate cooling of left-overs, especially in the summer heat
- Bacteria grow faster in warm climates, as well as in humidity

For virus related food poisonings, such as norovirus, 80% of outbreaks occur between November and April, likely due to the increased proximity of people to each other during winter months; or, in the case of cruise ships, the close proximity of people to each other in general.

What Causes Food Poisoning

What causes Food Poisoning?

There are several causes of food poisoning. Most infections are preventable with proper hygiene, adherence to food preparation safety guidelines, and an understanding of higher risk food types. An understanding and appreciation of the complex path our foods take from “farm to table” is also helpful in fully grasping all the potential impacts that this can – and does – have on our foods.

Farm to Table Challenges:

Many animals we eat have natural bacteria in their intestines that find their way to our kitchens.
Bacteria also exist in farm soils and water. Soil and water touch our food.
There are different viruses, bacteria, and parasites that cause food poisoning. Most of the time the infection is spread (in farm or slaughterhouse) among animals and poultry via feces from another infected animal. That infected meat or poultry is then packaged and sold to consumers.
Sometimes improper hygiene might be used by laborers on agricultural properties, resulting in contaminated water, as well as contaminated fruits and vegetables.
Imported foods may not have the health and safety rigor of foods produced in the US.

Raw Foods Pose a Unique Risk:

Raw Milk. The popularity of farmer’s market and organic shopping has created an attitude that foods coming from those venues are immune to pathogens. This is incorrect; “organic” does not mean pathogens can’t be in a particular food item. There is no such thing as “healthier or happier” animals resulting in pathogen-free foods. Healthy animals contain pathogens. Of particular concern is the demand for non-pasteurized milks, yogurts, and cheeses. These foods have been implicated as high risk for food poisoning by campylobacter, E.coli and Salmonella.
Sprouting has become very popular due to the healthy nutrients in the raw sprouts and ease in growing them, but the same environment that grows sprouts (warm, moist and contained environments) easily grows bacteria such as listeria. The general public may not be aware of this risk.
Raw fruits and vegetables can have bacteria on them from animal manure, human sewage, etc. Many people routinely do not wash their fruits and vegetables; or people do not wash them because they erroneously think that if they are peeling them they do not need to be washed.
Processed foods that do not require cooking (deli meats, cheeses) can contain Listeria. The general public may not be aware of this risk.
High-risk shellfish such as oysters have been implicated as a high-risk raw food, especially for people having underlying liver disease. A pathogen known as vibrio can be found in such shellfish and causes food poisoning symptoms in otherwise healthy people, but can cause a serious infection in the bloodstream and septic shock in immunocompromised people. These more serious infections are fatal about 50% of the time. Vibrio rates have increased 32% in the past few years. Contaminated sea water has been implicated.

Poor Food Preparation and Cross Contamination:

If not fully cooked, infected meat or poultry will spread the infection to those eating or touching the food. A food thermometer is the only reliable way to measure this.
Even if you do not eat or touch the food you may still be affected by cross-contamination; if the juice from the poultry spills on the counter, or the knife you use is then used for cutting vegetables, etc. Cutting boards are a major source of cross-contamination.
Inadequate refrigeration of meats, poultry and left-overs. This includes both leaving foods out of the refrigerator too long as well as the refrigerator not being cold enough.

Infected Food Workers

In the food services industry, workers may not wash their hands or may come to work ill, spreading infection. Restaurants should have hands-free sinks in restrooms and work areas, although some studies have shown this to be rare. Studies have shown more managers within the food services industry call in sick versus the low-level workers; perhaps illustrating that workers feel compelled to work to earn money rather than stay at home when ill.
Cross-contamination can occur in restaurant kitchens if proper guidelines are not followed.
In a study reported in the Journal of Food Protection in 2006, 3 contributing factors were identified in norovirus outbreaks:
- Handling of food by an infected worker (65%)
- Bare-handed food contact (35%)
- Having a certified kitchen manager (to enforce food handling rules) reduced infections
- Employ illness while at work had often not been observed or acted upon.

Homemade Foods

Improperly canned foods (canned at home) can cause botulism.
The use of raw eggs in cookie dough, homemade ice-cream and other foods can cause infection.

Pets

Pets can be infected from the same things that affect humans, such as eating infected meats, meat/poultry drippings, etc. People can in turn become infected by coming into contact with pet feces.
Reptiles have naturally occurring salmonella in their intestinal tract, and therefore in their feces. People – especially children – can be infected through handling pet turtles, lizards, etc.
Baby chicks – sometimes given as Easter gifts to children – can spread salmonella infections.

Risk Factors For Food Poisoning

A number of risk factors can affect whether or not a person is affected by food poisoning.

Age and Health: A person’s age and health will play a role in the impact of an infection. In general, people are more at risk if they are:

Infants and young children under 5: This group is at higher risk because their immune systems haven’t fully developed. Additionally, younger children are more apt to put their hands in their mouths after coming into contact with a pathogen. Bottle-fed infants can get salmonella if their milk is left out of refrigeration for too long.
Pregnant women: Changes in a woman’s body during pregnancy, including metabolism, immunity and circulation, may increase the risk of food poisoning. According to the CDC, pregnant women are 10 times more likely than the general population to get listeria.
Unborn embryos and fetuses: Bacteria can cross the placenta and infect the unborn fetus. Early in pregnancy, a listeria infection could lead to miscarriage. Later on in pregnancy, the infection could lead to stillbirth or premature birth.
Older adults: Adults over the age of 65 may have lower levels of stomach acid, or may be erroneously taking stomach acid reducing medications themselves; and can be at increased risk, as a less acidic environment allows the penetration of more harmful bacteria. As well, some may have weakened immune systems, which can increase risk of food poisoning. Certain strains of bacteria can cause more serious complications in older adults and those with weakened immune systems. One example is with E.coli, where hemolytic uremic syndrome can occur in escalated infections. This syndrome damages the lining of the tiny blood vessels in the kidneys, sometimes leading to kidney failure. This is also the most common cause of acute kidney failure in children.
People with chronic diseases: typically have lower immune response; many also have underlying medical conditions and/or may take medications meant to lower the actions of the immune system. For example, according to the FDA, people with weakened immune systems are 40 times more likely to get infected with Campylobacter.

Lifestyle:

Some infections have ethnic or cultural risk factors. Hispanic pregnant women are 24 times more likely than the general population to get listeria. This is likely due to this ethnic group’s higher consumption of Mexican-style soft cheese, such as queso fresco, where the bacteria are found.
International travelers: Many bacteria causing food poisonings can be found during International travel. Higher risk countries are most of Asia (except Japan), Africa, Mexico, the Middle East, and Central and South America. E.coli, Campylobacter and Salmonella are the most frequently reported infections for US travelers abroad.
People who consume raw foods
People who frequently eat out or take out: People who frequently eat out have less control over food preparation precautions. Issues can be mitigated by ordering well cooked foods and checking posted health department inspection scores for a given restaurant.

Diagnosing Food Poisoning

Symptoms of Food Poisoning

Prognosis

Screening

Prevention

Food poisoning is a preventable public health issue. However, some of the prevention is out of a consumer’s control, involving the farm, production plants, and many other points from the farm to the table. In restaurants, consumers have little insight into food preparation and employee food safety adherence.

Many government groups in public health have responsibilities relating to making the food supply less contaminated. Individuals can reduce their risk of infection by doing the following:

Practice Good Hygiene

Wash your hands frequently, especially after using the bathroom and before handling food. Wash hands for 20 seconds using soap and be sure to clean under the fingernails.
Wash your hands after diapering a child, after cleaning up pet feces, etc.
Wash your hands after touching a reptile or chick, or after touching anything they’ve come into contact with.
Do not prepare food if you’ve been sick.
Do not prepare food if you’ve been sick.

Avoid Cross-Contamination

Clean utensils, cutting boards and surfaces often. Use warm soapy water for utensils and sanitize with a bleach solution on cutting boards and surfaces. Use separate cutting boards for different types of foods.
Don’t cross-contaminate different types of uncooked foods such as meat, poultry, eggs, fruits and vegetables
- Separate uncooked food products at the grocery store
- Separate uncooked food products in your refrigerator
- Use separate cutting boards, storage, plates, etc.

Cook to a Healthy Temperature

Use a food thermometer. You can’t visually determine if a food is cooked to a safe enough temperature that will ensure all harmful organisms are killed.
Cook ground beef to 160 F (71.1 C); whole meats such as steaks; lamb, pork and veal, to at least 145 F (62.8 C). Cook chicken and turkey to 165 F (73.9 C). Make sure fish and shellfish are cooked thoroughly. Ensure eggs are cooked until yoke is firm.
Stuffing poultry is not recommended.
Maintain a temperature of 140 F while serving foods after cooking. Use a slow cooker or warming tray to do this while serving a meal. Promptly refrigerate leftovers.
Slow-cookers can be safety used; however, be sure to thaw meats prior to adding them to a slow-cooker so that the meat’s cooking temperature can get higher more quickly.
BBQ’ing is safe, but good following good heating guidelines and proper refrigeration is important. Marinate meats in a refrigerator or cooler. Keep meats cold until ready to BBQ. Heat appropriately (bring a thermometer) and keep at 140 F while serving. Ice immediately thereafter.
Thaw foods in the refrigerator. If you use the microwave to thaw foods be sure to cook foods immediately thereafter.

Refrigerate Appropriately

Bacteria can grow on perishable foods within two hours unless you refrigerate them. If you are outside and the temperature is 90 F or higher, illness-causing bacteria can grow in only one hour.
Your fridge temperature needs to be between 40 F and 32 F. Use a thermometer. When you put hot foods inside, especially large quantities of hot food, you should divide leftovers into several smaller, shallow containers so they will chill more quickly.
Don’t over-pack your fridge, as in order for it to chill food – which slows bacteria growth – cold air needs to be able to circulate throughout your fridge.
Store left-overs quickly.

Use Caution When Consuming Raw Foods

Do not consume non-pasteurized, raw milk products (milk, yogurt, cheeses).
Do not consume non-pasteurized fruit juices.
Thoroughly wash raw fruits and vegetables and ensure no cross-contamination with other types of food during food preparation. Clean fruit and veggies, even if you are peeling them. You can contaminate the inside when you touch bacteria on the outside.
Cook/steam high risk shell-fish such as oysters (especially if you are in a high risk category of the population).
Recognize that “organic” labeling does not mean “infection-free” when it comes to food, whether that be meat, poultry, seafood, eggs, fruits or vegetables.

When Eating at Restaurants or at School

If food is not cooked adequately (poultry is pink or the juice isn’t clear) send it back.
Observe the restaurant’s most recent health department inspection scores.
If you’ve eaten at a deli or restaurant and become ill from food poisoning, report it to your local health department so they can track incidents at that location.
When packing children’s lunches for school, make sure to keep cold things cold (with an ice pack), hot things hot (with an appropriate thermal container), and have your child wash their hands prior to eating or provide wipes.

International Travel, Outdoors

Do not drink untreated surface water while outdoors.
If you suspect your drinking water might be contaminated, boil the water for 1 minute (3 minutes at elevations above 6,500 feet). Cool it and refrigerate it.
Water filters will not remove noroviruses and many other pathogens.
Take precautions when consuming foods and beverages in developing countries, including water, while traveling. Even if locals are drinking the water, the pathogens will be unfamiliar to your system and will cause a reaction. Avoid water, ice, raw fruits and vegetables (including salads), and “over-handled” foods. Stick to foods that have to be heated and served hot.

Miscellaneous Notes on Canning and Honey

Use caution when canning fruits and vegetables, as well as fermented fish (such as sardines) at home as botulism has been linked to home-canned foods with a low acid content.
Do not feed honey to children under the age of one as it may result in infant botulism.

When Someone in Your Home Is Infected

Disinfect all contaminated surfaces after any vomiting or diarrhea.
Remove and wash soiled clothing or anything vomit or diarrhea has come into contact with. Use hot water and soap.
Flush stool and/or vomit in the toilet and clean all surfaces.
Do not let anyone who has been sick prepare food.
Even after a person appears to be better they may still be carrying bacteria in their stools.

The CDC maintains excellent information on food poisoning and the USDA has an interactive page where you can ask a variety of questions relating to foodborne illness, safe food handling and storage, and safe preparation of meat, poultry and egg products. An example is, “How long can I keep ham in the refrigerator?”

Medication And Treatment

For most cases of food poisoning, no prescription medication is required. However, besides resting, the health issue that may need to be dealt with is dehydration (due to excessive diarrhea and vomiting). Fluids and electrolytes, minerals such as potassium, sodium and calcium, are lost when someone has persistent diarrhea or vomiting.

Rehydration:

Drink a lot of water, decaffeinated fluids or a rehydration drink such as Pedialyte. Drink a cup of water, fluid (sports drink, broth), or rehydration drink each time you have a large, loose stool, if possible.
Fruit juices and soda should not be used as they contain too much sugar and not enough electrolytes.
Sucking on ice chips can help.
You’ll know that you are getting adequate fluids when you’re urinating again normally and when your urine is clear.
Children and adults with persistent diarrhea or vomiting may become severely dehydrated and may need to be given salts and fluids through an IV (intravenously). This may require hospitalization.

Anti-Diarrhea Medications:

Adults who do not have a fever and who have diarrhea that isn’t bloody may get relief from taking bismuth subsalicylate (Pepto-Bismol) or the medication loperamide (Imodium A-D).
Those with a fever or bloody diarrhea should not use anti-diarrhea medications as they can slow digestion processes causing the absorption of greater amounts of bacteria.

Diet:

Ease back into eating gradually. Eat low-fat, easy-to-digest foods such as toast, bananas and rice.
Avoid dairy, nicotine, caffeine, alcohol, sugar, spicy and fatty foods until you are feeling better.

Antibiotics:

Depending on the source of your infection, your doctor may prescribe antibiotics (such as ciprofloxacin) if your symptoms are severe or you are within a high-risk population.
Norovirus cannot be treated with antibiotics as it is a viral infection, not a bacterial infection.
Salmonella infections can become invasive in 8% of cases, where the infection may spread from the intestines into the blood stream. Antibiotics will be prescribed in such cases. The challenge doctors have now is one of antibiotic resistance. So many antibiotics are used in our food animals that infections can become resistant to antibiotics that are typically prescribed.
Food poisoning caused by listeria will often need to be treated with intravenous antibiotics during hospitalization due to the possibility of sepsis occurring. Listeria typically infects those in high risk populations. During pregnancy, prompt antibiotic treatment may help keep the infection from crossing the placenta to the unborn fetus.

Anti-toxins:

In botulism the bacteria produces a neurotoxin that can make someone extremely ill. This requires a botulism anti-toxin to be administered.

Blood transfusions:

Some people may need blood transfusions, platelet transfusions, plasma exchange or kidney

Complementary and Alternative Treatment

A stronger, healthier digestive system and a healthy immune response may help maintain intestinal health should you be exposed to a foodborne pathogen. This is really more of a preventative strategy. Eating healthy, whole foods; nutrient-dense vegetables; healthy proteins; complex carbohydrates and healthy fats, will provide the vitamins and minerals your body needs to maintain a healthier immune response. Exercising, getting a good night’s sleep on a regular basis; and practicing the preventative tips provided in this Condition Center will all help.

Probiotics, such as Lactobacillus acidophilus and Lactobacillus bulgaricus, can help restore and support the naturally occurring beneficial bacteria in the intestine. There is no evidence that probiotics used prior to exposure to a pathogen prevents a person from being infected. There is no evidence a probiotic cures food poisoning by killing off the infection. A probiotic can be helpful, however, in getting the digestive system back in balance with good bacteria after a person takes antibiotics for a food poisoning infection.

Herbs: There are no proven alternative solutions – such as herbs – to prevent or treat food poisoning. According to the National Center for Complementary and Integrative Health (NCCIH), there are many herbs that have been used in traditional Chinese medicine to strengthen immune function and/or provide relief from intestinal stress, but clinical evidence is still lacking. And no testing has been done relating to food poisoning cures.

Here is a list of herbs that need further examination as to any role they might play in either preventing or treating food poisoning. They have not been proven to be effective in clinical trials.

Ginger root (Zingiber officinale) – may have a role in addressing nausea and gastric distress.
Licorice (Glycyrrhiza glabra)-may have a role in addressing viral infections.
Asian ginseng (Panax ginseng)-may have a role in boosting the immune system.
Astragalus root (Astragalus membranaceus) – may have a role in boosting the immune system.
Chinese cinnamon bark (Cinnamomum aromaticum) – may have a role in relieving gastrointestinal distress.
Milk thistle (Silybum marianum) – may have a role in protecting the liver.
Goldenseal (Hydrastis Canadensis) – may have antibacterial properties. Clinical studies on the compound, berberine, found in goldenseal, showed that the compound may be beneficial for certain infections, such as those that cause some types of diarrhea. More research is necessary to understand what role goldenseal might play relating to food poisoning infections. NCCIH is funding research on goldenseal, including studies of its potential antibacterial mechanisms.
Chamomile (Matricaria recutita) – may have a role in addressing gastrointestinal issues including diarrhea. The NCCIH states that in combination with other herbs, chamomile may be of some benefit for upset stomach and for diarrhea in children.

When To Contact A Doctor

Questions For Your Doctor

Questions For A Doctor

Pre-Diagnosis for food poisoning:

Am I considered in a high risk population relating to food poisoning? How can I reduce my risk?
Are members of my family in a high risk population relating to food poisoning?
How is food poisoning different from other digestive orders that I might have?
I am traveling to a particular country, what should I be worried about relating to food poisoning while there? What preventative measures should I take?
I want to eat raw foods, including non-pasteurized milk products. Can you talk with me about why that is not healthy for me?
I am going on a cruise and worried about norovirus, what can I do to reduce my risk?
I love eating shellfish but heard it is high-risk for a pathogen called vibrio. I’ve had liver problems in the past, should I stop eating shellfish?
I heard eating soft cheese was dangerous, can you tell me more about that?
I love to can vegetables at home, what can I do to ensure I don’t introduce botulism into my canned foods?
I found a dented can at home, should I throw it away?
My child wants a frog for his birthday, but I’ve heard they can cause food poisoning, what should I do?
I eat out a lot, how can I be sure the restaurant is practicing good food handling hygiene?

Post-Diagnosis:

Are there other possible causes for my symptoms?
How long can I expect to be sick? What precautions should I take around my family? Should I continue to go to work or school?
Am I contagious?
Are there definitive tests that can be done so I know I have food poisoning?
Should I report this to the local public health department?
I keep hearing about antibiotic resistance. Should I take an antibiotic just to be sure?
If I am treated with an antibiotic, should I take a probiotic to get my gastrointestinal tract flora (bacteria) balanced again?
Are there alternative therapies (herbs, supplements) that I can take to help me recover from food poisoning?
When should I call you if I don’t feel better? What other issues might I expect?
Am I now immune to this infection?
What can I do so this doesn’t happen again?

Food Poisoning

What Is Food Poisoning

What Causes Food Poisoning

Risk Factors For Food Poisoning

Diagnosing Food Poisoning

Symptoms of Food Poisoning

Prognosis

Screening

Prevention

Medication And Treatment

Complementary and Alternative Treatment

When To Contact A Doctor

Questions For Your Doctor

Questions For A Doctor

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