All of us have eaten something and within a few hours have symptoms that may include nausea, vomiting, diarrhea, and/or abdominal pain. The knee-jerk reaction is to assume that you are suffering from food poisoning, also known as foodborne illness. It is with this background that I will discuss the basics of food poisoning.
Microbial foodborne illness occurs commonly throughout the world, including in the United States. Fortunately, most people recover from an episode of foodborne illness without any need to consult with a health care provider and without any long-term complications.
The symptoms of foodborne illness depend upon which microbe gets into your system. Symptoms can appear hours after you eat the contaminated food, or may not appear until days or weeks later. The most common symptoms include:
Nausea
Vomiting
Abdominal pain
Diarrhea, which may be watery or bloody
Fever
Less commonly, neurologic symptoms develop, such as blurry vision, dizziness, or tingling in the arms. In some instances, the most life-threatening problems occur several days after the start of intestinal symptoms, and these can include kidney failure, meningitis, arthritis, and paralysis, depending on which foodborne microbe you have been exposed to.
There are many ways that food can lead to illness. It can be caused by eating food that is contaminated by a microorganism: a bacterium, virus, or parasite. Updated information on outbreaks may be found on the website FDA: Outbreaks of Foodborne Illness. For suspected foodborne illness, the timing of symptom onset following exposure to the suspect food can be informative. Ingested preformed toxins (those produced by Staphylococcus aureus and Bacillus cereus) cause illness within hours of exposure, whereas ingested pathogens that subsequently produce toxin (enterotoxigenic Escherichia coli) or directly damage or invade across the intestinal epithelial cell wall (Salmonella, Campylobacter, Shigella) usually result in symptoms after approximately 24 hours or longer.
Salmonella — Samonella is the leading bacterial cause of foodborne illness in the United States with an estimated one million cases of salmonellosis each year. There are many types of Salmonella, including those that cause typhoid fever and those that cause gastroenteritis. In the United States, the type that causes gastroenteritis is much more common. Salmonella is very common in the intestines of animals and reptiles and may exist in the environment. When food is contaminated from the environment or from contact with animals, it can make humans sick when they subsequently consume that food. Contamination of food can occur on a farm, during food processing, or as a result of cross-contamination (transfer from raw meat to salad) in the home, at a restaurant, or at some other point in the supply chain. Thus, most cases of Salmonella foodborne illness are due to either cross-contamination or undercooking of raw meat or poultry products or contamination of fresh produce. However, there have also been large outbreaks of Salmonella from other foods, such as peanut butter.
Escherichia coli — Certain Escherichia coli (E.coli) bacteria can cause foodborne illness, particularly an illness known as "traveler's diarrhea." Infection with E.coli can occur when food or water becomes contaminated with infected feces. Some types of E.coli infection can be very serious, resulting in kidney failure or worse.
Norovirus — Norovirus infection is the most common foodborne illness and is often acquired when infected food handlers contaminate the food they are preparing (eg, in restaurants). Norovirus is very infectious and easily passed from person to person or by touching contaminated surfaces. Symptoms usually start 24 to 48 hours after exposure with nausea, vomiting, diarrhea, and abdominal pain. Most cases resolve without medical treatment.
Hepatitis A virus — Hepatitis A virus is transmitted in foods contaminated by an infected human, such as a food handler, or from raw shellfish. Hepatitis A causes jaundice (yellowing of the skin or whites of the eyes) and occasionally liver failure. Symptoms do not usually appear until 15 to 50 days after infection, which can make it difficult to determine the source of infection. In nonimmune individuals, post-exposure vaccination or administration of passive immune globulin can help prevent infection. In the United States, a vaccine for hepatitis A is recommended for all children.
Listeria monocytogenes — Listeria is a bacterium that has traditionally been found in unpasteurized or contaminated milk, soft cheese, and other dairy products or in contaminated processed/deli meats, hot dogs, and smoked seafood. More recently, Listeria monocytogenes has been found in a variety of other ready-to-eat foods such as hummus, sunflower seeds, and frozen vegetables. Listeria infection may cause gastrointestinal symptoms. A much more serious infection, known as listeriosis, may occur one to three weeks later if the bacteria invade the bloodstream. Listeriosis can occur without any of the gastrointestinal symptoms. Listeriosis is usually seen in pregnant women or older adults and the immunocompromised.
Foodborne illness is usually diagnosed based on a person's symptoms and history of what they have eaten in the prior week. However, it is not always possible or necessary to determine the particular food or microorganism that caused the illness, especially if the illness is mild and begins to improve within a few days.
If your symptoms are persistent or severe, if you have an underlying medical condition, or if there are worrisome signs or symptoms (temperature greater than 100.4°F/38°C, severe abdominal pain, inability to eat or drink, bloody stool, or vomit), you should see a health care provider for evaluation and treatment. Young children and older adults with these symptoms should also be evaluated quickly. Children and older people can lose fluid rapidly from vomiting or having diarrhea, which can quickly lead to dehydration.
If needed, a sample of stool or blood can be sent to a laboratory to determine which microorganism is responsible for the symptoms. The need for this type of testing depends upon the person's symptoms and history.
In most cases of foodborne illness, treatment is primarily supportive. Supportive treatment includes drinking adequate fluids, eating small, low-fat meals, and resting as needed. Oral rehydration solutions are particularly useful for providing adequate hydration and include electrolytes that can be lost from copious vomiting or diarrhea. Antibiotics are not usually needed or recommended but may be used for some types of foodborne illness. In most cases, symptoms resolve quickly and no special treatment is necessary. In people with persistent diarrhea and/or vomiting, intravenous fluids may be needed to prevent dehydration. Antidiarrheal medications, such as Imodium, can be useful for the symptomatic treatment of watery diarrhea.
For further guidance and medical advocacy, please go to PaladinMDs because “it’s like having a doctor in the family.”
If Imodium is ineffective, what other drug can be used to control diarrhea in cases of food borne illnesses? I know that Tylenol 3 works but with the ever tightening restrictions on opioids it might be problematic to get prescribed. Or am I wrong?