Food poisoning
Last reviewed: January 10, 2011.
Food poisoning occurs when you swallow food or water that contains bacteria, parasites, viruses, or toxins made by these germs. Most cases of food poisoning are from common bacteria such as Staphylococcus or E. coli.
Causes, incidence, and risk factors
Food poisoning can affect one person or a group of people who all ate the same contaminated food. It more commonly occurs after eating at picnics, school cafeterias, large social functions, or restaurants.
The germs may get into the food you eat (called contamination) in different ways:
· Meat or poultry can come into contact with bacteria from the intestines of an animal that is being processed
· Water that is used during growing or shipping can contain animal or human waste
· Food handling or preparation in grocery stores, restaurants, or homes
Food poisoning often occurs from eating or drinking:
· Any food prepared by someone who does not wash their hands properly
· Any food prepared using cooking utensils, cutting boards, and other tools that are not fully cleaned
· Dairy products or food containing mayonnaise (such as coleslaw or potato salad) that have been out of the refrigerator too long
· Frozen or refrigerated foods that are not stored at the proper temperature or are not reheated properly
· Raw fish or oysters
· Raw fruits or vegetables that have not been washed well
· Raw vegetables or fruit juices and dairy products (look for the word “pasteurized,” which means the food has been treated to prevent contamination)
· Undercooked meats or eggs
· Water from a well or stream, or city or town water that has not been treated
Many types of germs may cause food poisoning, including:
· Campylobacter enteritis
· Cholera
· Staphylococcus aureus
· Shigella
Infants and elderly people are at the greatest risk for food poisoning. You are also at higher risk if:
· You have a serious medical condition, such as kidney disease or diabetes
· You have a weakened immune system
· You travel outside of the United States to areas where you are exposed to germs that cause food poisoning
Pregnant and breastfeeding women have to be especially careful to avoid food poisoning.
Symptoms
Symptoms from the most common types of food poisoning usually start within 2 – 6 hours of eating the food. That time may be longer or shorter, depending on the cause of the food poisoning.
Possible symptoms include:
· Diarrhea (may be bloody)
· Fever and chills
· Headache
· Weakness (may be serious)
Signs and tests
Your health care provider will examine you for signs of food poisoning, such as pain in the stomach and signs your body does not have as much water and fluids as it should. This is called dehydration.
Tests may be done on your stools or the food you have eaten to find out what type of germ is causing your symptoms. However, tests may not always find the cause of the diarrhea.
In more serious cases, your health care provider may order a sigmoidoscopy. A thin, hollow tube with a light on the end is placed in the anus to look for the source of bleeding or infection.
Treatment
You will usually get better in a couple of days. The goal is to make you feel better and make sure your body has the proper amount of fluids.
Getting enough fluids and learning what to eat will help keep you or your child comfortable. You may need to:
· Manage the diarrhea
· Control nausea and vomiting
· Get plenty of rest
If you have diarrhea and are unable to drink or keep down fluids, you may need fluids given through a vein (by IV). This is especially true for young children.
If you take diuretics, ask your health care provider if you need to stop taking the diuretic while you have diarrhea. Never stop or change medications without first talking to your health care provider.
For the most common causes of food poisoning, your doctor will NOT prescribe antibiotics.
You can buy medicines at the drugstore that help slow diarrhea.
· Do not use these medicines without talking to your health care provider if you have bloody diarrhea, a fever, or the diarrhea is severe.
· Do not give these medicines to children.
Expectations (prognosis)
Most people fully recover from the most common types of food poisoning within 12 – 48 hours. Serious complications can occur, however, from certain types of food poisoning.
Death from food poisoning in people who are otherwise healthy is rare in the United States.
Complications
Dehydration is the most common complication. This can occur from any causes of food poisoning.
Less common, but much more serious complications depend on the bacteria that are causing the food poisoning. These may include:
· Arthritis
· Bleeding problems
· Damage to the nervous system
· Kidney problems
· Swelling or irritation in the tissue around the heart
Calling your health care provider
Call for an appointment with your health care provider if you have:
· Blood or pus in your stools
· Diarrhea and are unable to drink fluids due to nausea or vomiting
· A fever above 101°F, or your child has a fever above 100.4°F along with diarrhea
· Signs of dehydration (thirst, dizziness, light-headedness)
· Recently traveled to a foreign country and developed diarrhea
· Diarrhea that has not gotten better in 5 days (2 days for an infant or child), or has gotten worse
· A child who has been vomiting for more than 12 hours (in a newborn under 3 months you should call as soon as vomiting or diarrhea begins)
· Food posoning from mushrooms, fish, or botulism
Prevention
See: Preventing food poisoning
References
1. Schiller LR, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 15.
2. Sodha SV, Griffin PM, Hughes JM. Foodborne disease. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 99.
3. Craig SA, Zich DK. Gastroenteritis. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 92.
ood Poisoning
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Food poisoning is a common, yet distressing and sometimes life-threatening problem for millions of people in the U.S., and throughout the world. People infected with foodborne organisms may be symptom-free or may have symptoms ranging from mild intestinal discomfort to severe dehydration and bloody diarrhea. Depending on the type of infection, people can even die as a result of food poisoning.
More than 250 different diseases can cause food poisoning. Some of the most common diseases are infections caused by bacteria, such as Campylobacter, Salmonella, Shigella, E. coli O157:H7, Listeria, and botulism.
Salmonella: Protect Yourself Against This Culprit
What Is Campylobacter Infection?
Campylobacter is a bacterium that causes acute diarrhea. Transmission usually occurs through ingestion of contaminated food, water, or unpasteurized milk, or through contact with infected infants, pets, or wild animals.
Symptoms of campylobacter include:
· Diarrhea (sometimes bloody)
· Nausea and vomiting
· Abdominal pain and/or cramping
· Malaise (general uneasiness)
· Fever
Is Campylobacter Infection a Serious Health Concern?
Campylobacter infection can be serious, especially in those with weakened immune systems. In rare cases, campylobacter infection can cause additional problems such as arthritis or brain and nerve problems. Occasionally, these problems occur after the diarrhea has stopped.
How Is Campylobacter Infection Diagnosed and Treated?
If you think you may have been exposed to campylobacter infection, see your doctor. By testing a sample of stool, the bacteria can be identified.
If you are found to have the infection, you will likely recover on your own without treatment within two to five days. Drink plenty of fluids to prevent becoming dehydrated.
In more severe cases, antibiotics (such as Cipro), if given early in the illness, can be used to shorten the length of time you are sick.
What Is Salmonella?
Salmonella is a bacterial infection that can be passed on to humans from domestic and wild animals, including poultry, pigs, cattle, and pets. But most often, it is caused by drinking unpasteurized milk or by eating undercooked poultry and poultry products such as eggs. Any food prepared on surfaces contaminated by raw chicken or turkey can also become tainted with salmonella. Less often, the illness may stem from food contaminated by a food worker.
Salmonella can escape from the intestine and go into the blood and travel to other organs. It may become a chronic infection in some people, who can be symptom-free yet capable of spreading the disease to others.
Salmonella infections occur worldwide, but it is most extensively reported in North America and Europe.
Symptoms of salmonella include acute onset of:
· Fever
· Abdominal pain
· Diarrhea
· Nausea
· Vomiting (sometimes)
These symptoms, along with loss of appetite, can persist for several days.
Can Salmonella Infection Cause Serious Health Problems?
Although most people recover completely (which sometimes can take several months), salmonella infection may cause a condition known as Reiter’s syndrome in a small percentage of people. Symptoms of Reiter’s syndrome include joint pain, eye irritation, and pain when urinating. The joint pain of Reiter’s syndrome may develop into chronic arthritis.
Salmonella infection rarely causes death, although it can occur in the very young, very old, or among those who have compromised immune systems.
How Is Salmonella Infection Diagnosed and Treated?
If you think you may have been exposed to the salmonella infection, see your doctor. By testing a sample of stool, the bacteria can be identified.
Salmonella infections usually go away in five to seven days and often do not require treatment unless you become severely dehydrated or the infection spreads outside of the intestines. If treatment is needed, antibiotics are prescribed.
How Can I Avoid Salmonella?
To prevent salmonella infection, avoid eating raw or undercooked meat or poultry products, including eggs. It is also important to avoid “cross-contamination” which can occur if food is being prepared using the same utensils, or on the same surfaces, as those used for raw or undercooked meats or poultry products.
Wash hands frequently during and after food preparation. Those with a salmonella infection should not be involved in food preparation.
Wash hands with soap after handling reptiles, birds, or after contact with pet feces. Avoid contact between reptiles (turtles, iguanas, other lizards, and snakes) and infants or people with weakened immune systems.
What Is Shigella?
Shigella is a bacteria generally transmitted through feces. It causes dysentery, an infection of the intestines causing severe diarrhea. The disease generally occurs in tropical or temperate climates, especially under conditions of crowding, where personal hygiene is poor.
Symptoms of shigella include:
· Bloody diarrhea
· Fever
· Nausea
· Vomiting
· Cramps
How Is Shigella Diagnosed and Treated?
If you think you may have been exposed to shigella, see your doctor. By testing a sample of stool, the bacteria can be identified.
People with mild infections usually recover within a few days without special treatment. Drinking fluids to prevent dehydration is usually all that is needed. However, with severe infections, antibiotics and more aggressive treatment to prevent dehydration are ofteeeded.
How Can Shigella Infection Be Avoided?
The shigella bacteria from stools of infected people can be passed to others if hygiene or hand-washing habits are inadequate. To help prevent transmitting the infection, always wash hands thoroughly after using the bathroom or changing diapers.
What Is E. Coli O157:H7?
E. coli O157:H7 is a growing cause of foodborne illness. An estimated 73,000 cases of these E. coli infections occur in the U.S. every year, according to the CDC.
Most E. coli O157:H7 infections have been associated with eating undercooked, contaminated ground beef. Drinking unpasteurized milk and swimming in or drinking sewage-contaminated water can also cause infection. Bacteria from stools of infected people can be passed to others if less than adequate hygiene or hand-washing habits are present. Young children often continue to shed the organism in their feces for a week or two after their illness resolves.
Symptoms of E.coli infection can include severe bloody diarrhea and abdominal cramps, but sometimes the infection causes non-bloody diarrhea, a slight fever, or no symptoms at all.
Can E. Coli O157:H7 Infection Cause Serious Health Problems?
Yes. In some people, particularly children under the age of 5 and the elderly, the E. coli infection can cause a serious complication called hemolytic uremic syndrome. Hemolytic uremic syndrome causes the destruction of red blood cells and kidney failure. About 2%-7% of infections lead to this complication, according to the CDC.
How Is E. Coli O157:H7 Infection Diagnosed and Treated?
If you think you may have been exposed to the E. coli infection, see your doctor. By testing a sample of stool, the bacteria can be identified. It is recommended by the CDC that all those who have sudden, bloody diarrhea get their stool tested for this type of E. coli.
Most people recover on their own within about five to 10 days.
Hemolytic uremic syndrome is a medical emergency and most often will be treated in an intensive care unit.
How Is E. Coli O157:H7 Infection Prevented?
You can prevent E. coli infection by thoroughly cooking ground beef, avoiding unpasteurized milk, and washing hands carefully after handling meat, using the bathroom, or changing diapers.
What Is Listeria Infection?
Listeria is a bacteria primarily found in soil and water. According to the CDC, vegetables can become contaminated from soil or from manure used as fertilizer. Animals carrying the bacterium can also contaminate food. Listeria has been found in many types of uncooked foods, such as meats and vegetables, as well as in processed foods that become contaminated after processing, such as soft cheeses (like feta and crumbled blue cheese) and cold cuts.
Unpasteurized milk or foods made from unpasteurized milk may also be sources of listeria infection. Listeria is killed by pasteurization, and heating procedures used to prepare ready-to-eat processed meats should be sufficient to kill the bacterium. However, unless good manufacturing practices are followed, contamination can occur even after processing.
According to the CDC, an estimated 2,500 people in the U.S. become seriously ill from a listeria infection each year, and of these, 500 will die. The CDC reports that those at increased risk for developing listeriosis include:
· Pregnant women.
· People with weakened immune systems.
· People with cancer, diabetes, or kidney disease.
· People with AIDS.
· People, such as those with asthma, who take steroid medications.
· The elderly.
Symptoms of a listeria infection can include:
· Fever
· Muscle aches
· Nausea
· Diarrhea
If listeria infection spreads to the nervous system (brain and spinal cord), the following symptoms can occur:
· Headache
· Stiff neck
· Confusion
· Loss of balance
· Convulsions
Infected pregnant women may experience only a mild, flu-like illness; however, infection during pregnancy can lead to premature delivery, infection of the newborn, or even stillbirth. There is no routine screening test to find out if you are likely to contract listeria infection during pregnancy. If you have symptoms of listeriosis, consult your doctor immediately.
How Is Listeria Infection Diagnosed and Treated?
Listeria infection is often diagnosed by a medical history and confirmed by blood or spinal fluid tests.
Antibiotic treatment will usually cure the infection, and when given promptly to an infected pregnant woman, may prevent infection of her fetus.
Even with prompt treatment, some infections result in death. In the elderly and people with other serious medical problems, these infections are more likely to be fatal.
What Is Botulism?
The bacterium Clostridium botulinum is responsible for causing the rare but serious illness botulism.
According to the CDC, the three main types of botulism are foodborne, wound, and infant botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism, which is very rare, is caused by a toxin produced from a wound infected with C. botulinum. Infant botulism is caused by consuming the spores of botulinum bacteria, which grow in a child’s intestines.
All forms of botulism can be deadly and are considered medical emergencies.
Symptoms of botulism include:
· Blurred vision
· Double vision
· Droopy eyelids
· Slowed or slurred speech
· Difficulty swallowing
· Dry mouth
· Muscle weakness
In infants with botulism the symptoms include:
· Poor feeding habits
· Constipation
· Weak crying
· Lethargy
· Poor muscle tone
If these symptoms are untreated, they may lead to paralysis of the arms, legs, trunk, and respiratory muscles. Symptoms of foodborne botulism usually develop 18 to 36 hours after consuming contaminated food, but symptoms can occur as early as six hours or as late as a week to 10 days.
How Is Botulism Diagnosed and Treated?
A diagnosis of botulism is made by the presence of appropriate symptoms of nerve weakness and by lab tests that detect the toxin or by culture of C. botulinum from the person’s stool.
The respiratory failure (inability to breathe) and paralysis that occur with severe botulism may require intensive medical and nursing care in a hospital.
If diagnosed in its early stages, foodborne botulism can be treated with an antitoxin medication.
Your doctor may also try to remove any contaminated food left in the digestive system by inducing vomiting or by using enemas.
Infants infected with the bacteria require hospitalization and possibly care in an intensive care unit. The botulism antitoxin is not recommended for infants.
How Can Botulism Be Prevented?
Although there are very few cases of botulism poisoning each year, prevention is extremely important. According to the CDC, foodborne botulism has often been linked to home-canned foods with a low acid content. These foods include asparagus, green beans, beets, and corn. People have also become infected from other sources including chopped garlic in oil, chili peppers, tomatoes, improperly handled baked potatoes cooked in aluminum foil, and home-canned or fermented fish (such as sardines).
Persons who can their own food should follow strict canning procedures to reduce contamination of foods.
Honey should not be given to children younger than 12 months of age, as it can contain spores of C. botulinum and is known to cause infant botulism.
Food Poisoning Overview
Food poisoning is a common, usually mild, but sometimes deadly illness. Typical symptoms include nausea, vomiting, abdominal cramping, and diarrhea that occur suddenly (within 48 hours) after consuming a contaminated food or drink. Depending on the contaminant, fever and chills, bloody stools, dehydration, and nervous system damage may follow. These symptoms may affect one person or a group of people who ate the same thing (called an outbreak).
· The Centers for Disease Control and Prevention (CDC) estimates that in the United States, 1 in 6 people becomes sick from eating contaminated food. In 2001, the CDC estimated that food poisoning causes about 48 million illnesses, 128,000 hospitalizations, and up to 3,000 deaths each year.
· Norovirus and salmonella are the most common infectious forms of food-borne illness. Salmonella causes the most deaths followed by Toxoplasma and Listeria.
· Worldwide, diarrheal illnesses are among the leading causes of death. Travelers to developing countries often encounter food poisoning in the form oftraveler’s diarrhea or “Montezuma’s revenge.” Additionally, there are possible new global threats to the world’s food supply through terrorist actions using food toxins as weapons.
· Increased virulence of known pathogens has caused deadly outbreaks such as the E. Coli STEC outbreak in Germany in 2011.
Food Poisoning Causes
More than 250 known diseases can be transmitted through food. The CDC estimates unknown or undiscovered agents cause 68% of all food-borne illnesses and related hospitalizations. Many cases of food poisoning are not reported because people suffer mild symptoms and recover quickly. Also, doctors do not test for a cause in every suspected case because it does not change the treatment or the outcome.
The known causes of food poisoning can be divided into two categories: infectious agentsand toxic agents.
· Infectious agents include viruses, bacteria, and parasites.
· Toxic agents include poisonous mushrooms, improperly prepared exotic foods (such as barracuda – ciguatera toxin), or pesticides on fruits and vegetables.
Food usually becomes contaminated from poor sanitation or preparation. Food handlers who do not wash their hands after using the bathroom or have infections themselves often cause contamination. Improperly packaged food stored at the wrong temperature also promotes contamination.
Food Poisoning Symptoms
Symptoms of food poisoning depend on the type of contaminant and the amount eaten. The symptoms can develop rapidly, within 30 minutes, or slowly, worsening over days to weeks. Most of the common contaminants cause:
· nausea
· vomiting
· diarrhea
· abdominal cramping
· fever
Usually food poisoning is not serious, and the illness runs its course in 24-48 hours.
Viruses account for most food poisoning cases where a specific contaminant is found.
· Noroviruses are a group of viruses that cause a mild illness (often termed “stomach flu”) with nausea, vomiting, diarrhea, abdominal pain, headache, and low-grade fever. These symptoms usually resolve in two to three days. It is the most common viral cause of adult food poisoning and is transmitted from water, shellfish, and vegetables contaminated by feces, as well as from person to person. Outbreaks are more common in densely populated areas such as nursing homes, schools, and cruise ships (hence the viral infection is also known as the “Cruise Ship Illness”). The term Norovirus has been approved as the official name for this group of viruses. Several other names have been used for noroviruses, including Norwalk-like viruses, caliciviruses (because they belong to the virus family Caliciviridae), and small round structured viruses.
· Rotavirus: Causes moderate to severe illness with vomiting followed by watery diarrhea and fever. It is the most common cause of food poisoning in infants and children and is transmitted from person to person by fecal contamination of food and shared play areas.
· Hepatitis A: Causes moderate illness with sudden onset of fever, loss of appetite, abdominal pain, and feeling of tiredness followed by jaundice, which is a yellowing of the eyes and skin. Symptoms usually last less than two months, but can be prolonged or relapse for up to six months. It is transmitted from person to person by fecal contamination of food.
Bacteria can cause food poisoning in two different ways. Some bacteria infect the intestines, causing inflammation and difficulty absorbing nutrients and water, leading to diarrhea. Other bacteria produce chemicals in foods (known as toxins) that are poisonous to the human digestive system. When eaten, these chemicals can lead to nausea and vomiting, kidney failure, and even death.
· Salmonellae: Salmonellae are bacteria that may cause food poisoning; the illness itself is often referred to as Salmonella or Salmonella infection. TheCDC estimates that each year 1 million people are infected with Salmonella, amounting to $365 million in direct medical costs annually. Salmonellaecause a moderate illness with nausea, vomiting, crampy diarrhea, andheadache, which may come back a few weeks later as arthritis (joint pains). In people with impaired immune systems (such as people with kidney disease,HIV/AIDS, or those receiving chemotherapy for cancer), Salmonellae can cause a life-threatening illness. The illness is transmitted by undercooked foods such as eggs, poultry, dairy products, and seafood.
· Campylobacter: Causes mild illness with fever, watery diarrhea, headache, and muscle aches. Campylobacter is the most commonly identified food-borne bacterial infection encountered in the world. It is transmitted by raw poultry, raw milk, and water contaminated by animal feces.
· Staphylococcus aureus: Causes moderate to severe illness with rapid onset of nausea, severe vomiting, dizziness, and abdominal cramping. These bacteria produce a toxin in foods such as cream-filled cakes and pies, salads (most at risk are potato, macaroni, egg, and tuna salads, for example) and dairy products. Contaminated salads at picnics are common if the food is not chilled properly.
· Bacillus cereus: Causes mild illness with rapid onset of vomiting, with or without diarrhea and abdominal cramping. It is associated with rice (mainly fried rice) and other starchy foods such as pasta or potatoes. It has been speculated that this bacteria may also be used as a potential terrorist weapon.
· Escherichia coli (E coli): Causes moderate to severe illness that begins as large amounts of watery diarrhea, which then turns into bloody diarrhea. There are many different types of this bacteria. The worst strain can cause kidney failure and death (about 3% to 5% of all cases). It is transmitted by eating raw or undercooked hamburger, unpasteurized milk or juices, or contaminated well water. Outbreaks of food poisoning due to E. coli have also occurred following ingestion of contaminated produce.
· Shigella (traveler’s diarrhea): Causes moderate to severe illness with fever,diarrhea containing blood or mucus or both, and the constant urge to have bowel movements. It is transmitted in water polluted with human wastes.
· Listeria monocytogenes: Listeriosis is a moderate to severe illness with nausea and vomiting. Some affected individuals can progress to developmeningitis from Listeria. It is transmitted on many tips of uncooked foods such as meats, fruits, vegetables, soft cheeses, unpasteurized milk, and cold cut meats. Pregnant woman and newborns are at increased risk for serious infections. In 2011, in an outbreak caused by tainted cantaloupe, 25 people died and 123 people were infected in 26 states.
· Clostridium botulinum (botulism): Causes severe illness affecting the nervous system. Symptoms start as blurred vision. The person then develops problems talking and overall weakness. Symptoms then progress to breathing difficulty and the inability to move arms or legs. Infants and young children are particularly at risk. It is transmitted in foods such as home-packed canned goods, honey, sausages, and seafood.
Because botulism can be released in the air, it is considered a potential biological weapon for terrorists.
· Vibrio cholerae: Causes mild to moderate illness with crampy diarrhea, headache, nausea, vomiting, and fever with chills. It strikes mostly in the warmer months of the year and is transmitted by infected, undercooked, or raw seafood.
· Vibrio parahaemolyticus: Causes moderate to severe abdominal cramping, nausea, vomiting, and fever. In immunocompromised individuals, it can cause severe or deadly disease. It is transmitted by eating raw or undercooked fish, particularly oysters.
Parasites rarely cause food poisoning. When they do, they are usually swallowed in contaminated or untreated water and cause long-lasting but mild symptoms.
· Giardia (beaver fever): Causes mild illness with watery diarrhea often lasting one to two weeks. It is transmitted by drinking contaminated water, often from lakes or streams in cooler mountainous climates.
The infection can also be spread from person to person by food or other items contaminated with feces from an infected person.
· Cryptosporidium: Causes moderate illness with large amounts of watery diarrhea lasting two to four days. May become a long-lasting problem in people with poor immune systems (such as people with kidney disease or HIV/AIDS or those on chemotherapy for cancer). It is transmitted by contaminated drinking water.
· Toxoplasma: The CDC estimates that more than 60 million people in the U.S. carry the Toxoplasma parasite, but few have symptoms because the immune system keeps the parasite from causing illness. When it does cause disease, symptoms include headache, blurred vision, and eye pain. It is transmitted by eating undercooked or raw meat, contaminated water, or contact with contaminated cat feces. Pregnant women and those with compromised immune systems infected with Toxoplasma can have severe health complications.
Toxic agents are the least common cause of food poisoning. Illness is often an isolated episode caused by poor food preparation or selection (such as picking wild mushrooms).
· Mushroom toxins: Illness can range from mild to deadly depending on the type of mushroom eaten. Often there is nausea, vomiting, and diarrhea. Some types of mushrooms produce a nerve toxin, which causes sweating, shaking, hallucinations, and coma.
· Ciguatera poisoning: Caused by eating fish that contains toxins produced by a marine algae called Gambierdiscus toxicus. It can cause moderate to severe illness with numbness of the area around the mouth and lips that can spread to the arms and legs, nausea, vomiting, muscle pain and weakness, headache, dizziness, and rapid heartbeat. The toxin may cause sensory problems in which hot things feel cold and cold things feel hot. It is transmitted by eating certain large game fish from tropical waters-most specifically barracuda, grouper, snapper, and jacks. According to the CDC, ciguatera has no cure. Symptoms may disappear in days or weeks, but may persist for years.
· Scombroid: Causes mild to moderate illness with facial flushing, burning around the mouth and lips, peppery-taste sensations, a red rash on the upper body, dizziness, headache, and itchy skin. Severe symptoms may include blurry vision, respiratory distress, and swelling of the tongue and mouth. Symptoms typically last from four to six hours, and rarely more than one or two days. It is transmitted in seafood, mostly mahi-mahi and tuna, but can also be in Swiss cheese.
· Pesticides: Cause mild to severe illness with weakness, blurred vision, headache, cramps, diarrhea, increased production of saliva, and shaking of the arms and legs. Toxins are transmitted by eating unwashed fruits or vegetables contaminated with pesticides.
When to Seek Medical Care
Contact your doctor if any of the following situations occur:
· Nausea, vomiting, or diarrhea lasts for more than two days.
· The ill person is a child younger than three years of age.
· The abdominal symptoms are associated with a low-grade fever.
· Symptoms begin after recent foreign travel.
· Other family members or friends who ate the same thing are also sick.
· The ill person cannot keep any liquids down.
· The ill person does not improve within two days even though they are drinking large amounts of fluids.
· The ill person has a disease or illness that weakens their immune system (for example, HIV/AIDS, cancer and undergoing chemotherapy, kidney disease).
· The ill person cannot take their normal prescribed medications because of vomiting.
· The ill person has any nervous system symptoms such as slurred speech, muscle weakness, double vision, or difficulty swallowing.
· The ill person is pregnant.
Go to the nearest hospital’s emergency department if any of the following situations occur:
· The ill person passes out or collapse, become dizzy, lightheaded, or has problems with vision.
· A fever higher than 101 F (38.3 C) occurs with the abdominal symptoms.
· Sharp or cramping pains do not go away after 10-15 minutes.
· The ill person’s stomach or abdomen swells.
· The skin and/or eyes turn yellow.
· The ill person is vomiting blood or having bloody bowel movements.
· The ill person stops urinating, have decreased urination, or have urine that is dark in color.
· The ill person develops problems with breathing, speaking, or swallowing.
· One or more joints swell or a rash breaks out on the ill person’s skin.
· The ill person or caretaker considers the situation to be an emergency.
Food Poisoning Diagnosis
If the person visits a doctor or a hospital emergency department because they think they may have food poisoning, a thorough examination will be performed, including measurements of blood pressure, pulse, breathing rate, and temperature. The doctor will perform a physical exam, which screens for outward signs and symptoms of the illness. They will assess how dehydrated the patient is and examine the abdominal area to make sure the illness is not serious.
· The doctor may need to do a rectal examination. The doctor performs this test by inserting a lubricated and gloved finger gently into the rectum. The purpose is to make sure there are no breaks in the rectal wall. A sample of stool is taken and tested for blood and mucus. In some cases, a sample of stool or vomit can be sent to the laboratory for further testing to find out which toxin caused the illness. In a majority of cases, a specific cause is not found.
· A urine sample helps assess how dehydrated the patient is and may indicate possible kidney damage.
· Blood tests may be performed to determine the seriousness of the illness. An X-ray of the abdomen or a CT scan may be taken if the doctor suspects the patient’s symptoms may be caused by another illness.
Food Poisoning Treatment
Food Poisoning Self-Care at Home
Short episodes of vomiting and small amounts of diarrhea lasting less than 24 hours can usually be cared for at home.
· Do not eat solid food while nauseous or vomiting but drink plenty of fluids.
o Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
o Avoid alcoholic, caffeinated, or sugary drinks. Over-the-counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
o Sports drinks such as Gatorade and Powerade are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.
o Home remedies to treat nausea or diarrhea such as tea with lemon and ginger can be used for relief from symptoms. There are no proven herbal food poisoning cures. Consult a health care practitioner before taking any natural food poisoning remedies.
· After successfully tolerating fluids, eating should begin slowly, wheausea and vomiting have stopped. Plain foods that are easy on the stomach should be started in small amounts. Initially consider eating rice, wheat, breads, potatoes, low-sugar cereals, lean meats, and chicken (not fried). Milk can be given safely, although some people may experience additional stomach upset due to lactose intolerance.
· Most food poisonings do not require the use of over-the-counter medicines to stop diarrhea, but they are generally safe if used as directed. It is not recommended that these medications be used to treat children. If there is a question or concern, always check with a doctor.
Food Poisoning Medical Treatment
The main treatment for food poisoning is replacing fluids into the body (rehydration) through an IV and by drinking. The patient may need to be admitted to the hospital. This depends on the severity of the dehydration, response to therapy, and ability to drink fluids without vomiting. Children, in particular, may need close observation.
· Anti-vomiting and diarrhea medications may be given.
· The doctor may also treat any fever to make the patient more comfortable.
· Antibiotics are rarely needed for food poisoning. In some cases, antibiotics worsen the condition. Only a few specific causes of food poisoning are improved by using these medications. The length of illness with traveler’s diarrhea (shigellae) can be decreased with antibiotics, but this specific illness usually runs its course and improves without treatment.
· With mushroom poisoning or eating foods contaminated with pesticides, aggressive treatment may include intravenous (IV) fluids, emergency intervention for life-threatening symptoms, and giving medications such as antidotes, such as activated charcoal. These poisonings are very serious and may require intensive care in the hospital.
Food Poisoning Follow-up
After visiting a doctor or the emergency department, the patient should follow any specific instructions and take any medications prescribed exactly as directed. Continue to drink extra fluids until the diarrhea stops completely. The affected individual may need to miss one to two days of work or school to let the body recover. If any symptoms change or worsen, contact a doctor.
Food Poisoning Prevention
Safe steps in food handling, cooking, and storage are essential to avoiding food-borne illness. Bacteria cannot be seen, smelled, or tasted, and they may be on any food.
Follow the CDC food safety guidelines to keep contaminants away.
Safe shopping
· Buy cold foods last during your shopping trip. Get them home fast.
· Never choose torn or leaking packages.
· Do not buy foods past their “sell-by” or expiration dates.
· Keep raw meat and poultry separate from other foods.
· Pregnant women should avoid foods that can carry Listeria and should discuss healthy foods during their pregnancy with their OB/GYN physician.
Safe storage of foods
· Keep it safe; refrigerate.
· Unload perishable foods first and immediately refrigerate them. Place raw meat, poultry, or fish in the coldest section of your refrigerator.
· Check the temperature of your appliances. To slow bacterial growth, the refrigerator should be at 40 F (4.44 C) , the freezer at 0 F (-17.7 C).
· Cook or freeze fresh poultry, fish, ground meats, and variety meats within two days.
Safe food preparation
· Keep everything clean!
· Wash hands before and after handling raw meat and poultry.
· Sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart of water.
· Do not cross-contaminate. Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.
· Marinate meat and poultry in a covered dish in the refrigerator. Discard any uncooked/unused marinade.
Thawing food safely
· Refrigerator: Allows slow, safe thawing. Make sure thawing juices do not drip on other foods.
· Cold water: For faster thawing, place food in a leak-proof plastic bag and submerge in cold tap water.
· Microwave: Cook meat and poultry immediately after microwave thawing.
Safe cooking
· Use a meat thermometer
· Cook ground meats to 160 F (71 C)
· Cook ground poultry to 165 F (74 C)
· Cook beef, veal, and lamb steaks, roasts and chops to 145 F (63 C)
· Cook all cuts of fresh pork to 160 F (71 C).
· Whole poultry should reach 180 F (82 C) in the thigh; breasts 170 F (76.6 C).
· Keep hot foods hot and cold foods cold.
· Never leave food out more than two hours (or more than one hour in temperatures above 90 F [32 C]).
· Bacteria that cause food poisoning grow rapidly at room temperature.
· Use cooked leftovers within four days.
Food Poisoning Prognosis
Some of the most severe cases of food poisoning can result in long-term illness and death. However, most food poisoning is not serious. Most people begin feeling better within 24 to 48 hours. Queasiness or nausea and slight diarrhea may last one to two days longer.
What is salmonellosis?
Salmonellosis is an infection with bacteria called Salmonella. Most persons infected with Salmonelladevelop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, theSalmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.
Salmonella is actually a group of bacteria that can cause diarrheal illness in humans. They are microscopic living creatures that pass from the feces of people or animals to other people or other animals. There are many different kinds of Salmonella bacteria. Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common in the United States. Salmonella germs have been known to cause illness for over 100 years. They were discovered by an American scientist named Salmon, for whom they are named.
Many different kinds of illnesses can cause diarrhea, fever, or abdominal cramps. Determining thatSalmonella is the cause of the illness depends on laboratory tests that identify Salmonella in the stool of an infected person. Once Salmonella has been identified, further testing can determine its specific type.
Salmonella infections usually resolve in 5-7 days and often do not require treatment other than oral fluids. Persons with severe diarrhea may require rehydration with intravenous fluids. Antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin, are not usually necessary unless the infection spreads from the intestines. Some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of food animals.
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons with Salmonella develop pain in their joints, irritation of the eyes, and painful urination. This is called Reiter’s syndrome. It can last for months or years, and can lead to chronic arthritis which is difficult to treat. Antibiotic treatment does not make a difference in whether or not the person develops arthritis.
Salmonella live in the intestinal tracts of humans and other animals, including birds. Salmonella are usually transmitted to humans by eating foods contaminated with animal feces. Contaminated foods usually look and smell normal. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but any food, including vegetables, may become contaminated. Thorough cooking kills Salmonella. Food may also become contaminated by the hands of an infected food handler who did not wash hands with soap after using the bathroom.
Salmonella may also be found in the feces of some pets, especially those with diarrhea, and people can become infected if they do not wash their hands after contact with pets or pet feces. Reptiles, such as turtles, lizards, and snakes, are particularly likely to harbor Salmonella. Many chicks and young birds carry Salmonella in their feces. People should always wash their hands immediately after handling a reptile or bird, even if the animal is healthy. Adults should also assure that children wash their hands after handling a reptile or bird, or after touching its environment.
There is no vaccine to prevent salmonellosis. Because foods of animal origin may be contaminated with Salmonella, people should not eat raw or undercooked eggs, poultry, or meat. Raw eggs may be unrecognized in some foods, such as homemade Hollandaise sauce, Caesar and other homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings. Poultry and meat, including hamburgers, should be well-cooked, not pink in the middle. Persons also should not consume raw or unpasteurized milk or other dairy products. Produce should be thoroughly washed.
Cross-contamination of foods should be avoided. Uncooked meats should be kept separate from produce, cooked foods, and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after touching uncooked foods. Hand should be washed before handling food, and between handling different food items.
People who have salmonellosis should not prepare food or pour water for others until their diarrhea has resolved. Many health departments require that restaurant workers with Salmonellainfection have a stool test showing that they are no longer carrying the Salmonella bacterium before they return to work.
People should wash their hands after contact with animal feces. Because reptiles are particularly likely to have Salmonella, and it can contaminate their skin, everyone should immediately wash their hands after handling reptiles. Reptiles (including turtles) are not appropriate pets for small children and should not be in the same house as an infant. Salmonella carried in the intestines of chicks and ducklings contaminates their environment and the entire surface of the animal. Children can be exposed to the bacteria by simply holding, cuddling, or kissing the birds. Children should not handle baby chicks or other young birds. Everyone should immediately wash their hands after touching birds, including baby chicks and ducklings, or their environment.
Every year, approximately 40,000 cases of salmonellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be thirty or more times greater. Salmonellosis is more common in the summer than winter.
Children are the most likely to get salmonellosis. The rate of diagnosed infections in children less than five years old is about five times higher than the rate in all other persons. Young children, the elderly, and the immunocompromised are the most likely to have severe infections. It is estimated that approximately 400 persons die each year with acute salmonellosis.
It is important for the public health department to know about cases of salmonellosis. It is important for clinical laboratories to send isolates of Salmonella to the City, County, or State Public Health Laboratories so the specific type can be determined and compared with other Salmonella in the community. If many cases occur at the same time, it may mean that a restaurant, food or water supply has a problem that needs correction by the public health department.
Some prevention steps occur everyday without you thinking about it. Pasteurization of milk and treatment of municipal water supplies are highly effective prevention measures that have been in place for decades. In the 1970s, small pet turtles were a common source of salmonellosis in the United States, so in 1975, the sale of small turtles was banned in this country. However, in 2008, they were still being sold, and cases of Salmonella associated with pet turtles have been reported. Improvements in farm animal hygiene, in slaughter plant practices, and in vegetable and fruit harvesting and packing operations may help prevent salmonellosis caused by contaminated foods. Better education of food industry workers in basic food safety and restaurant inspection procedures may prevent cross-contamination and other food handling errors that can lead to outbreaks. Wider use of pasteurized egg in restaurants, hospitals, and nursing homes is an important prevention measure. In the future, irradiation or other treatments may greatly reduce contamination of raw meat.
The Centers for Disease Control and Prevention (CDC) monitors the frequency of Salmonellainfections in the country and assists the local and state health departments in investigating outbreaks and devising control measures. CDC also monitors the different types of Salmonella that are reported annually by public health laboratories of state and local health departments. The Food and Drug Administration (FDA) inspects imported foods, oversees inspection of milk pasteurization plants, promotes better food preparation techniques in restaurants and food processing plants, and regulates the sale of turtles. The FDA also regulates the use of specific antibiotics as growth promotants in food animals. The US Department of Agriculture monitors the health of food animals, inspects egg pasteurization plants, and is responsible for the quality of slaughtered and processed meat. The US Environmental Protection Agency regulates and monitors the safety of drinking water supplies.
You can discuss any medical concerns you may have with your doctor or other heath care provider. Your local City or County Health Department can provide more information about this and other public health problems that are occurring in your area. General information about the public health of the nation is published every week in the “Morbidity and Mortality Weekly Report (MMWR)”, by the CDC in Atlanta, GA. Every spring, the MMWR publishes a report of the incidence of Salmonella and other infections during the previous year in FoodNet sentinel surveillance sites. Epidemiologists in your local and state health departments are tracking many important public health problems, investigating special problems that arise, and helping to prevent them from occurring in the first place, and from spreading, when they occur.
· Cook poultry, ground beef, and eggs thoroughly. Do not eat or drink foods containing raw eggs, or raw (unpasteurized) milk.
· If you are served undercooked meat, poultry or eggs in a restaurant, don’t hesitate to send it back to the kitchen for further cooking.
· Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
· Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
· Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.
· Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons.
· Don’t work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time.
· Mother’s milk is the safest food for young infants. Breastfeeding prevents salmonellosis and many other health problems.
What is salmonellosis?
Salmonellosis is a type of food poisoning caused by the Salmonellabacterium. There are many different kinds of these bacteria. Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common types in the United States.
Every year approximately 40,000 cases of salmonellosis are reported in the U.S. Many milder cases are not diagnosed or reported, so the actual number of infections may be 30 or more times greater.1 Salmonellosis is more common in the summer than in the winter. Children are the most likely to get salmonellosis. Young children, older adults, and people who have impaired immune systems are the most likely to have severe infections.
What causes salmonellosis?
You can get salmonellosis by eating food contaminated with salmonella. This can happen in the following ways:
· Food may be contaminated during food processing or food handling.
· Food may become contaminated by the unwashed hands of an infected food handler. A frequent cause is a food handler who does not wash his or her hands with soap after using the bathroom.
· Salmonella may also be found in the feces of some pets, especially those withdiarrhea. You can become infected if you do not wash your hands after contact with these feces.
· Reptiles, baby chicks and ducklings, and small rodents such as hamsters are particularly likely to carry Salmonella. You should always wash your hands immediately after handling one of these animals, even if the animal is healthy. Adults should also be careful that children wash their hands after handling reptiles, pet turtles, baby chicks or ducklings, or small rodents.
Beef, poultry, milk, and eggs are most often infected with salmonella. But vegetables may also be contaminated. Contaminated foods usually look and smell normal.
What are the symptoms?
Symptoms of salmonellosis include diarrhea, fever, and abdominal cramps. They develop 12 to 72 hours after infection, and the illness usually lasts 4 to 7 days. Most people recover without treatment. But diarrhea and dehydration may be so severe that it is necessary to go to the hospital. Older adults, infants, and those who have impaired immune systems are at highest risk.
If you only have diarrhea, you usually recover completely, although it may be several months before your bowel habits are entirely normal. A small number of people who are infected with salmonellosis develop Reiter’s syndrome, a disease that can last for months or years and can lead to chronic arthritis.
How is salmonellosis diagnosed?
Salmonellosis is diagnosed based on a medical history and a physical exam. Your doctor will ask you questions about your symptoms, foods you have recently eaten, and your work and home environments. A stool culture and blood tests may be done to confirm the diagnosis.
How is it treated?
You treat salmonellosis by managing any complications until it passes. Dehydration caused by diarrhea is the most common complication. Antibiotics are not usually needed unless the infection has spread.
To prevent dehydration, take frequent sips of a rehydration drink (such asPedialyte). Try to drink a cup of water or rehydration drink for each large, loose stool you have. Soda and fruit juices have too much sugar and not enough of the important electrolytes that are lost during diarrhea, and they should not be used to rehydrate.
Try to stay with your usual diet as much as possible. Eating your usual diet will help you to get enough nutrition. Doctors believe that eating a normal diet will also help you feel better faster. But try to avoid foods that are high in fat and sugar. Also avoid spicy foods, alcohol, and coffee for 2 days after all symptoms have disappeared.
How can you prevent salmonellosis?
To prevent salmonellosis:
· Do not eat raw or undercooked eggs. Raw eggs may be used in some foods such as homemade hollandaise sauce, Caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.
· Cook foods until they are well done. Use a meat thermometer to be sure foods are cooked to a safe temperature. Do not use the color of the meat (such as when it is no longer “pink”) to tell you that it is done.
· Avoid raw or unpasteurized milk or other dairy products.
· Wash or peel produce before eating it.
· Avoid cross-contamination of food. Keep uncooked meats separate from produce, cooked foods, and ready-to-eat foods. Thoroughly wash hands, cutting boards, counters, knives, and other utensils after handling uncooked foods.
· Wash your hands before handling any food and between handling different food items.
· Do not prepare food or pour water for others when you have salmonellosis.
· Wash your hands after contact with animal feces. Since reptiles are particularly likely to carry salmonella bacteria, wash your hands immediately after handling them. Consider not having reptiles (including turtles) as pets, especially if you have small children or an infant.
What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum and sometimes by strains of Clostridium butyricum and Clostridium baratii. There are five main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulinum toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. Adult intestinal toxemia (adult intestinal colonization) botulism is a very rare kind of botulism that occurs among adults by the same route as infant botulism. Lastly, iatrogenic botulism can occur from accidental overdose of botulinum toxin. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism is a public health emergency because many people can be poisoned by eating a contaminated food.
What kind of germ is Clostridium botulinum?
Clostridium botulinum is the name of a group of bacteria. They can be found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.
How common is botulism?
In the United States, an average of 145 cases are reported each year.Of these, approximately 15% are foodborne, 65% are infant botulism, and 20% are wound. Adult intestinal colonization and iatrogenic botulism also occur, but rarely. Outbreaks of foodborne botulism involving two or more persons occur most years and are usually caused by home-canned foods. Most wound botulism cases are associated with black-tar heroin injection, especially in California.
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the respiratory muscles, arms, legs, and trunk. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.
How is botulism diagnosed?
Physicians may consider the diagnosis if the patient’s history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis. Tests for botulinum toxin and for bacteria that cause botulism can be performed at some state health department laboratories and at CDC.
How can botulism be treated?
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks or months, plus intensive medical and nursing care. The paralysis slowly improves. Botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. Antitoxin for infants is available from the California Department of Public Health, and antitoxin for older children and adults is available through CDC.If given before paralysis is complete, antitoxin can prevent worsening and shorten recovery time. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria followed by administration of appropriate antibiotics. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.
Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 3-5%. A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months, and some patients die from infections or other problems related to remaining paralyzed for weeks or months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid recovery.
How can botulism be prevented?
Many cases of botulism are preventable. Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets and corn and is caused by failure to follow proper canning methods. However, seemingly unlikely or unusual sources are found every decade, with the common problem of improper handling during manufacture, at retail, or by consumers; some examples are chopped garlic in oil, canned cheese sauce, chile peppers, tomatoes, carrot juice, and baked potatoes wrapped in foil. In Alaska, foodborne botulism is caused by fermented fish and other aquatic game foods. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods, and carefully follow instructions on safe home canning including the use of pressure canners/cookers as recommended through county extension services or from the US Department of Agriculture. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulinum toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs. Most infant botulism cases cannot be prevented because the bacteria that causes this disease is in soil and dust. The bacteria can be found inside homes on floors, carpet, and countertops even after cleaning. Honey can contain the bacteria that causes infant botulism so, children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older.
Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers. Persons in state health departments and at CDC are knowledgeable about botulism and available to consult with physicians 24 hours a day. If antitoxin is needed to treat a patient, it can be quickly delivered to a physician anywhere in the country. Suspected outbreaks of botulism are quickly investigated, and if they involve a commercial product, the appropriate control measures are coordinated among public health and regulatory agencies. Physicians should immediately report suspected cases of botulism to their state health department.
For information and quidelines on canning foods at home: USDA Home Canning Guide
Symptoms
Foodborne botulism
Signs and symptoms of foodborne botulism typically begin between 18 and 36 hours after the toxin gets into your body, but can range from a few hours to several days, depending on the amount of toxin ingested. Signs and symptoms of foodborne botulism include:
· Difficulty swallowing or speaking
· Dry mouth
· Facial weakness on both sides of the face
· Blurred or double vision
· Drooping eyelids
· Trouble breathing
· Nausea, vomiting and abdominal cramps
· Paralysis
Wound botulism
Most people who develop wound botulism inject drugs several times a day, so it’s difficult to determine how long it takes for signs and symptoms to develop after the toxin enters the body. Most common in people who inject black tar heroin, wound botulism signs and symptoms include:
· Difficulty swallowing or speaking
· Facial weakness on both sides of the face
· Blurred or double vision
· Drooping eyelids
· Trouble breathing
· Paralysis
Infant botulism
If infant botulism is related to food, such as honey, problems generally will begin within 18 to 36 hours after the toxin enters the baby’s body. Signs and symptoms include:
· Constipation (often the first sign)
· Floppy movements due to muscle weakness and trouble controlling the head
· Weak cry
· Irritability
· Drooling
· Drooping eyelids
· Tiredness
· Difficulty sucking or feeding
· Paralysis
Certain signs and symptoms usually are absent with botulism, including no elevation in blood pressure or heart rate, no confusion, and no fever. However, fever is sometimes present with wound botulism.
When to see a doctor
Seek urgent medical care if you suspect that you have botulism. Early treatment increases your chances of survival. Seeking medical care promptly may also serve to alert public health authorities. They can keep other people from eating contaminated food.
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Prevention
Use proper canning techniques
Be sure to use proper techniques when canning foods at home to ensure that any botulism germs in the food are destroyed:
· Pressure cook these foods at 250 F (121 C) for at least 30 minutes.
· Consider boiling these foods for 10 minutes before serving them.
Prepare and store food safely
· Don’t eat preserved food if its container is bulging or if the food smells spoiled. However, taste and smell won’t always give away the presence of C. botulinum. Some strains don’t make food smell bad or taste unusual.
· If you wrap potatoes in foil before baking them, eat them hot or store them in the refrigerator — not at room temperature.
· Store oils infused with garlic or herbs in the refrigerator.
Infant botulism
To reduce the risk of infant botulism, avoid giving honey — even a tiny taste — to babies under the age of 1 year.
Wound botulism
To prevent wound botulism and other serious bloodborne diseases, never inject or inhale street drugs.
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· See Also
· Infant botulism: Can it be prevented?
