-IBIS-1.5.0-
tx
digestive system
food poisoning
diagnoses
definition and etiology
definition and etiology:
an acute syndrome of gastrointestinal distress caused by infection of or ingestion of toxins from micro-organisms or plants, including species of staphylococcus, clostridium, salmonella, vibrio, salmonella, campylobacter, yersinia and bacillus
signs and symptoms
staphylococcus
signs and symptoms:
onset usually 2-4 hours after eating
nausea and vomiting
abdominal cramping
prostration
diarrhea
headache
fever
may be subnormal temperature and lowered blood pressure
lab findings:
(+) isolation of coagulase-(+) staph from suspected food
enterotoxin-producing staph in stool
increased WBCs in stool presumptive evidence for staph poisoning
clostridium perfringens:
signs and symptoms:
onset usually 10-12 hours after ingestion
sudden onset of colic followed by diarrhea
nausea and vomiting
fever usually absent
lab findings:
culture of organism in food or stool
clostridium botulinum:
a. food botulism:
signs and symptoms:
onset is typically abrupt, with neurologic symptoms starting 12-36 hours after ingestion of contaminated food
diplopia
blurred vision
dry mouth
loss of pupillary accommodation
bulbar paresis
decreased or absent pupillary light reflex
GI illness: nausea, vomiting, diarrhea, abdominal cramping
paralysis: symmetrical, descending (usually) or ascending (sometimes)
fever is absent
patients are alert and oriented, even with severe poisoning
constipation, urinary retention, decreased saliva production
sensory system is unchanged
b. infantile
signs and symptoms:
constipation
neuromuscular weakness
paralysis
c. wound: similar neuromuscular symptoms appear without the gastrointestinal symptoms; this type of botulism is quite rare
d. unclassified: signs and symptoms are similar to the classic food poisoning although no source for the disease can be uncovered.
lab findings for all botulism:
check food, stool, wound, and serum for toxin using mouse bioassay technique and special anaerobic cultures
routine lab studies are not helpful in diagnosing botulism
electrodiagnostic studies can differentiate botulism from other diseases causing paralysis
salmonella:
signs and symptoms: onset is sudden, usually 12-36 hours after ingestion
headache
abdominal pain
diarrhea, occasional vomiting and nausea, anorexia (can last for days)
dehydration can be severe, especially when infants are afflicted
fever is often present
rarely, the organism can localize in a body tissue and create abscesses, arthritis, pericarditis, pneumonia, endocarditis, cholecystitis or meningitis
lab findings:
stool analysis for salmonella: when enterocolitis is present
blood culture: when there is enteric fever and septicemia
vibrio parahaemolyticus:
signs and symptoms:
onset usually 12-24 hours after ingestion
watery diarrhea
abdominal cramps
occasional nausea, vomiting, headaches
occasional dysentery-like clinical picture with mucous or bloody stools, high fever, and high WBC counts
lab findings:
isolation of the bacteria from stool
high WBC with dysentery
campylobacter jejuni and coli
signs and symptoms: the disease expression ranges from mild to severe
onset usually 3-5 days after ingestion
acute: diarrhea, abdominal pain, malaise, nausea/vomiting, fever
liquid stools, often foul-smelling, with blood and mucous
lab findings:
cultured organisms from the stool
yersinia enterocolitica:
signs and symptoms:
onset 3-7 days after ingestion
acute watery diarrhea
acute mesenteric lymphadenitis
fever, headache, pharyngitis
anorexia, vomiting
erythema nodosum, arthritis, iritis
lab findings:
(+) blood cultures
(+) fecal culture
(+) serologic agglutination
bacillus cereus
signs and symptoms:
nausea and vomiting (onset 1-6 hours after ingestion)
cramping and diarrhea (onset 6-16 hours after ingestion)
lab findings:
(+) identification in food and/or
(+) identification in stool
course and prognosis
staphylococcus:
Recovery from Staph poisoning is usually complete within a day or two. Fatalities are rare, and follow electrolyte and/or fluid imbalances, mostly affecting the very old, the very young, and the chronically ill. No treatment is usually needed, but occasional replacement of fluid and electrolytes by IV solution is helpful.
clostridium perfringens:
Usually mild and self-limiting within 24 hours in healthy persons.
clostridium botulinum:
Botulism is a medical emergency. Death occurs from respiratory failure, although with proper treatment and antitoxin administration, the fatality rate is < 10-15 % for food-borne poisonings and 2% for infantile botulism. Antitoxin including all three subtypes (A, B, and E) should be given as soon as possible after diagnosis. Treatment of the other individual symptoms may be needed (e.g. by catheterization, enemas). Recovery, while usually full, may be very protracted, with residual weakness, respiratory impairment and autonomic symptoms lasting up to one year after hospitalization.
salmonella:
Salmonellosis is rarely fatal. Death occurs primarily in infants, the elderly, and the infirm. However, the disease may be very intense, and require convalescence. Antibiotics may prolong the carrier state and encourage resistant strains.
vibrio parahemolyticus:
The disease is typically self-limiting, though with the dysentery-type, electrolyte and fluid IV replacement may be necessary. Death is rare.
campylobacter jejuni and coli:
The disease is typically self-limited, although 20% of patients may develop a prolonged clinical picture that requires medical attention. Relapses among recovered patients is not uncommon. Antibiotics may not shorten the course of the disease, but may shorten the 2-7 weeks that carriers shed organisms.
yersinia enterocolitica:
The disease is rarely fatal, but abdominal complications require antimicrobial therapy.
bacillus cereus:
The disease is generally self-limiting within 24 hours.
differential diagnosis
most cases of food poisoning are mild and self-limiting, but in severe cases, a stool culture is indicated to differentiate the offending agent; food poisoning also must be differentiated from other infectious gastrointestinal complaints, disorders like ulcerative colitis and irritable bowel syndrome, and miscellaneous poisonings: e.g. shellfish, belladonna
clostridium botulinum
Guillain-Barre syndrome: has mild sensory changes
Fisher's syndrome: Guillain-Barre with ataxia, ophthalmoplegia, areflexia
myasthenia gravis: has a more gradual onset
tick paralysis: tick may be evident; paresthesias occur
diphtheria
poliomyelitis: spinal fluid is abnormal, paralysis and weakness is asymmetrical
miscellaneous poisonings: e.g. shellfish, belladonna
footnotes