Gastroenterology
Food Poisoning Overview: Toxins
Background
- A common but preventable public health issue
- About 17% of US population will become ill due to contaminated food
- There are > 250 different foodborne diseases, mostly due to bacteria, viruses, and parasites
- Poisonings can also be due to toxins (for example, poisonous mushrooms or toxin-producing bacteria)
- Some toxins (e.g., Staphylococcal toxin) may not be inactivated even when boiled
- See also IDSA Guidelines
Enterotoxin Production (Non-inflammatory)
- Toxins act as secretagogues
- Mucosa is not physically violated
- Signs/Symptoms
- Diarrhea is watery and voluminous
- Minor fever, no septicemia
- No leukocytes or blood in stool
- STEC may lead to HUS
Pathogens
- Staphylococcus aureus
- Creamy pastries, potato salad, meat, milk
- 2-6 hrs, very rapid onset after ingestion
- Vomiting and explosive, non-bloody diarrhea
- No treatment, usually self-limited in 12-24 hrs
- Bacillus cereus
- Enterotoxin and enterotoxin made in vivo
- Fried rice and vegetables (reheated)
- 1-6 hrs vomiting, diarrhea 6-18 hrs
- Vomiting and abdominal pain or diarrhea
- No treatment, course < 12-24 hrs
- Clostridium perfringens
- Beef (left at room temperature for too long), poultry, gravy
- No incubation period; can develop 24 hrs post-ingestion
- Cramps and sudden explosive, non-bloody diarrhea
- No treatment, course < 24 hrs
- Toxigenic Escherichia coli
- Water (contaminated by feces)
- 1-3 days, usually predominant summer
- Watery, explosive onset, nausea, chills, cramps
- No treatment if illness runs course after several days, otherwise:
- Ciprofloxacin: 500 mg PO BID for 3-5 days, or
- TMP / SMX:
- Pediatrics: TMP 5 mg/kg / SMX 25 mg/kg BID for 5-7 days
- Adults: TMP 160 mg / SMX 800 mg BID for 5-7 days
- Vibrio cholerae
- Most often Gulf Coast
- Water, crabs, shrimp
- 6-48 hrs
- Abrupt, explosive, "rice water" stool, severe fluid and electrolyte problems
- No abdominal pain or fever
- Treatment:
- Supportive fluids and electrolytes may be needed
- Doxycycline: 300 mg PO once, or
- Tetracycline
- Pediatrics (> 10 years old): 10 mg/kg QID for 7-10 days
- Adults: 250 mg QID for 7-10 days
- Alternative
- Ciprofloxacin: 1 g PO once, or
- Azithromycin: 1000 mg PO once, or
- TMP-SMX:
- Pediatrics: TMP 5 mg/kg / SMX 25 mg/kg BID for 5-7 days
- Adults: TMP 160 mg / SMX 800 mg BID for 5-7 days
- Clostridium botulinum
- Improperly canned fruits and vegetables, smoked fish
- 1-8 days
- Vomiting, cranial neuropathy; diplopia, dysphagia, dysarthria
- Treatment:
- Listeria monocytogenes
- Treatment
- Ampicillin (DOC)
- 1-2 g IV/IM q4-6h
- Add gentamicin for Gram(-) coverage such as E. coli causing meningitis
- 1-2.5 mg/kg/dose IV/IM div q8-12h OR 3-6 mg/kg/day IV/IM TID
- Generally added for infants < 1 month old
- For broad coverage of bacterial meningitis in populations susceptible
- Adults w/ depressed cell immunity ≥ 50 yo
- Listeria NOT susceptible to cephalosporins
- Penicillin G
- Alternative to ampicillin
- Sulfamethoxazole/Trimethoprim: 2nd line DOC
- Clostridioides difficile
- Toxin-mediated, not from food
- Antibiotics-induced (any, but especially ampicillin, clindamycin, ceph.)
- Usually starts at end of antibiotic course or up to 2 weeks after finishing
- Necrotizing toxin produces colitis
- Profuse watery diarrhea, (green), fever; abdominal. pain, leukocytosis
- STOP implicated antibiotics (avoid antidiarrheals)
- See C Diff Tx
Related Topics
References
- Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. Nov 29, 2017;65(12):e45-e80
- Centers for Disease Control and Prevention (CDC). Foodborne Germs and Illnesses by Type. Available at: https://www.cdc.gov/food-safety/?CDC_AAref_Val=https://www.cdc.gov/foodsafety/diseases/index.html. [Accessed August 2024]
- Centers for Disease Control and Prevention (CDC). Cholera - Vibrio cholerae infection. Available at: https://www.cdc.gov/cholera/treatment/?CDC_AAref_Val=https://www.cdc.gov/cholera/treatment/antibiotic-treatment.html [Accessed August 2024]
- Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroent. 2013;108:478-98
- Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. May 2010;31(5):pp.431-455
- Bauer MP, Kuijper EJ, van Dissel JT. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect 2009;15:pp.1067-1079
- Kelly CP, LaMont JT. Clostridium difficile - more difficult than ever. N Engl J Med 2008;359:pp.1932-1940
- McFee RB, Abdelsayed GG. Clostridium difficile. Dis Mon 2009;55:pp.439-470
- Temple ME, Nahata MC. Treatment of listeriosis. Ann Pharmacother. May 2000;34(5):656-661
- Surawicz CM, Brandt LJ, Binion DG. Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections . Am J Gastroenterol. Feb 26, 2013;108:478-498
- Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. Jun 24, 2021;ciab549.
- Listeria Monocytogenes. StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534838/. [Accessed August 2024]
Contributor(s)
- Ho, Nghia, MD
- Khan, Shariq, MD
- Ballarin, Daniel, MD
Updated/Reviewed: August 2024