Diagnosis and Management of Foodborne Illness

 


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Am Fam Physician. 2015 Sep 1;92(5):358-365.

  Patient information: See related handout on food poisoning, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

The Centers for Disease Control and Prevention estimates that each year, one in six Americans will experience a foodborne illness. The most common causes in the United States are viruses, such as norovirus; bacteria, such as Salmonella, Escherichia coli, Campylobacter, and Listeria; and parasites, such as Toxoplasma gondii and Giardia. Resources are available to educate consumers on food recalls and proper handling, storage, and cooking of foods. Diagnosis and management of a foodborne illness are based on the history and physical examination. Common symptoms of foodborne illnesses include vomiting, diarrhea (with or without blood), fever, abdominal cramping, headache, dehydration, myalgia, and arthralgias. Definitive diagnosis can be made only through stool culture or more advanced laboratory testing. However, these results should not delay empiric treatment if a foodborne illness is suspected. Empiric treatment should focus on symptom management, rehydration if the patient is clinically dehydrated, and antibiotic therapy. Foodborne illnesses should be reported to local and state health agencies; reporting requirements vary among states.

Foodborne illness can be caused by a multitude of microorganisms such as viruses, bacteria, and parasites. Foodborne illness is a worldwide problem, and U.S. outbreaks often garner media attention and result in food recalls. Foodborne illnesses are becoming a greater challenge because of new and emerging microorganisms and toxins, the growth of antibiotic resistance, increasing food contamination caused by new environments and methods of food production, and an increase in multistate outbreaks.1 There are more than 250 identified pathogens that cause foodborne illness. The Centers for Disease Control and Prevention (CDC) estimates that one in six Americans (approximately 48 million) will become sick from a foodborne pathogen each year, resulting in 128,000 hospitalizations and 3,000 deaths.2 Most foodborne illnesses, hospitalizations, and deaths are caused by one of eight common pathogens: norovirus, nontyphoidal Salmonella, Clostridium perfringens, Campylobacter, Staphylococcus aureus, Toxoplasma gondii, Listeria monocytogenes, and Shiga toxin–producing Escherichia coli 2 (Table 13). E. coli is commonly divided into two broad types, Shiga toxin–producing—of which E. coli O157:H7 is the best studied—and non-Shiga toxin–producing, which includes enteropathogenic, enteroinvasive, enteroaggregative, and diffusely adherent E. coli. New pathogens emerge constantly, whereas others decrease in significance or disappear altogether. Predicting the emergence or disappearance of specific pathogens—other than in the setting of an identified outbreak—is difficult and has not significantly prevented or limited foodborne illnesses.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Stool cultures are the diagnostic standard for bacterial foodborne illness; however, culture results are positive in less than 40% of cases.

C

4, 5

A single dose of ondansetron (Zofran) is recommended in children with clinically significant gastroenteritis-related vomiting.

A

1214

Oral rehydration therapy is effective in preventing and treating dehydration in patients of all ages.

A

1619

Empiric antibiotic therapy should be considered in cases of suspected foodborne illness if the patient is febrile and has signs of invasive disease, if symptoms have persisted for more than one week or are severe, or if hospitalization may be required.

C

10, 16, 17, 19


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Stool cultures are the diagnostic standard for bacterial foodborne illness; however, culture results are positive in less than 40% of cases.

C

4, 5

A single dose of ondansetron (Zofran) is recommended in children with clinically significant gastroenteritis-related vomiting.

A

1214

Oral rehydration therapy is effective in preventing and treating dehydration in patients of all ages.

A

1619

Empiric antibiotic therapy should be considered in cases of suspected foodborne illness if the patient is febrile and has signs of invasive disease, if symptoms have persisted for more than one week or are severe, or if hospitalization may be required.

C

10, 16, 17, 19


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

Table 1.

Summary of Foodborne Illnesses

Organism (common name of illness)

The Authors

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TIMOTHY L. SWITAJ, MD, is deputy commander for clinical services at Reynolds Army Community Hospital, Fort Sill, Okla....

KELLY J. WINTER, DO, is a staff family physician at William Beaumont Army Medical Center, Fort Bliss, Tex.

SCOTT R. CHRISTENSEN, MD, is officer-in-charge at the family medicine clinic #1 at Reynolds Army Community Hospital.

Address correspondence to Timothy L. Switaj, MD, at timothy.l.switaj.mil@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

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