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, food poisoning causes about 76 million illnesses, 325,000 hospitalizations, and
up to 5,000 deaths each year. One of the most common bacterial forms of infection,
the salmonellae organisms, account for $1 billion in medical costs and lost work time.

 Worldwide, diarrheal illnesses are among the leading causes of death. Travelers to
developing countries often encounter food poisoning in the form of traveler'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.

Food Poisoning Causes

More than 250 known diseases can be transmitted through food. The CDC estimates
unknown or undiscovered agents cause 81% 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
agents and toxic agents.

o Infectious agents include viruses, bacteria, and parasites.

o Toxic agents include poisonous mushrooms, improperly prepared exotic foods

(such as barracuda), 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.
What Is Food Poisoning?

Food poisoning comes from eating foods that contain germs like
bad bacteria or toxins, which are poisonous substances. Bacteria are all around us, so mild
cases of food poisoning are common. You may have had mild food poisoning — with
diarrhea and an upset stomach — but your mom or dad just called it a stomach bug or
stomach virus.

You might think the solution is to get rid of all the bacteria. But it isn't possible and you
wouldn't want to do it, even if you could. Bacteria are all around us, including in food, and
sometimes they can be good for you. It's confusing, but one thing is for sure — the bacteria in
the rotten leftovers weren't good for you. But you can learn how to avoid those bad germs in
food.
Causes
See also: Pathogen

Poorly stored food in a refrigerator

Foodborne illness usually arises from improper handling, preparation, or food storage. Good
hygiene practices before, during, and after food preparation can reduce the chances of
contracting an illness. There is a general consensus in the public health community that
regular hand-washing is one of the most effective defenses against the spread of foodborne
illness. The action of monitoring food to ensure that it will not cause foodborne illness is
known as food safety. Foodborne disease can also be caused by a large variety of toxins that
affect the environment. For foodborne illness caused by chemicals, see Food contaminants.

Foodborne illness can also be caused by pesticides or medicines in food and naturally toxic
substances like poisonous mushrooms or reef fish.

[edit] Bacteria

Bacteria are a common cause of foodborne illness. In the United Kingdom during 2000 the
individual bacteria involved were as follows: Campylobacter jejuni 77.3%, Salmonella
20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.1%.[3] In the past, bacterial
infections were thought to be more prevalent because few places had the capability to test for
norovirus and no active surveillance was being done for this particular agent. Symptoms for
bacterial infections are delayed because the bacteria need time to multiply. They are usually
not seen until 12–72 hours or more after eating contaminated food.

Most common bacterial foodborne pathogens are:

  Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome and
periodontitis[4]
 Clostridium perfringens, the "cafeteria germ"[5]
 Salmonella spp. – its S. typhimurium infection is caused by consumption of eggs that are not
adequately cooked or by other interactive human-animal pathogens [6][7][8]

Salmonella

 Escherichia coli O157:H7 enterohemorrhagic (EHEC) which causes hemolytic-uremic

syndrome

Other common bacterial foodborne pathogens are:

 Bacillus cereus
 Escherichia coli, other virulence properties, such as enteroinvasive (EIEC), enteropathogenic
(EPEC), enterotoxigenic (ETEC), enteroaggregative (EAEC or EAgEC)
 Listeria monocytogenes
 Shigella spp.
 Staphylococcus aureus
 Streptococcus
 Vibrio cholerae, including O1 and non-O1
 Vibrio parahaemolyticus
 Vibrio vulnificus
 Yersinia enterocolitica and Yersinia pseudotuberculosis

Less common bacterial agents:

 Brucella spp.
 Corynebacterium ulcerans
 Coxiella burnetii or Q fever
 Plesiomonas shigelloides

[edit] Exotoxins

In addition to disease caused by direct bacterial infection, some foodborne illnesses are
caused by exotoxins which are excreted by the cell as the bacterium grows. Exotoxins can
produce illness even when the microbes that produced them have been killed. Symptoms
typically appear after 1–6 hours depending on the amount of toxin ingested.
  Clostridium botulinum
 Clostridium perfringens
 Staphylococcus aureus
 Bacillus cereus

For example Staphylococcus aureus produces a toxin that causes intense vomiting. The rare
but potentially deadly disease botulism occurs when the anaerobic bacterium Clostridium
botulinum grows in improperly canned low-acid foods and produces botulin, a powerful
paralytic toxin.

Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some other
bacteria, produce the lethal tetrodotoxin, which is present in the tissues of some living animal
species rather than being a product of decomposition.

[edit] Mycotoxins and alimentary mycotoxicoses

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins through
food consumption. Mycotoxins sometimes have important effects on human and animal
health. For example, an outbreak which occurred in the UK in 1960 caused the death of
100,000 turkeys which had consumed aflatoxin-contaminated peanut meal. In the USSR in
World War II, 5000 people died due to Alimentary Toxic Aleukia (ALA).[9] The common
foodborne Mycotoxins include:

 Aflatoxins – originated from Aspergillus parasiticus and Aspergillus flavus. They are
frequently found in tree nuts, peanuts, maize, sorghum and other oilseeds, including corn
and cottonseeds. The pronounced forms of Aflatoxins are those of B1, B2, G1, and G2,
amongst which Aflatoxin B1 predominantly targets the liver, which will result in necrosis,
cirrhosis, and carcinoma.[10][11] In the US, the acceptable level of total aflatoxins in foods is
less than 20 μg/kg, except for Aflatoxin M1 in milk, which should be less than 0.5 μg/kg. [12]
The official document can be found at FDA's website.[13][14]
 Altertoxins – are those of Alternariol (AOH), Alternariol methyl ether (AME), Altenuene
(ALT), Altertoxin-1 (ATX-1), Tenuazonic acid (TeA) and Radicinin (RAD), originated from
Alternaria spp. Some of the toxins can be present in sorghum, ragi, wheat and tomatoes.[15]
[16][17]
Some research has shown that the toxins can be easily cross-contaminated between
grain commodities, suggesting that manufacturing and storage of grain commodities is a
critical practice.[18]
 Citrinin
 Citreoviridin
 Cyclopiazonic acid
 Cytochalasins
 Ergot alkaloids / Ergopeptine alkaloids – Ergotamine
 Fumonisins – Crop corn can be easily contaminated by the fungi Fusarium moniliforme, and
its Fumonisin B1 will cause Leukoencephalomalacia (LEM) in horses, Pulmonary edema
syndrome (PES) in pigs, liver cancer in rats and Esophageal cancer in humans.[19][20] For
human and animal health, both the FDA and the EC have regulated the content levels of
toxins in food and animal feed.[21][22]
 Fusaric acid
 Fusarochromanone
 Kojic acid
 Lolitrem alkaloids
 Moniliformin
  3-Nitropropionic acid
 Nivalenol
 Ochratoxins – In Australia, The Limit of Reporting (LOR) level for Ochratoxin A (OTA) analyses
in 20th Australian Total Diet Survey was 1 µg/kg,[23] whereas the EC restricts the content of
OTA to 5 µg/kg in cereal commodities, 3 µg/kg in processed products and 10 µg/kg in dried
vine fruits.[24]
 Oosporeine
 Patulin – Currently, this toxin has been advisably regulated on fruit products. The EC and the
FDA have limited it to under 50 µg/kg for fruit juice and fruit nectar, while limits of 25 µg/kg
for solid-contained fruit products and 10 µg/kg for baby foods were specified by the EC.[24][25]
 Phomopsins
 Sporidesmin A
 Sterigmatocystin
 Tremorgenic mycotoxins – Five of them have been reported to be associated with molds
found in fermented meats. These are Fumitremorgen B, Paxilline, Penitrem A, Verrucosidin,
and Verruculogen.[26]
 Trichothecenes – sourced from Cephalosporium, Fusarium, Myrothecium, Stachybotrys and
Trichoderma. The toxins are usually found in molded maize, wheat, corn, peanuts and rice,
or animal feed of hay and straw.[27][28] Four trichothecenes, T-2 toxin, HT-2 toxin,
diacetoxyscirpenol (DAS) and deoxynivalenol (DON) have been most commonly encountered
by humans and animals. The consequences of oral intake of, or dermal exposure to, the
toxins will result in Alimentary toxic aleukia, neutropenia, aplastic anemia,
thrombocytopenia and/or skin irritation.[29][30][31] In 1993, the FDA issued a document for the
content limits of DON in food and animal feed at an advisory level. [32] In 2003, US published a
patent that is very promising for farmers to produce a trichothecene-resistant crop. [33]
 Zearalenone
 Zearalenols

[edit] Emerging foodborne pathogens

Many foodborne illnesses remain poorly understood. Approximately sixty percent of

outbreaks are caused by unknown sources.[citation needed]

 Aeromonas hydrophila, Aeromonas caviae, Aeromonas sobria

[edit] Preventing bacterial food poisoning

Proper storage and refrigeration of food help in the prevention of food poisoning
Prevention is mainly the role of the state, through the definition of strict rules of hygiene and
a public services of veterinary surveying of animal products in the food chain, from farming
to the transformation industry and delivery (shops and restaurants). This regulation includes:

 traceability: in a final product, it must be possible to know the origin of the ingredients
(originating farm, identification of the harvesting or of the animal) and where and when it
was processed; the origin of the illness can thus be tracked and solved (and possibly
penalized), and the final products can be removed from the sale if a problem is detected;
 enforcement of hygiene procedures like HACCP and the "cold chain";
 power of control and of law enforcement of veterinarians.

In August 2006, the United States Food and Drug Administration approved Phage therapy
which involves spraying meat with viruses that infect bacteria, and thus preventing infection.
This has raised concerns, because without mandatory labelling consumers wouldn't be aware
that meat and poultry products have been treated with the spray. [1]

At home, prevention mainly consists of good food safety practices. Many forms of bacterial
poisoning can be prevented even if food is contaminated by cooking it sufficiently, and either
eating it quickly or refrigerating it effectively[citation needed]. Many toxins, however, are not
destroyed by heat treatment.

[edit] Viruses

Viral infections make up perhaps one third of cases of food poisoning in developed countries.
In the US, more than 50% of cases are viral and noroviruses are the most common foodborne
illness, causing 57% of outbreaks in 2004. Foodborne viral infection are usually of
intermediate (1–3 days) incubation period, causing illnesses which are self-limited in
otherwise healthy individuals, and are similar to the bacterial forms described above.

 Enterovirus
 Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation
period and its ability to spread beyond the stomach and intestines, into the liver. It often
induces jaundice, or yellowing of the skin, and rarely leads to chronic liver dysfunction. The
virus has been found to cause the infection due to the consumption of fresh-cut produce
which has fecal contamination.[34][35]
 Hepatitis E
 Norovirus
 Rotavirus
 Rotavirus

[edit] Parasites

Most foodborne parasites are zoonoses.

 Platyhelminthes:
o Diphyllobothrium sp.
o Nanophyetus sp.
o Taenia saginata
o Taenia solium

The scolex of Taenia solium

o Fasciola hepatica

See also: Tapeworm and Flatworm

 Nematode:
o Anisakis sp.
o Ascaris lumbricoides
o Eustrongylides sp.
o Trichinella spiralis
o Trichuris trichiura
 Protozoa:
o Acanthamoeba and other free-living amoebae
o Cryptosporidium parvum
o Cyclospora cayetanensis
o Entamoeba histolytica
o Giardia lamblia
 Giardia lamblia

o Sarcocystis hominis
o Sarcocystis suihominis
o Toxoplasma gondii

[edit] Natural toxins

Several foods can naturally contain toxins, many of which are not produced by bacteria.
Plants in particular may be toxic; animals which are naturally poisonous to eat are rare. In
evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive
defenses such as poisons and distasteful substances, for example capsaicin in chili peppers
and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised
by the animal, but acquired by eating poisonous plants to which the animal is immune, or by
bacterial action.

 Alkaloids
 Ciguatera poisoning
 Grayanotoxin (honey intoxication)
 Mushroom toxins
 Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
 Pyrrolizidine alkaloids
 Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning,
neurotoxic shellfish poisoning, amnesic shellfish poisoning and ciguatera fish poisoning
 Scombrotoxin
 Tetrodotoxin (fugu fish poisoning)

Some plants contain substances which are toxic in large doses, but have therapeutic
properties in appropriate dosages.

 Foxglove contains cardiac glycosides.

 Poisonous hemlock (conium) has medicinal uses.

[edit] Other pathogenic agents

 Prions, resulting in Creutzfeldt-Jakob disease

[edit] "Ptomaine poisoning"

An early theory on the causes of food poisoning involved ptomaines (from Greek ptōma,
"fall, fallen body, corpse"), alkaloids found in decaying animal and vegetable matter. While
some alkaloids do cause poisoning, the discovery of bacteria left the ptomaine theory
obsolete and the word ptomaine is no longer used scientifically.
Food poisoning

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/001652.htm

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

Causes

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 the normal bacteria from the intestines of an
animal that is being processed
 Water that is used during growing or shipping can contain manure 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 use proper hand washing techniques
 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
sat 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 vegetable or fruit juices and dairy (look for the word "pasteurized")
 Undercooked meats or eggs
 Water from a well or stream, or city or town water that has not been treated

Food poisoning can be caused by:

 BotulismBotulism (Clostridium botulinum)

 CampylobacterCampylobacter enteritis
 CholeraCholera
 E. coli enteritisE. coli enteritis
 Fish poisoningFish poisoning
 Listeria
 Many different viruses
 Staphylococcus aureusStaphylococcus aureus
 SalmonellaSalmonella
 ShigellaShigella
  Yersinia

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 there is more exposure to organisms
that cause food poisoning

Pregnant and breastfeeding women have to be especially careful to avoid food poisoning.
What is food poisoning?

Food poisoning is an unpleasant illness which is caused by eating contaminated food. This
includes food which has been poorly prepared, cooked at the wrong temperature or as a result
of poor hygiene. It can also occur if raw food is stored next to cooked food.

This contamination includes bacteria, viruses, toxins or parasites.

This is a common illness which ranges from relatively mild through to serious, even life
threatening conditions. The degree of severity of food poisoning will depend upon the cause.

Whatever the extent, food poisoning is a horrible illness which most of us have experienced
at some point in our lives.

According to the Food Standards Agency (FSA) there are nearly 900, 000 cases of food
poisoning each year. However, this figure may be higher due to the fact that not every case of
food poisoning is reported.

(Source: NHS Choices: food poisoning)

So, food poisoning is more common than we realise.

Increase in the number of cases of food poisoning

Food poisoning is not only a common illness but one which appears to be on the increase.

Why is this?

There are two reasons for this:

 Changing lifestyles
 Global food market

Changing lifestyles

Our lifestyles have changed over the last few years which include an increasing reliance on
ready prepared meals, eating out rather than cooking and taking more holidays abroad.

We all lead busy lives and as a result of that tend to spend less time preparing and cooking
food. People often cook several meals in advance and freeze them for a long period of time or
buy convenience food which only has to be put in a microwave oven.

Another popular option is buying takeaway meals. It is a quick option with the minimum of
fuss and offers a wide variety of choice.

But with this increased choice and flexibility comes an increase in health risks. Food
poisoning occurs if food is not stored in the refrigerator at the correct temperature or is kept
past its ‘sell by’date. Another problem is when food is reheated even though it is not designed
to be or is not cooked for the right amount of time.
This applies to food bought for consumption at home, from a local fast food outlet or a
restaurant.

Another factor is that women as well as men go out to work which means that they have less
time (and inclination!) to cook a meal. At one time the woman stayed at home and had a meal
ready for her family once they arrived home from work and school but that is less common
nowadays.

If you are tired after a long day at work then the last thing you want to do is to spend hours
preparing a meal when it is so much easier to put something in the microwave.

This combined with the fact that cookery is not as widely taught as it used to be has led to a
decrease in basic cooking skills.

However, there has been a swing back to what are considered old fashioned cooking skills
which is largely due to the current economic climate. People are having to cut back and are
looking at ways of reducing their outgoings which often includes staying in and cooking
rather than eating out or buying ready made meals.

This may reduce the number of food poisoning cases.

Global food market

Another reason is our ‘global village’: we are able to access a greater range of foods than
before which are flown in from all parts of the world.

But these foods are often from countries which have different standards of food safety from
the UK which means that it is easy for bacteria to quickly spread from one host to another.

Many of us have become accustomed to purchasing foods ‘out of season’, for example
strawberries which be bought in winter rather than the summer. We expect to walk into a
supermarket and purchase these foods whenever we want and don’t always give this a second
thought.

But whilst it is ideal to have a wide range of choice there is an increased risk of contracting
food poisoning due to variable food standards.

However there is a trend towards buying locally produced food or foods which are in season
which might help alleviate this problem. Plus this also supports local growers which is
beneficial for the economy.

Knowing where your food is sourced from and the standards of care and safety that have been
applied may help to reduce the incidences of food poisoning.

What causes food to become contaminated?

Many cases of food poisoning can be attributed to poor food hygiene. Food which has not
been properly prepared, cooked or stored becomes a ripe breeding ground for bacteria which
multiply and then release toxins which are absorbed by the body.
These toxins cause the characteristic symptoms of food poisoning which are nausea, stomach
pains, vomiting and diarrhoea. These symptoms develop quickly, often within 48 hours.

This is discussed in more detail in our bacterial food poisoning section.

Contamination and cross-contamination are the two main causes of food poisoning. Both of
these are discussed in greater detail in our causes of food poisoning section.

Food can also be contaminated by viruses and pesticides. Viruses, for example norovirus are
known for causing food poisoning, especially in areas where large numbers of people
congregate, e.g. on board a cruise ship.

Find out more in our viral food poisoning section.

Pesticides are substances sprayed onto crops to protect them against pests, for example
insects or weeds. However, there are risks to health from using these which includes
symptoms of food poisoning.

Find out more in our toxins section of this guide.

To summarise: most but not all cases of food poisoning are caused by infected food.
However, food poisoning can be caused by viruses spread by person to person contact or
close proximity to an infected animal.

Food poisoning also occurs from drinking water which has been infected with bacteria or
parasites such as giardia.

So whilst contaminated food is the most likely cause of food poisoning, do not discount the
possibility of it being caused by a virus, parasite or toxin.
Aspects of food poisoning

 Caused by contaminated food and/or water

 Spread by the consumption of any infected food product
 Causes abdominal pain, nausea, vomiting and diarrhoea
 Can lead to dehydration, kidney failure and reactive arthritis in severe cases.

Food poisoning occurs when a food product is consumed which is contaminated by bacteria.
These bacteria attach themselves to the lining of the intestines and start to multiply. Toxins
are then released which attack cells within this lining that results in the symptoms described
above.

These toxins can be absorbed by the body which may cause problems elsewhere.

So, food poisoning occurs due to the bacteria in the contaminated food and the toxins
produced.

Foods which are likely to cause food poisoning

Food poisoning is caused by the consumption of food which has been contaminated by
bacteria or other similar toxins. However, there are certain foods which carry a greater risk
for food poisoning than others.

These foods include:

 Poultry, e.g. chicken

 Eggs
 Red meat
 Pork
 Cooked rice/pasta
 Coleslaw
 Unpasteurised milk
 Shellfish
 Unwashed fruit and vegetables

Other groups include ready-to-cook foods such as those found in chiller cabinets in
supermarkets. These include pre-packaged sandwiches, cooked meats (e.g. salami), pates and
soft cheeses such as Brie.

A major risk with this group of foods is listeria: this type of bacteria is found within these
foods and is especially risky to pregnant women, babies and people with a weakened immune
system.
Listeria is discussed further in our bacterial food poisoning section.