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Paging Dr. Frischer - Food Poisoning
WRITTEN BY :   Dr. Alan Frischer

A few hours after eating something suspicious, you develop nausea, vomiting, abdominal cramps and diarrhea. You may be suffering from food poisoning. Let’s discuss how it happened, how to get healthy again, and how to prevent it from happening in the future.
Although food poisoning can be deadly, it is quite common and usually mild. It occurs when food or water contains bacteria, viruses, parasites or toxins. Infants and the elderly are at the greatest risk, and travelers to developing countries may experience traveler’s diarrhea (“Montezuma’s revenge”). The Centers for Disease Control (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. Of course, many cases are mild enough that they are never reported; the sufferers stay home and eventually get better without any intervention.
Frankly, when a patient comes to me, I look for the cause only if there’s a particular outbreak, or when the illness is quite severe. The specific cause makes no difference (most of the time) in how I treat it. However, a good reason to be concerned about the source of the food poisoning is to identify whether a particular case needs a specific treatment, or to prevent it from spreading further. This is why government agencies monitor outbreaks.
When a specific infectious cause is found, it’s most often a virus. Noroviruses are a group that causes a mild illness, and the illness is frequently mislabeled “the stomach flu”. This is the most common cause of adult food poisoning, and classic symptoms include nausea, vomiting, abdominal pain, headache, diarrhea, and a low-grade fever. Symptoms appear one to two days following exposure and last for two to three days. It is transmitted through contaminated water, shellfish, and vegetables, and then spread person-to-person from contact with their contaminated feces.
Outbreaks are seen in crowded places like nursing homes, schools and cruise ships.
The second most common virus is the Rotavirus. This causes a moderate to severe illness with vomiting and watery diarrhea and fever after a two-day incubation period. It is the most common cause of food poisoning in infants and children and is transmitted from person to person when fecal matter contaminates food or play areas.
Hepatitis A is actually another infectious form of food poisoning, and is also transmitted when food comes into contact with contaminated feces, or from person to person. It causes a mild illness with sudden onset of fevers, loss of appetite, and a feeling of tiredness followed by jaundice (yellowing of the eyes and skin). These symptoms appear after a three to five week incubation period, making it difficult to trace the source. It resolves completely in nearly all cases.
Among bacterial causes, Salmonella has been well publicized, and causes nausea, vomiting, diarrhea, abdominal cramps, and headaches five to 21 days after exposure. It is transmitted in raw or undercooked foods such as eggs, poultry, dairy products, and seafood.
Campylobacter is the most commonly identified food-borne bacterial infection in the world. It is transmitted by raw poultry, raw milk, and water contaminated by animal feces. Symptoms appear about five days following exposure.
Staphylococcus aureus is a bacterium that produces a toxin in foods such as cream-filled cakes and pies, salads (mainly potato, macaroni, egg and tuna salad), and dairy products. This is the organism responsible for the classic food poisoning at the family picnic. Symptoms appear one to six hours after eating contaminated food.
Escherichia coli (E. Coli) has many strains, with the worst causing kidney failure and death. It is transmitted by raw or undercooked hamburger, un-pasteurized milk or juices, contaminated produce, or contaminated well water. Symptoms appear in two to five days.
Shigella (travelers’ diarrhea) is transmitted in water polluted with…you guessed it: feces. Symptoms appear in 1/2 to three days.
Parasites rarely cause food poisoning. They are swallowed in contaminated or untreated water and cause long-lasting but mild symptoms. Giardia, one of the most common parasites, causes watery diarrhea, one to two weeks after exposure, and typically lasts for one to two weeks. It is found in contaminated water from lakes or streams in cool mountain climates. It can also be spread from person to person by food or other items contaminated with feces.
What can you do at home if you develop food poisoning?
•Start by taking small, frequent sips of clear liquids in order to stay hydrated
•Avoid alcohol or caffeinated beverages. Gatorade-type drinks are a good choice, but are best diluted with water, as heavily sugared fluids can worsen diarrhea. If you are taking diuretic medications, you may need to stop them – but only after consulting with your doctor.
•Avoid eating solid foods. After any vomiting and diarrhea have stopped, begin with the standard “BRAT” diet: Bread, Rice, Applesauce, dry Toast, crackers, gelatin, pudding, yogurt, and soup broth. Over-the-counter anti-diarrhea medications, such as Imodium AD and Pepto-Bismol, are generally helpful and safe when used as directed. Consult your physician for advice.
When is it time to seek out medical care?
•The nausea, vomiting, or diarrhea lasts for more than two days without improvement
•The patient is under three years old
•There is an accompanying fever
•The illness begins after foreign travel
•The infected person cannot keep liquids down
•The patient has a chronic disease as well
•The symptoms make it impossible to take normal prescribed medications
There are associated neurological symptoms such as weakness, double vision, slurred speech, or difficulty swallowing.
If you do see a doctor, the focus is generally on getting re-hydrated. You may be given anti-vomiting and anti-diarrhea medications, and any fever will be treated. Sometimes, antibiotics will be prescribed, but remember that many forms of food poisoning are viral, and antibiotics will be of no help!
Prevention is the key when it comes to food poisoning.
•Shop safely. Bring refrigerated foods home quickly, don’t buy torn or leaking packages, and don’t buy foods past their “sell-by” or expiration date.
•Store foods safely. If a food requires refrigeration, put it away immediately. Place raw meat, poultry, and fish in the coldest part of your refrigerator. Check your refrigerator’s temperature: it should be set to 40 degrees, and the freezer to zero degrees. Cook or freeze fresh poultry, fish, and meats within two days.
•Thaw foods safely. The refrigerator allows slow, safe thawing. Prevent the thawing juices from dripping onto other foods. To quick-thaw, place the food in a leak-proof plastic bag and submerge it in cold tap water. When thawing in a microwave, cook meat and poultry immediately afterwards.
•Prepare your food safely. Keep everything very clean: wash your hands, cutting board, knife, and counter tops with hot, soapy water before and after handling raw meat and poultry, and sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart water. Do not cross-contaminate: keep raw meat, poultry, fish, and their juices away from other food. Marinate meat and poultry in a covered dish in the refrigerator, and then discard any uncooked or unused marinade.
•Cook foods safely, and use a meat thermometer. Cook ground meats to 160 degrees, ground poultry to 165 degrees, beef, veal, and lamb steaks, roasts and chops to 145 degrees, and whole poultry to 170 to 180 degrees. Bacteria grow rapidly at room temperature, so never leave food out for more than two hours, and use cooked leftovers within four days.
•Of course, not all of the food we eat is under our control. The Center for Science in the Public Interest (CSPI) reports that on a typical day, 44% of American adults eat at a restaurant, and that 41% of all food borne illness outbreaks can be traced to restaurant food. A single food safety mistake in a restaurant can cause far more illnesses than a single mistake in our kitchen at home. Choose your restaurants carefully.
•You’ve probably gathered that, when discussing food poisoning, the two key words are feces and hands! Wash your hands often and carefully, and enjoy your good, contamination-free food.

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Published: April 9, 2010 – Volume 8 – Issue 51



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