Food Poisoning
The 5 Minute Pediatric Consult
Timothy A.S. Sentongo and Andrew E. Mulberg
DEFINITION
Rapid onset of diarrhea, vomiting, and fever 12 to 72 hours after the ingestion of contaminated food
CAUSES
PATHOLOGY
- Ingestion of preformed toxin
- Elaboration of toxin from bacteria into the gastrointestinal tract
- Direct invasion of mucosa by bacteria
EPIDEMIOLOGY
At least 300 outbreaks of food-borne disease are reported each year.
INFECTION
- Parental infections:
- Upper respiratory tract
- Urinary tract infections
- Otitis media
- Escherichia coli
- Vibrio
- Clostridium difficile
- Yersinia enterocolitica
- Aeromonas hydrophilia
- Giardia lamblia
- Entamoeba histolytica
- Rotavirus
- Campylobacter jejuni, most common
- Listerosis
- Vibriosis
- Yersinia
FOOD INTOLERANCE/FOOD ALLERGIES
- Cow’s milk protein allergy
- Carbohydrate intolerance (most common is lactose)
MISCELLANEOUS
- Use of antibiotics
- Malnutrition
- Altered mucosal structure
- Defective disaccharidase activity
- Abnormal motility
- Changed intestinal bacterial flora
DIETARY MANIPULATIONS
- Hyperosmolar formulas
- Food additives (dyes, processing materials, coloring)
- Caffeine
- Overfeeding
- Low fat intakes (especially during recovery phase)
- Excessive fluids
HISTORY
- Outbreak of illness following ingestion of a meal
- Others in family with similar symptoms
- Time of onset of vomiting after ingestion—relates to type of bacterial toxins (see the table Clinical Aspects of Food Poisoning in Section VIII of this book)
- E. coli, Campylobacter, and Salmonella are more frequent in summer months
- See table Clinical Aspects of Food Poisoning in Section VIII of this book.
- Botulism
- Severity related to host susceptibility and to amount of toxin ingested
- Disease may be so mild that consultation is not obtained; in other cases, it is fatal within a few hours.
- Generalized hypotonia
- Absent deep tendon reflexes
- Dilated, reactive pupils
- Poor suck
- Decreased to absent gag reflex
- Ptosis
TESTS
- Isolation of the organism from stools and the suspected food
- Demonstrating the toxin in the suspected food
- Identifying 105 organisms per gram of suspected food
- Finding 106 organisms or spores per gram of patient’s stool or vomitus
- Lesions on the hands of food handlers may be the source of contamination and should be cultured.
Botulism
- Toxin in stools is diagnostic.
- Stool culture for Clostridium botulinum
- Electromyography with repetitive stimulation
- Lumbar puncture to exclude other diagnoses
Enterohemorrhagic E. coli 0157:H7
- No specific treatment
- Intramuscular antiemetics
- If clinically dehydrated, rehydration can be accomplished in 4 to 6 hours, using an oral solution containing 75 to 90 mEq Na/L.
- IV fluids for patients unable to be rehydrated via the oral route (because of ileus, circulatory failure, CNS complications), or with stool losses greater than 10 mL/kg/hr
- Most foods (except for lactose) should be tolerated in the pediatric patient recovering from food poisoning.
- The “BRATT” diet (bananas, rice, applesauce, toast, tea) is inappropriate for the management of acute diarrheal episodes, due to low calorie, protein, and fat contents.
- A balanced, varied diet, providing easily digestible, complex carbohydrates, will promote increased stool consistency.
DRUGS
Antibiotics
Salmonella
- Not used in patients with uncomplicated gastroenteritis
- Does not shorten the duration of the disease
- Can prolong the duration of excretion of Salmonella organisms
- Antimicrobial therapy is warranted for Salmonella gastroenteritis occurring in patients with an increased risk of invasive disease and other complications:
- Infants under 3 months of age
- Patients with malignancies
- Hemoglobinopathies
- AIDS
- Recipients of immunosuppressive therapy
- Persons with chronic gastrointestinal tract disease
- Patients with severe colitis
- Ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, cefotaxime, or ceftriaxone is recommended for susceptible strains in patients for whom therapy is recommended.
Botulism
- Supportive care
- Monitor cardiac and respiratory function.
- Endotracheal intubation and assisted ventilation
- Avoid aminoglycosides.
PROGNOSIS
- Most gastroenteritis secondary to food poisoning is mild and self-limited.
- Recovery is complete in 2 to 5 days in most individuals.
- In the very young, the prognosis is more guarded, because these patients can become dehydrated quickly.
- Once the patient has survived the paralytic phase of botulism, the outlook for complete recovery is excellent.
PREVENTION
- Parenteral vaccines are not recommended for use in children.
- Botulism in infants, 1 year:
- Wash objects placed in infants’ mouths (pacifiers, toys, etc.).
- Wash or peel skin of fruits and vegetables.
- Avoid honey.
| COMMON QUESTIONS AND ANSWERS |
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Q: What are the most common causes of food poisoning?
A: Bacteria (Salmonella, Staphylococcus).
Q: How are the signs and symptoms of food poisoning different from a viral gastroenteritis?
A: The signs and symptoms of food poisoning and gastroenteritis are similar in that the patient displays diarrhea, vomiting, and fever. Usually, food poisoning occurs after ingestion of a meal, at which time several people can be affected.
Q: Which foods are most likely to be contaminated?
A: Dairy products that are not refrigerated properly and meat that is not cooked at high enough temperatures.
ICD-9-CM 005.9
Salmonella infections, staphylococcal infections. In: Peter G, ed. 1994 Red book: report of the Committee on Infectious Diseases, 23rd ed. Elk Grove Village, IL: American Academy of Pediatrics, 1994: 412, 423.
Todd EC. Epidemiology of food-borne diseases: a worldwide review. World Health Stat Q 50(1–2):30–50.
Wolfle J. Kowalewski S. Epidemiology of ingestions in a regional poison control center over twenty years. Vet Hum Toxicol 1995;37(4):367–368.
Copyright © 2000 Lippincott Williams & Wilkins
M. William Schwartz, Louis M. Bell, Jr., Peter M. Bingham, Esther K. Chung, David F. Friedman and Andrew E. Mulberg, The 5 Minute Pediatric Consult