Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

586 Food Poisoning

Food Poisoning......................................

JAYSHREE MATADIAL, MD and SUZABBE M. MATSUI, MD

history & physical

■Acute illness with gastrointestinal and/or neurologic features: vom-

iting, abdominal pain, diarrhea, headache, parasthesias systemic

symptoms of cholinergic excess, histamine excess, blisters

■Similar symptoms in others who may have shared suspect meal

■Incubation period usually <24 hr

■History of exposure to possibly contaminated food including

roasted, boiled, stewed, steamed, or canned meats, poultry, dairy

products, raw or undercooked foods, seafood, unrefrigerated foods,

water exposure or food that may have been improperly stored or

handled

tests

Basic tests:

■Stool for C&S, O&P (patients with prolonged or inflammatory symp-

toms)

■Blood cultures (if febrile)

■Stool for fecal leukocytes

■Serum for electrolytes to monitor imbalances

■CBC with differential

Specific Diagnostic Tests:

■Endoscopy with biopsy

■Rectal swab (C. perfringens, V. parahaemolyticus, L. monocytogenes,

C. jejuni, E. coli, Salmonella, Shigella)

■Food for bacterial culture (S. aureus, Salmonella, C. botulinum,

Shigella, C. jejuni, E. coli O157:H7, V. parahaemolyticus, V. cholerae)

■Toxin assays of stool and food (C. botulinum)

■Darkfield microscopy of stool (V. cholerae)

■Serotyping (E. coli)

differential diagnosis

■Incubation period <2 hr

➣Predominantly UGI symptoms, nausea, vomiting

➣Heavy metals

➣Chemicals

➣Mushrooms (usually benign: 6–12 hr incubation for amitoxin or

m onomethylhydrazine containing mushrooms)