Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Most times, the diagnosis of food poisoning is made by history and physical
examination. Often, the patient volunteers the diagnosis when they come for
medical care. For example, "I got sick after eating potato salad at a picnic" or "I
drank a raw egg protein shake".
The health care practitioner may ask questions about the symptoms, when they started, and
how long they have lasted. A review of systems may help give direction as to
what type of infection is present. For example, a patient with
numbness of their
feet and weakness may be asked about whether they have opened any home canned
food recently.
Travel history may be helpful to see if the patient had been
camping near a stream or lake and the potential for drinking contaminated water,
or if they have travelled out of the Country recently and have eaten different
foods than they normally do, for example, did the patient eat raw eggs or wild
game?
Physical examination begins with taking the vital signs of the patient (such
as blood pressure,
pulse rate and temperature). Clinical signs of dehydration include dry, tenting
skin, sunken eyes, dry mouth, and lack of sweat in the armpits and groin. In
infants, in addition to the above subtle signs of dehydration may include poor
muscle tone, poor suckling, and sunken fontanelle.
Routine blood tests are not usually ordered unless there is concern about
something more than the vomiting and diarrhea. In patients with significant
dehydration, the health care practitioner may want to check electrolyte levels in the blood
as well as kidney function. If there is concern about hemolytic uremic syndrome,
a complete blood count (hemogram, CBC) to check the red
blood cells, white blood cells, and platelet count may be
ordered. If there is concern about hepatitis,
liver function tests may be
ordered.
Stool samples may be useful especially if there is concern about infections caused by
Salmonella, Shigella and Campylobacter, the common
non traveler's diarrhea This is especially true when the patient presents with bloody
diarrhea, thought to be due to infection. If there is concern about a parasite infection, stool samples can be examined also for the presence of parasites.
Depending on the
suspected cause of the food poisoning, there are some immunological tests (for
example, detection of Shiga toxins) that the CDC recommends. Other methods may
be used (for example, detection of prions in tissue samples).
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Norovirus infection causes stomach flu, or gastroenteritis. It's a very contagious illness with symptoms that include nausea and vomiting, diarrhea, stomach cramps, fever, headache, chills, and muscle aches. Norovirus infection cannot be treated with antibiotics, so treatment focuses on maintaining proper hydration.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Botulism is an illness caused by a neurotoxin produced by the bacterium Clostridium botulinum. There are three types of botulism: food-borne, wound, and infant. Symptoms include muscle paralysis, dry mouth, constipation, slurred speech, and blurred vision. If food-borne and wound botulism are detected early enough, they may be treated with an antitoxin. Infant botulism is treated intravenously with BabyBIG (Botulism Immune Globulin).
Listeria is a type of bacteria that can cause food poisoning. Listeriosis symptoms include diarrhea, nausea and fever. Pregnant women are 20 times more likely than other healthy adults to get listeriosis. Listeria infection is treated with antibiotics.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Trichinosis is a food-borne disease caused by ingesting parasites (roundworms) in undercooked pork or wild-game meat. Symptoms of trichinosis include diarrhea, nausea, muscle aches, itching, fever, chills, and joint pains. Trichinosis usually resolves without treatment, but more severe cases are treated with thiabendazole, albendazole, or mebendazole.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Brucellosis is an infectious disease caused by the Brucella bacteria. Symptoms and signs include sweating, fever, fatigue, dizziness, headache, cough, chest, joint, and abdominal pain, and enlarged liver and/or spleen. Brucellosis is treated with antibiotics.
Anthrax is a deadly infectious disease that may be transmitted to humans by infected animals or by biological warfare. There are three types of anthrax: cutaneous, inhalation, and gastrointestinal. Symptoms of cutaneous anthrax include a swollen glands, muscle ache, headache, fever, nausea, vomiting, and a red-brown raised spot that enlarges, blisters, and hardens, forming an ulcer crater with black crust. Symptoms of inhalation anthrax are flulike and may progress to respiratory distress, shock, coma, and death. Symptoms of gastrointestinal anthrax include loss of appetite, bloody diarrhea, and abdominal pain. Treatment for cutaneous anthrax involves penicillin, tetracycline, erythromycin, and ciprofloxin. Inhalation anthrax necessitates treatment with IV therapy with antibiotics.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Cryptosporidiosis is an intestinal disease caused by the Cryptosporidium parasite. Symptoms include watery diarrhea, stomach cramps, nausea and vomiting, fever, weight loss, dehydration, and weight loss. Antibiotics are used in the treatment of cyptosporidiosis.
Cysticercosis is an infection caused by Taenia solium, the pork tapeworm. Symptoms include seizures, lethargy, nausea and vomiting, headache, vision changes, weakness, and confusion. Treatment depends upon the individual's symptoms and the stage of the infection. Treatment may incorporate anthelmintics, corticosteroids, anticonvulsants, and/or surgery.
Enterovirulent Escherichia coli (E. coli) are strains of related bacteria that have a strong propensity to cause gastrointestinal tract infections. Examples of strains include: EHEC (enterohemorrhagic E. coli), ETEC (enterotoxigenic E. coli), EPEC (enteropathogenic E. coli), EIEC (enteroinvasive E. coli), EAEC (enteroadherent E. coli), and EAggEC (enteroaggregative E. coli). Symptoms may vary depending on the strain the individual contracts. Infection is spread generally through contaminated food or drink.
Mad cow disease (or bovine spongiform encephalopathy [BSE]) is a fatal disease that attacks the central nervous system of adult cattle. Though the specific cause isn't known, it is speculated that infectious prions are the likely cause. Creutzfeldt-Jacob disease is found in people and is similar to BSE. A variation of this disease is thought to be caused by eating beef products from BSE-infected cattle.
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