eMedicine Specialties > Gastroenterology > Systemic Disease
Food Poisoning: Follow-up
Updated: Nov 18, 2009
Follow-up
Further Outpatient Care
- Because most cases of food poisoning are self-limited, prolonged follow-up care is not required.
- Stool cultures should be monitored in individuals working in hospitals, food establishments, and daycare centers and who are infected with E coli O157:H7 or Salmonella or Shigella organisms until they become culture-negative without antibiotics. These people should not return to work until that time.
Deterrence/Prevention
- Food poisoning caused by infectious agents is prevented by the following:
- Strict personal hygiene
- Adequate cooking
- Avoidance of cross-contamination of raw and cooked foods
- Keeping food at appropriate temperatures (ie, <40°F for refrigerated items and >140°F for hot items)
- Proper maintenance of vending machines and avoidance of acidic beverages in metallic containers prevent heavy metal poisoning.
- Avoiding eating wild mushrooms prevents mushroom poisoning.
- Prevention of fish poisoning requires avoidance of large tropical fish (ciguatera poisoning) and compliance with seasonal or emergency quarantines of shellfish harvesting areas (shellfish poisoning).
- Raw or undercooked milk, poultry, eggs, meat, and seafood are best avoided.
- Local health authorities should be notified if an outbreak of food poisoning occurs. This leads to appropriate actions to prevent further spread of food poisoning.
- Irradiation of food (ie, the use of ionizing radiation or ionizing energy to treat foods, either packaged or in bulk form) can eliminate food-borne pathogens.
- Annually, more than half a million tons of food is now irradiated worldwide.
- Treating raw meat and poultry with irradiation at the slaughter plant could eliminate bacteria, such as E coli O157:H7 and Salmonella and Campylobacter organisms.
- No evidence of adverse health effects is found in the well-controlled clinical trials involving irradiated food.
- Traveler's diarrhea
- Prophylaxis is not recommended routinely because of the risk of adverse effects from the drugs (eg, rash, anaphylaxis, vaginal candidiasis) and the development of resistant gut flora.
- Possible regimens for prophylaxis include bismuth subsalicylate (Pepto-Bismol, 524 mg PO qid with meals and qhs), doxycycline (100 mg PO qd; resistance documented in many areas of the world), TMP/SMX (160 mg/800 mg 1 double-strength tab qd), or norfloxacin (400 mg PO qd; fluoroquinolones should not be prescribed to children or pregnant women). No significant resistance to the fluoroquinolones has been reported in high-risk areas, and they are the most effective antibiotics in regions where susceptibilities are not known.
Complications
- Complications are very rare in healthy hosts, except in cases of botulism or mushroom poisoning. Infants, elderly people, and immunocompromised hosts are more susceptible to complications. Other complications include the following:
- Guillain-Barré syndrome (Campylobacter infection)
- Reactive arthritis
- Hemolytic uremic syndrome (E coli O157:H7)
- Irritable bowel symptoms may follow acute gastroenteritis.
Patient Education
- For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center and Public Health Center. Also, see eMedicine's patient education articles Food Poisoning, Abdominal Pain in Adults, Vomiting and Nausea, Diarrhea, Traveler's Diarrhea, and Foreign Travel.
More on Food Poisoning |
| Overview: Food Poisoning |
| Differential Diagnoses & Workup: Food Poisoning |
| Treatment & Medication: Food Poisoning |
Follow-up: Food Poisoning |
| References |
| Further Reading |
| « Previous Page |
References
Hughes JM, Angulo FJ. Food borne diseases. In: Hurst JW, ed. Medicine for the Practicing Physician. 4th ed. Appleton & Lange: Stamford, Conn; 1996:344-7.
Smith JL. Foodborne illness in the elderly. J Food Prot. Sep 1998;61(9):1229-39. [Medline].
Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--10 States, 2008. MMWR Morb Mortal Wkly Rep. Apr 10 2009;58(13):333-7. [Medline]. [Full Text].
Surveillance for foodborne disease outbreaks - United States, 2006. MMWR Morb Mortal Wkly Rep. Jun 12 2009;58(22):609-15. [Medline]. [Full Text].
Jacobs RA. General problems in infectious diseases: acute infectious diarrhea. In: Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment 2001. 40th ed. New York, NY: McGraw-Hill; 2000:1215-6.
Xerry J, Gallimore CI, Iturriza-Gómara M, Gray JJ. Tracking the transmission routes of genogroup II noroviruses in suspected food-borne or environmental outbreaks of gastroenteritis through sequence analysis of the P2 domain. J Med Virol. Jul 2009;81(7):1298-304. [Medline].
Malek M, Barzilay E, Kramer A, Camp B, Jaykus LA, Escudero-Abarca B, et al. Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005. Clin Infect Dis. Jan 1 2009;48(1):31-7. [Medline].
Archer DL. Incidence and cost of foodborne diarrheal disease in the United States. J Food Prot. 1985;48:887-94.
Butterton JR, Calderwood SB. Acute infectious diarrheal diseases and bacterial food poisoning. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2001:834-9.
Gianella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Vol 2. 2006:2333-91.
Sherman PM, Wine E. Emerging intestinal infections. Gastroenterology & Hepatology Annual Review. 2006;1:50-54. [Full Text].
Further Reading
Clinical guidelines
Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals.
American Medical Association - Medical Specialty Society
Center for Food Safety and Applied Nutrition - Federal Government Agency [U.S.]
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Food Safety and Inspection Service - Federal Government Agency [U.S.]. 2001 Jan (revised 2004 Apr 16). 33 pages. NGC:003593
Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2006 Aug 11 (revised 2009 Feb 6). 25 pages. NGC:007073
Clinical trial
Study of Human Botulism Immunoglobulin in Infants With Botulism
Related eMedicine topics
Food Poisoning (Pediatrics: General Medicine)
Gastroenteritis, Bacterial
Gastroenteritis, Viral
Botulism
CBRNE - Staphylococcal Enterotoxin B
Keywords
food poisoning, gastroenteritis, botulism, Salmonella, E coli, cholera, Norovirus, enterotoxins, Vibrio cholerae, Escherichia coli, Clostridium perfringens, Bacillus cereus, Staphylococcus, Giardia lamblia, Cryptosporidium, Norwalk virus, foodborne illness, Campylobacter jejuni, Vibrio parahaemolyticus, Yersinia enterocolitica, Clostridium difficile, Entamoeba histolytica, Shigella, tenesmus, shigellosis
Follow-up: Food Poisoning