eMedicine Specialties > Gastroenterology > Systemic Disease

Food Poisoning: Follow-up

Author: Roberto M Gamarra, MD, Fellow, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Providence Hospital and Medical Center
Coauthor(s): David M Manuel, MD, Fellow, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital and Medical Center; Michael H Piper, MD, FACG, FACP, Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates PLC; Senthil Nachimuthu, MD, Fellow, Section of Cardiology, Department of Medicine, Tulane University School of Medicine; Priyankha Balasundaram, MD, Faculty, Tulane University School of Medicine; Director, Kovai Heart Foundation, Columbatore, India
Contributor Information and Disclosures

Updated: Apr 22, 2008

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

 


More on Food Poisoning

Overview: Food Poisoning
Differential Diagnoses & Workup: Food Poisoning
Treatment & Medication: Food Poisoning
Follow-up: Food Poisoning
References
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References

  1. 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.

  2. Smith JL. Foodborne illness in the elderly. J Food Prot. Sep 1998;61(9):1229-39. [Medline].

  3. 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.

  4. Archer DL. Incidence and cost of foodborne diarrheal disease in the United States. J Food Prot. 1985;48:887-94.

  5. 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.

  6. Gianella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Vol 2. 2006:2333-91.

  7. Sherman PM, Wine E. Emerging intestinal infections. Gastroenterology & Hepatology Annual Review. 2006;1:50-54. [Full Text].

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Further Reading

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Contributor Information and Disclosures

Author

Roberto M Gamarra, MD, Fellow, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Providence Hospital and Medical Center
Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America
Disclosure: Nothing to disclose.

Coauthor(s)

David M Manuel, MD, Fellow, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital and Medical Center
David M Manuel, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society of Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America
Disclosure: Nothing to disclose.

Michael H Piper, MD, FACG, FACP, Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates PLC
Michael H Piper, MD, FACG, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Senthil Nachimuthu, MD, Fellow, Section of Cardiology, Department of Medicine, Tulane University School of Medicine
Senthil Nachimuthu, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Priyankha Balasundaram, MD, Faculty, Tulane University School of Medicine; Director, Kovai Heart Foundation, Columbatore, India
Disclosure: Nothing to disclose.

Medical Editor

Jose A Perez, Jr, MD, MSEd, Director of Medical Education, Residency Program Director, Associate Professor, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Kern Medical Center
Jose A Perez, Jr, MD, MSEd is a member of the following medical societies: American College of Physician Executives and American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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