and More, about Food Poisoning
There are more than 250
types of food poisoning. It’s no wonder that one in six Americans
gets food poisoning every year.
The causes of foodborne
illness range from amebiasis and anthrax to vibrio and yersinia.
They include bacteria, viruses, pesticides, natural toxins, molds,
parasites, and more. But most people don’t want an encyclopedia of
food poisoning (though such things exist). They just don’t want to
Here are some Frequently
Asked Questions about foodborne illness:
What foods cause the
most cases of food poisoning?
The foods most often
involved in cases of food poisoning are leafy vegetables, dairy,
fruits and nuts, poultry, vegetables that grow on vines or stalks,
beef, eggs, pork, grains and beans, and root vegetables.
The foods most often
involved in food poisoning deaths are poultry, dairy, vegetables
that grow on vines or stalks, fruits and nuts, leafy vegetables,
pork, eggs, fish, and beef.
Who gets food poisoning?
Anyone who eats
contaminated food is at risk. Food poisoning is especially dangerous
for some groups of people, though:
infants and young children;
people with chronic health conditions;
people with a weak immune system, for
example those with cancer, AIDS, diabetes, liver disease, or
What are the symptoms of food poisoning?
Most types of food poisoning cause
gastrointestinal (GI) symptoms. These include nausea/upset
stomach, stomach cramps, vomiting, and diarrhea.
One of the dangers of food poisoning is
dehydration. Vomiting and diarrhea cause the body to lose a lot
of fluid. If someone loses too much fluid, abnormal blood
chemistry follows. This can cause weakness, tiredness, even an
irregular heartbeat. Dehydration is especially serious for
children and the elderly.
Depending on the type of food poisoning,
other symptoms are possible.
What are the most common
causes of food poisoning?
Here are common causes of
food poisoning in the US.
causes about 5.5 million illnesses every year.
Found in many
foods, including raw produce, contaminated drinking water,
shellfish from contaminated water, and food contaminated by a
food handler and then not reheated.
nausea, vomiting (especially in children), diarrhea
(especially in adults), fever, and headache.
about 12 – 48 hours after eating contaminated food and last
for about 12-60 hours.
Salmonella causes about 1
million illnesses every year. Salmonella is the leading
cause of hospitalization and of death due to foodborne illness.
Found in many
foods, including unpasteurized milk or juice, cheese, eggs,
poultry, contaminated raw produce, and peanut butter.
fever and abdominal pain, vomiting, and diarrhea.
about 6 – 48 hours after eating contaminated food and last
for about 4-7 days.
perfringens causes about 970,000 illnesses every year.
Found in meats,
poultry, gravy, and other foods kept at room temperature too long.
severe abdominal pain and watery diarrhea.
about 8-16 hours after eating contaminated food and last for
about 24 hours.
causes about 850,000 illnesses every year. It is most common
in children under 5 years old.
Found in poultry
(raw or undercooked), unpasteurized milk, and contaminated
fever, vomiting and diarrhea (which may be bloody), and
Symptoms begin in
2-5 days and last from 2-10 days.
go away on their own, but some people develop arthritis or a
neurological condition called Guillain-Barré syndrome.
causes about 240,000-250,000 illnesses every year, although most
of those aren't foodborne.
Found in dairy
products (milk, ice cream, cream, custard), eggs, potato
salad, egg salad, shrimp salad, ground ham, and rice pudding.
Illness is usually spread by food handlers and usually
results from foods left at room temperature for too long.
sore throat, pain while swallowing, fever, headache, nausea
and vomiting, even a rash and symptoms of rheumatic fever.
Symptoms are usually not severe in healthy people, but
Streptococcus infections can be dangerous for elderly
people or those with a major health condition.
begin in 1-3 days and begin to clear up in about four days.
Onset and recovery are delayed for people who develop
is one of a few foodborne illnesses for which antibiotics
causes about 130,000 illnesses every year. (Shigella is
sometimes called “bacillary dysentery”.)
Found in raw
produce, uncooked foods, contaminated water, and cooked
foods that are not reheated after being touched by an
infected food handler.
fever, stomach cramps, and diarrhea, which may contain blood
Symptoms begin in
about 4-7 days and last about 1-2 days.
E. coli (O157,
non-O157, and other types) causes more than
200,000 illnesses every year.
enterocolitica causes nearly 100,000 illnesses every
pork (including chitterlings) and other meats, unpasteurized
milk, oysters, fish and crabs; also, infected food handlers.
stomach pain, diarrhea, and high fever, sometimes with
vomiting. Bloody diarrhea is possible.
Symptoms begin in
24 hours, or as long as 2 weeks or more. They may resolve on
their own within a few days to 3 weeks. Some people get
joint pains and rashes which may take months to resolve.
gondii causes about 87,000 illnesses every year and is
the second leading cause of death due to foodborne illness.
undercooked contaminated meat, unwashed fruits and
vegetables, and contaminated water. This parasite can
sometimes be found in cat feces and soil; it is essential to
wash hands after handling litter boxes or gardening.
fever, headache, muscle aches, rash, and damage to the eyes
or brain. Many people who are infected have no symptoms at
all. Infected pregnant women can pass the illness to their
children, who in rare cases may be born with brain or eye
In some cases,
symptoms never occur. If they do, they may last for weeks.
Illness can occur many years after exposure.
intestinalis causes about 77,000 illnesses every year.
a parasite that lives in the intestinal tract of humans and
animals. Sources include any food, water, or surfaces that
stomach cramps, nausea, gas, and diarrhea. Some people have
begin in 1-3 weeks and last for 2-6 weeks.
causes about 58,000 illnesses every year.
contaminated water or food and food touched by an infected
watery diarrhea, nausea and stomach cramps, and a low fever.
Symptoms begin in
2-10 days and may last for weeks or months. Apparent
recovery can be followed by a relapse.
causes about 63,000 illnesses every year.
meats, stews, rice products and starchy foods, milk, fish,
nausea, stomach cramps, and watery diarrhea.
within 10-16 hours and last for 24-48 hours.
What is botulism?
Botulism is a rare but
dangerous type of foodborne illness. Botulism is caused by bacteria,
Clostridium botulinum. These bacteria produce spores.
Botulism spores are found in soil, sediment in bodies of water, and
in a number of animals. Under the right conditions, sealed off
without oxygen, the spores then produce a toxin. Botulism toxin
affects the nervous system.
In the US, there are about
145 reported cases of botulism each year. About 15 percent are
foodborne botulism. About 65 percent are infant botulism. About 20
percent are wound botulism. (Wound botulism is not caused by eating
Infant botulism and
foodborne botulism have different sources, but effects and
treatment are the same.
usually is caused by improperly canned food. Most often, home
canned food is involved, but sometimes it’s from a commercial
muscle paralysis. Usually, it starts with droopy eyelids,
blurred vision, double vision, dizziness, and weakness. As
paralysis moves down the body, breathing muscles may be
Infant botulism is
often caused by giving honey to children under 12 months of age.
Early symptoms of
infant botulism include constipation, poor feeding, a lot of
drooling because of trouble swallowing, floppy muscles, and
Treatment of botulism
includes helping the person breathe and giving antitoxin. About
10 – 15 percent of victims will die without treatment.
muscles are paralyzed, a ventilator is needed. It may be
needed for weeks to months.
There is an
antitoxin for botulism poisoning. It must be requested from
the CDC, which will ship it to the treating hospital.
What about mushroom
Some mushrooms are
poisonous, even if they are not contaminated by bacteria, viruses,
Many kinds of wild mushrooms are poisonous to humans and to
pets. Without special training, there is no reliable way to tell
the safe ones from the harmful ones.
Symptoms depend on
the type of mushroom. Possible symptoms include nausea,
vomiting, diarrhea, hallucinations, coma, kidney damage,
liver damage, and death.
Symptoms from the
least dangerous poisonous mushrooms usually begin within
minutes to a few hours. The most dangerous mushrooms don’t
cause effects for at least several hours.
information about wild mushrooms, read “Don’t
Invite ‘The Death Angel’ to Dinner!”, an article from a
previous edition of The Poison Post®.
Do fish cause foodborne illness?
The puffer fish may be
poisonous, even if it’s not spoiled by bacteria or viruses. Some
fish and shellfish swallow toxins, so their flesh is poisonous to
eat. Others cause illness because of spoilage, even though there are
no clues that the fish is spoiled.
also known as blowfish or fugu: Parts of these fish
contain a poison called tetrodotoxin. In some cases, the poison
is found only in certain organs, for example the liver and skin.
In others, tetrodotoxin is found in the meat itself. It takes an
expert to tell which is which. Tetrodotoxin is also found in
some frogs, newts, horseshoe crabs, starfish, and blue-ringed
octopus (which inject the poison while biting). Very small
amounts can be fatal.
considered a delicacy by some BUT the fish must be cut in
just the right way. If not, poison can be transferred from
the dangerous organs to the meat. The unsuspecting diner can
be poisoned, even fatally. The only puffer fish that can be
legally imported is the “tiger puffer”, Takifugu rubripes,
from Japan. The fish must be cut by an expert.
with numbness of the lips and tongue, followed by nausea,
vomiting, and trouble walking. Paralysis can follow, along
with seizures, trouble breathing, and an irregular
heartbeat. If the breathing muscles become paralyzed, the
victim will die without a ventilator.
Symptoms can begin
in about 20 minutes. Death can occur within 20 minutes to 8
hours. If a victim survives for about 24 hours, he or she is
likely to recover. There is no antidote for tetrodotoxin;
victims are treated according to their symptoms.
is formed by some kinds of dinoflagellates that live in warm waters. Small
fish that eat these microorganisms are eaten by larger fish, those fish
eaten by yet larger fish, and so on. The accumulated ciguatoxin
in reef fish makes the flesh of the larger fish poisonous to
people who eat them.
Some of the fish
that commonly contain ciguatoxin are barracuda, grouper, large snappers, and amberjack and other large
jacks. These fish are found in warm water around the US,
including southern Florida, the Bahamas, the Virgin Islands,
Puerto Rico, and Hawaii.
There are no clues
to a fish with ciguatoxin. It will look, smell, and taste
the same as a fish that’s not contaminated.
There is no way to
remove ciguatoxin from fish.
The most unusual
symptom is hot-cold reversal: hot things feel cold to the
touch, cold things feel hot. Other symptoms include numbness
and tingling, itching, muscle aches,
headache, dizziness, and muscle weakness. Nausea, vomiting, and diarrhea may occur. Low
blood pressure, high or low pulse rate, and an irregular
heartbeat may also develop.
begin within 6 hours and may last for weeks or months.
Sometimes, symptoms last for years.
Be sure to call
the poison center if you experience these symptoms a few
hours after eating fish. Many doctors are not familiar with
this kind of foodborne illness but the poison center experts
has become a common cause of foodborne illness in the U.S.
Vibrio vulnificus is a bacterium that rarely causes
illness but can be fatal if it does. Vibrio
parahaemolyticus is a related bacterium that has much in
common with Vibrio vulnificus. They are found in coastal
areas, in warm salty water. Humans can be poisoned by eating
fish or shellfish that eat Vibrio, or by drinking
contaminated water. (Vibrio cholerae is a related but
different bacterium that causes the illness cholera.)
The most common
sources are oysters, clams, and shrimp. (It is NOT true that
eating oysters only in months with the letter “R” will
prevent this illness!)
gastrointestinal, including bloody diarrhea, vomiting,
and cramping. Fever is common. In people with a compromised
immune system, for example, people with cancer, AIDS,
diabetes, or liver or kidney disease, the bacteria may enter
the bloodstream and cause septicemia, a severe or fatal
within hours to days. Victims with GI symptoms alone usually
recover quickly. Victims who develop septicemia may die
fish poisoning looks like an allergic reaction. Some fish
develop high levels of histamine if they’re not refrigerated
properly. (Histamine is what causes other allergic symptoms, to
pollen or foods, for example.) Histamine has no odor or taste,
so the fish could taste normal.
include tuna, bluefish, amberjack, marlin, and mahi mahi,
among others. The problem occurs only when the fish are not
refrigerated at any time from when they’re caught until they
are prepared and served.
begin with a red, flushed face. A bad headache, itching, and
blurred vision may follow, along with diarrhea and stomach
quickly, within a few minutes to an hour. Treatment is with
antihistamines. Usually, the victim feels better within
about 12 hours.
How does food become contaminated?
Food can become
contaminated at many points from its origin to your table. Here are
just a few:
It might be
contaminated from the beginning. For example, a chicken with
infected reproductive organs can lay eggs containing salmonella.
Fish feeding in contaminated water might have contaminated
flesh. Vegetables irrigated with contaminated water, or grown
near livestock, may have organisms on the surface.
chemicals could somehow find their way into or onto food.
Watermelons contaminated with the pesticide aldicarb sickened
Food could be washed
or handled in a contaminated environment. Contaminated
cantaloupe caused a recent outbreak of foodborne illness.
Food could be
processed in a contaminated facility. This was the case with the
recent peanut butter recall.
techniques might not be used. For example, unpasteurized dairy
products (raw milk, raw milk cheese) and fruit juices have
caused illness. Meat processing plants must prevent organisms on
animal hides from reaching the meat.
Food handlers can
contaminate food. This can happen if they are ill, if they don’t
wash their hands often enough or after using the bathroom, or if
they have a cut or sore on their hands.
Foods might not be
refrigerated properly. Fish left out after being
caught is a cause of scombroid fish poisoning. Foods not kept
hot enough can also cause illness. Foods left at room
temperature for too long can make people sick. Families at home,
groups at picnics, community suppers, banquets, and restaurants
can all make this mistake.
food can happen in home and restaurant kitchens. If the same
knives and cutting boards are used for raw meat, poultry, or
fish and vegetables, organisms can be transferred from one to
How can I prevent food
Remember: Clean, Separate, Cook, and Chill!
No matter how complicated
the topic, home cooks need to do just a few things to keep their
food safe. FoodSafety.gov recommends four steps:
Wash your hands,
counters, cutting boards, knives, fruits, and vegetables.
your meat, poultry, or eggs. You can splash bacteria around
your fruits and vegetables from meat, poultry, eggs, and
keep these items separate in your grocery cart and grocery
bags. Use plastic bags for your raw meat, poultry, and
Store these things
separately in the refrigerator. Keep meats and poultry and
fish from dripping on other foods.
cutting boards, bowls, etc. for your raw meats, poultry,
fish, and eggs. Use clean knives on your fruits and
vegetables, too, especially if they will be served
food until it’s safe. This is important whether you’re using the
stove, oven, or microwave.
A thermometer is
Foodsafety.gov provides a chart to figure out safe internal
Keep cooked food
hot enough. Food poisoning organisms grow best between 40⁰
and 140⁰ Fahrenheit.
food quickly after cooking.
into the refrigerator within two hours.
Food should be at
room temperature for only one hour if the temperature is over
90⁰, for example at a picnic.
frozen foods on the counter. They will quickly be over 40⁰, in
the danger zone for bacteria to grow.
These tips lead to
a few other common-sense actions:
Don’t eat raw eggs or
dough containing raw eggs.
Don’t use marinade
from raw meat on cooked meat.
Don’t put cooked meat
back onto a plate that held raw meat – unless it’s been
And finally, remember that
food doesn’t last forever. If something’s been lurking in your
fridge, do NOT taste it to see if it’s OK.
Check your left-overs against the chart provided by foodsafety.gov.
A lot of consumer-oriented
food safety information is also found at
foodsafety's website. Besides the information noted above,
this site has information about cooking a turkey, checking food for
doneness, charts for specific foods, information about cooking food
for big events and special holidays, and keeping food safe after
power outages and emergencies.
How can I tell if I have food poisoning?
If more than one person
gets sick after the same meal or event, food poisoning is a
possibility. Otherwise, it can be hard to tell. Food poisoning can
look like a lot of other illnesses, especially if the symptoms are
mainly nausea, vomiting, and diarrhea.
A few foodborne illnesses
have characteristic symptoms: an allergic-type reaction from
scombroid fish poisoning, reversal of hot and cold sensations from
ciguatera fish poisoning, and hallucinations from some types of wild
mushrooms and from some weeds (Datura species) mistaken for
should I do if I get food poisoning?
At first, treatment will
be fluids to prevent dehydration. If someone can’t hold fluids down
– no matter why – call a health care provider.
Sometimes, a trip to the emergency room for IV fluids will be
If symptoms don’t go away
on their own within a couple of days, call your health care
provider. If food poisoning is possible, specific tests might be
done. A few types of food poisoning, if confirmed by testing, can be
treated with antibiotics. Otherwise, treatment is according to the
symptoms the patient is having.
Should I report food poisoning?
You should report
possible food poisoning. Public health officials want to figure out
if other people are at risk of getting sick. They also want to
prevent future episodes of foodborne illness.
If you think you have
gotten sick from eating a specific food or eating at a restaurant, call your county
or city health
For suspected problems with
meat, poultry, or egg-based foods, call the USDA Meat and
Poultry Hotline. Their number is 1-888-674-6854.
For suspected problems with
other foods, including eggs, call the FDA at
For pet food, you can
contact the FDA Consumer Complaint Coordinator. The telephone
number for DC, Maryland, and Virginia is 410-779-5713.
General guidelines for reporting food poisoning, along with links to
state health departments are on foodsafety's website.
What do food recalls mean?
A food recall means that a
product is removed from sale. Sometimes, it means alerting consumers
to check their own cabinets, refrigerators, or freezers for recalled
Food is recalled for a few
The food might contain
some type of organism that could make people sick.
The food might be
contaminated with a chemical or pesticide.
The food might have
been made or stored in unsanitary conditions. Examples include
leaky roofs, unclean machinery, or rodents or insects in the
The ingredient label
is incorrect. This can be dangerous for people with allergies,
for example to dairy, wheat, soy, eggs, and nuts. If the label
doesn’t match the ingredients, a product is called “mislabeled”
Foreign objects might
be in the food. Some examples include bits of plastic or small
metal pieces; this can occur if a machine breaks down during
The facility wasn’t
properly inspected or the food itself wasn’t properly inspected
Most food recalls happen
when a company finds a problem with one of its products. Sometimes,
people get sick and the FDA learns about it from health departments
or the CDC. Or, FDA or USDA may uncover a problem while inspecting a
The type of public notice
depends on how serious the potential problem is. A major threat to
public health involves contacting the media so that as many people
as possible hear about it; updates are provided as needed. On the
other hand, if a product is recalled before being sold, or if the
recall is less serious, the recall
may only be listed on a web site.
Where can I find out about food recalls?
Recalls that can affect
many people will be reported in the media. For example, this
happened when contaminated peanut butter was sold nationally and
also used in many types of foods, which were also sold nationally.
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