Food-borne Illnesses Table: Non-infectious Agents

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Etiology

Incubation Period

Signs and Symptoms

Duration of Illness

Associated Foods

Laboratory Testing

Treatment

Antimony

5 min – 8 hrs. usually <1 hr

Vomiting, metallic taste.

Usually self-limited

Metallic container.

Identification of metal in beverage or food.

Supportive care.

Arsenic

Few hrs

Vomiting, colic, diarrhea.

Several days

Contaminated food.

Urine. May cause eosinophilia.

Gastric lavage, BAL (dimercaprol).

Cadmium

5 min – 8 hrs. usually <1 hr

Nausea, vomiting, myalgia, increase in salivation, stomach pain.

Usually self-limited

Seafood, oysters, clams, lobster, grains, peanuts.

Identification of metal in food.

Supportive care.

Ciguatera fish poisoning (ciguatera toxin).

2-6 hrs

GI: abdominal pain, nausea, vomiting, diarrhea.

Days to weeks to months

A variety of large reef fish. Grouper, red snapper, amberjack, and barracuda (most common).

Radioassay for toxin in fish or a consistent history.

Supportive care, IV mannitol. Children more vulnerable.

3 hrs

Neurologic: paresthesias, reversal of hot or cold, pain, weakness.

2-5 days

Cardiovascular: bradycardia, hypotension, increase in T wave abnormalities.

Copper

5 min – 8 hrs. usually <1 hr

Nausea, vomiting, blue or green vomitus.

Usually self-limited

Metallic container.

Identification of metal in beverage or food.

Supportive care.

Mercury

1 week or longer

Numbness, weakness of legs, spastic paralysis, impaired vision, blindness, coma. Pregnant women and her developing fetus are especially vulnerable.

May be protracted

Fish exposed to organic mercury, grains treated with mercury-based fungicides.

Analysis of blood, hair.

Supportive care.

Mushroom toxins, short-acting (museinol, muscarine, psilocybin, coprius artemetaris, ibotenic acid)

< 2 hrs.

Vomiting, diarrhea, confusion, visual disturbance, salivation, diaphoresis, hallucinations, disulfiram-like reaction, confusion, visual disturbance.

Self-limited

Wild mushrooms (cooking may not destroy these toxins).

Typical syndrome and mushroom identified and/or demonstration of the toxin.

Supportive care.

Mushroom toxin, long-acting (amanita)

4-8 hrs diarrhea;
24-48 hrs liver failure

Diarrhea, abdominal cramps, leading to hepatic and renal failure.

Often fatal

Mushrooms.

Typical syndrome and mushroom identified and/or demonstration of the toxin.

Supportive care, life-threatening, life support.

Nitrite poisoning

1-2 hrs

Nausea, vomiting, cyanosis, headache, dizziness, weakness, loss of consciousness, chocolate-brown colored blood.

Usually self-limited

Cured meats, any contaminated foods, spinach exposed to excessive nitrification.

Analysis of the food, blood.

Supportive care, methylene blue.

Pesticides (organophosphates or carbamates)

Few min to few hours

Nausea, vomiting, abdominal cramps, diarrhea, headache, nervousness, blurred vision, twitching, convulsions.

Usually self-limited

Any contaminated food.

Analysis of the food, blood.

Atropine.

Puffer fish (tetrodotoxin)

< 30 min

Paresthesias, vomiting, diarrhea, abdominal pain, ascending paralysis, respiratory failure.

Death usually in 4-6 hours

Puffer fish.

Detection of tetrodotoxin in fish.

Life-threatening, may need respiratory support.

Scombroid (histamine)

1 min – 3 hrs

Flushing, rash, burning sensation of skin, mouth and throat, dizziness, uriticaria, paresthesias.

3-6 hrs

Fish: bluefin, tuna, skipjack, mackerel, marlin, and mahi mahi.

Demonstration of histamine in food or clinical diagnosis.

Supportive care, antihistamines.

Shellfish toxins (diarrheic, neurotoxic, amnesic)

Diarrheic shellfish poisoning (DSP) -
30 min to 2 hrs

Nausea, vomiting, diarrhea, and abdominal pain accompanied by chills, headache, and fever.

Hrs to 2-3 days

A variety of shellfish, primarily mussels, oysters, scallops, and shellfish from the Florida coast and the Gulf of Mexico.

Detection of the toxin in shellfish; high pressure liquid chromatography.

Supportive care, generally self-limiting. Elderly are especially sensitive to ASP.

Neurotoxic shellfish poisoning (NSP) –
few min to hrs

Tingling and numbness of lips, tongue, and throat, muscular aches, dizziness, reversal of the sensations of hot and cold, diarrhea, and vomiting.

Amnesic shellfish poisoning (ASP) -
24-48 hrs

Vomiting, diarrhea, abdominal pain and neurological problems such as confusion, memory loss, disorientation, seizure, coma.

Shellfish toxins (paralytic shellfish poisoning)

30 min – 3 hrs

Diarrhea, nausea, vomiting leading to paresthesias of mouth, lips, weakness, dysphasia, dysphonia, respiratory paralysis.

Days

Scallops, mussels, clams, cockles.

Detection of toxin in food or water where fish are located; high pressure liquid chromatography.

Life-threatening, may need respiratory support.

Sodium fluoride

Few min to 2 hrs

Salty or soapy taste, numbness of mouth, vomiting, diarrhea, dilated pupils, spasms, pallor, shock, collapse.

Usually self-limited

Dry foods (such as dry milk, flour, baking powder, cake mixes) contaminated with sodium fluoride-containing insecticides and rodenticides.

Testing of vomitus or gastric washings. Analysis of the food.

Supportive care.

Thallium

Few hrs

Nausea, vomiting, diarrhea, painful paresthesias, motor polyneuropathy, hair loss.

Several days

Contaminated food.

Urine, hair.

Supportive care.

Tin

5 min – 8 hrs. usually <1 hr

Nausea, vomiting, diarrhea.

Usually self-limited

Metallic container.

Analysis of the food.

Supportive care.

Vomitoxin

Few min to 3 hrs

Nausea, headache, abdominal pain, vomiting.

Usually self-limited

Grains, such as wheat, corn, barley.

Analysis of the food.

Supportive care.

Zinc

Hrs

Stomach cramps, nausea, vomiting, diarrhea, myalgias.

Usually self-limited

Metallic container.

Analysis of the food, blood and feces, saliva or urine.

Supportive care.

Etiology

Incubation Period

Signs and Symptoms

Duration of Illness

Commonly associated Foods

Laboratory Testing

Treatment