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Home , Diarrhea, Dysphagia, Vomiting

Common Agents Causing Foodborne Illness, Grouped by Symptoms

Upper Symptoms (, ) Occur First or Predominate (in order of incubation period) Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Nausea, vomiting, unusual taste, burning and beverages cooked in containers lined with Metallic <2 hours <1 day of mouth offending metal. Sudden onset of severe nausea and Staphylococcus aureus Unrefrigerated or improperly refrigerated meats, 1–6 hours vomiting. Abdominal cramps. 24–48 hours (preformed enterotoxin) and egg salads, cream pastries. and may be present. Sudden onset of severe nausea and 1–6 hours 24 hours Improperly refrigerated cooked or fried , meats. (preformed enterotoxin) vomiting. Diarrhea may be present. Lower Gastrointestinal Tract Symptoms (Abdominal Cramps, Diarrhea) Occur First or Predominate (in order of incubation period) Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Bacillus cereus (diarrheal Abdominal cramps, watery diarrhea, 10–16 hours 24–48 hrs Meats, stews, gravies, vanilla sauce. toxin) nausea. Clostridium perfringens Watery diarrhea, nausea, abdominal Meats, poultry, gravy, dried or precooked foods, time- 8–16 hours 24–48 hrs (toxin) cramps; fever is rare. and/or temperature abused . Watery diarrhea, abdominal cramps, 12–24 hours 2–5 days Raw or undercooked seafood such as fish or shellfish. nausea, vomiting. Abdominal cramps, fever and diarrhea. Food or contaminated with human fecal material. 1–4 days 4–7days Stools may contain and . Ready to eat foods touched by an infected food worker. Diarrhea, fever, abdominal cramps, Contaminated eggs, unpasteurized or juice, (nontyphi) 1–3 days 4–7days vomiting. cheese, contaminated raw fruits and vegetables. Enterotoxigenic E. coli Watery diarrhea, abdominal cramps, 1–3 days 3 to >7 days Food or water contaminated with human . (ETEC) some vomiting. Shiga toxin-producing E. Severe diarrhea that is often bloody, Undercooked beef especially hamburger, coli (STEC) including E. 2–6 days and vomiting. Usually, 5–10 days unpasteurized milk and juice, raw fruits and vegetables coli O157:H7 little or no fever is present. (e.g., sprouts), salami (rarely), and contaminated water. Diarrhea, cramps, fever, and vomiting; Raw and undercooked poultry, unpasteurized milk, jejuni 2–5 days 2–10 days diarrhea may be bloody. contaminated water. -like symptoms (diarrhea, Undercooked pork, unpasteurized milk, tofu, 3–7 days and vomiting, fever, and abdominal 1–3 weeks contaminated water. has occurred in infants pain). whose handled chitterlings. Washington State Department of Health Page 1 of 3 Last Revised: July 2009 FOODBORNE ILLNESS

Common Agents Causing Foodborne Illness, Grouped by Symptoms

May remit and 3 Diarrhea (usually watery), . Food contaminated with human fecal 5–8 days relapse over cramps, upset stomach, slight fever. material. weeks to months Diarrhea (usually watery), loss of May remit and Fresh herbs and produce (e.g., raspberries, basil, Cyclospora Ave. 7 days appetite, , stomach cramps, relapse over lettuce) nausea, vomiting, fatigue. weeks to months Drinking water. Food contaminated with human fecal 7–10 days Diarrhea, stomach cramps, gas. Days to weeks material. Both Upper and Lower Gastrointestinal Tract Symptoms Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Nausea, vomiting, cramping, diarrhea, Food or water contaminated with human fecal material, (and other fever, myalgias and some . 12–48 hours 12–60 hours including shellfish. Ready to eat foods touched by an caliciviruses) Diarrhea is more prevalent in adults. infected food worker. Vomiting is more prevalent in children. Generalized Symptoms Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Fever, muscle aches, and nausea or 9–48 hours for diarrhea. Pregnant women may have gastrointestinal mild flu-like illness, and infection can Fresh soft cheeses, unpasteurized milk, ready-to-eat symptoms; 2–6 lead to premature delivery or stillbirth. Variable deli meats, hot . weeks for invasive Elderly and immunocompromised patients may have bacteremia or meningitis. Diarrhea, dark urine, , and flu- Variable (2 Food or water contaminated with human fecal material, Average 30 days A like symptoms (i.e., fever, headache, weeks to 3 including shellfish. Ready to eat foods touched by an (range 15–50 d) nausea, and abdominal pain) months) infected food worker. Neurologic Symptoms Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Diarrhea, nausea, vomiting, parasthesias Paralytic Shellfish <3 hours of mouth, lip, weakness, dysphagia, Days Scallops, mussels, clams, cockles. Poisoning (PSP) dysphonia, respiratory paralysis. Washington State Department of Health Page 2 of 3 Last Revised: July 2009 FOODBORNE ILLNESS

Common Agents Causing Foodborne Illness, Grouped by Symptoms

Vomiting, diarrhea, blurred vision, Home-canned foods with a low acid content, improperly (ingested toxin) 12–36 hours diplopia, , and descending Days to months canned commercial foods, home-canned or fermented muscle weakness. fish, herb infused oils. Allergic Symptoms Occur (Facial Flushing, Itching) Usual Incubation Duration of Etiologic Agent Symptoms Common Vehicles Period Symptoms Monosodium Glutamate Burning sensation, chest tightness, <1 hour <1 day Chinese foods (MSG) flushing, dizziness, headache, nausea. Flushing, rash, burning sensation of skin, Fish: bluefin, tuna, skipjack, mackerel, marlin, escolar, Scombroid () <3 hours mouth and throat, dizziness, urticaria, 3–6 hours and mahi mahi. parasthesias.

Adapted from: Centers for Disease Control and Prevention. Diagnosis and Management of Foodborne Illnesses A Primer for Physicians and Other Health Care Professionals. MMWR 2004;53(RR04):7–12.

Washington State Department of Health Page 3 of 3 Last Revised: July 2009