Onset, Duration, and Symptoms of Foodborne Illness Approximate Predominant symptoms Associated organism or toxin onset time to symptoms Upper gastrointestinal tract symptoms (nausea, vomiting) occur first or predominate Less than 1 h Nausea, vomiting, unusual taste, Metallic salts burning of mouth. 1-2 h Nausea, vomiting, cyanosis, Nitrites headache, dizziness, dyspnea, trembling, weakness, loss of consciousness. 1-6 h mean 2-4 h Nausea, vomiting, retching, Staphylococcus aureus and its diarrhea, abdominal pain, enterotoxins prostration. 8-16 h (2-4 h Vomiting, abdominal cramps, Bacillus cereus emesis possible) diarrhea, nausea. 6-24 h Nausea, vomiting, diarrhea, Amanita species mushrooms thirst, dilation of pupils, collapse, coma. Sore throat and respiratory symptoms occur 12-72 h Sore throat, fever, nausea, Streptococcus pyogenes vomiting, rhinorrhea, sometimes a rash. 2-5 days Inflamed throat and nose, Corynebacterium diphtheriae spreading grayish exudate, fever, chills, sore throat, malaise, difficulty in swallowing, edema of cervical lymph node. Lower gastrointestinal tract symptoms (abdominal cramps, diarrhea) occur first or predominate 2-36 h, mean 6- Abdominal cramps, diarrhea, Clostridium perfringens, 12 h putrefactive diarrhea associated Bacillus cereus, Streptoco ccus with C. perfringens , sometimes faecalis, S. faecium nausea and vomiting. 12-74 h, mean Abdominal cramps, diarrhea, Salmonella species (including 18-36 h vomiting, fever, chills, malaise, S. arizonae), Shigella, nausea, headache, possible. enteropathogenic Escherichia Sometimes bloody or mucoid coli, other Enterobacteriacae , diarrhea, cutaneous lesions Vibrio parahaemolyticus , associated with V. vulnificus. Yersinia enterocolitica , Yersinia enterocolitica mimics Aeromonas hydrophila, flu and acute appendicitis. Plesiomonas shigelloides , Campylobacter jejuni, Vibrio cholerae (O1 and non-O1) V.vulnificus , V. fluvialis 3-5 days Diarrhea, fever, vomiting Enteric viruses abdominal pain, respiratory symptoms. 1-6 weeks Mucoid diarrhea (fatty stools) Giardia lamblia abdominal pain, weight loss. 1 to several Abdominal pain, diarrhea, Entamoeba histolytica weeks constipation, headache, drowsiness, ulcers, variable -- often asymptomatic. 3-6 months Nervousness, insomnia, hunger Taenia saginata, T. solium pains, anorexia, weight loss, abdominal pain, sometimes gastroenteritis. Neurological symptoms (visual disturbances, vertigo, tingling, paralysis) occur Less than 1 h *** SEE Shellfish toxin GASTROINTESTINAL AND/OR NEUROLOGIC SYMPTOMS (Shellfish Toxins) (this Appendix) Gastroenteritis, nervousness, Organic phosphate blurred vision, chest pain, cyanosis, twitching, convulsions. Excessive salivation, Muscaria-type mushrooms perspiration, gastroenteritis, irregular pulse, pupils constricted, asthmatic breathing. Tingling and numbness, Tetradon (tetrodotoxin) toxins dizziness, pallor, gastro- hemmorrhage, and desquamation of skin, fixed eyes, loss of reflexes, twitching, paralysis. 1-6 h Tingling and numbness, Ciguatera toxin gastroenteritis, dizziness, dry mouth, muscular aches, dilated pupils, blurred vision, paralysis. Nausea, vomiting, tingling, Chlorinated hydrocarbons dizziness, weakness, anorexia, weight loss, confusion. 2 h to 6 days, Vertigo, double or blurred vision, Clostridium botulinum and its usually 12-36 h loss of reflex to light, difficulty in neurotoxins swallowing. speaking, and breathing, dry mouth, weakness, respiratory paralysis. More than 72 h Numbness, weakness of legs, Organic mercury spastic paralysis, impairment of vision, blindness, coma. Gastroenteritis, leg pain, ungainly Triorthocresyl phosphate high-stepping gait, foot and wrist drop. Allergic symptoms (facial flushing, itching) occur Less than 1 h Headache, dizziness, nausea, Histamine (scombroid) vomiting, peppery taste, burning of throat, facial swelling and flushing, stomach pain, itching of skin. Numbness around mouth, Monosodium glutamate tingling sensation, flushing, dizziness, headache, nausea. Flushing, sensation of warmth, Nicotinic acid itching, abdominal pain, puffing of face and knees. Generalized infection symptoms (fever, chills, malaise, prostration, aches, swollen lymph nodes) occur 4-28 days, mean Gastroenteritis, fever, edema Trichinella spiralis 9 days about eyes, perspiration, muscular pain, chills, prostration, labored breathing. 7-28 days, mean Malaise, headache, fever, cough, Salmonella typhi 14 days nausea, vomiting, constipation, abdominal pain, chills, rose spots, bloody stools. 10-13 days Fever, headache, myalgia, rash. Toxoplasma gondii 10-50 days, mean Fever, malaise, lassitude, Etiological agent not yet 25-30 days anorexia, nausea, abdominal isolated -- probably viral pain, jaundice. Varying periods Fever, chills, head- or joint ache, Bacillus anthracis, Brucella (depends on prostration, malaise, swollen melitensis, B. abortus, B. suis, specific illness) lymph nodes, and other specific Coxiella burnetii, Francisella symptoms of disease in question. tularensis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium species, Pasteurella multocida, Streptobacillus moniliformis, Campylobacter jejuni, Leptospira species. Gastrointestinal and/or Neurologic Symptoms - (Shellfish Toxins) 0.5 to 2 h Tingling, burning, numbness, Paralytic Shellfish Poisoning drowsiness, incoherent speech, (PSP) (saxitoxins) respiratory paralysis 2-5 min to 3-4 h Reversal of hot and cold Neurotoxic Shellfish Poisoning sensation, tingling; numbness of (NSP) (brevetoxins) lips, tongue & throat; muscle aches, dizziness, diarrhea, vomiting 30 min to 2-3 h Nausea, vomiting, diarrhea, Diarrheic Shellfish Poisoning abdominal pain, chills, fever (DSP) (dinophysis toxin, okadaic acid, pectenotoxin, yessotoxin) 24 h Vomiting, diarrhea, abdominal Amnesic Shellfish Poisoning (gastrointestinal) pain, confusion, memory loss, (ASP) (domoic acid) to 48 h disorientation, seizure, coma (neurologic) .