Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 7) potx

Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning Part 7 Age Most of the morbidity and mortality from enteric pathogens involves children... If the history and the stoo

Chapter 122 Acute Infectious Diarrheal Diseases

and Bacterial Food Poisoning

(Part 7)

Age

Most of the morbidity and mortality from enteric pathogens involves children <5 years of age Breast-fed infants are protected from contaminated food and water and derive some protection from maternal antibodies, but their risk of infection rises dramatically when they begin to eat solid foods Infants and younger children are more likely than adults to develop rotavirus disease, while older children and adults are more commonly infected with norovirus Other organisms with higher attack rates among children than among adults include

enterotoxigenic, enteropathogenic, and enterohemorrhagic E coli; C jejuni; and

G lamblia In children, the incidence of Salmonella infections is highest among

those <1 year of age, while the attack rate for Shigella infections is greatest among

those 6 months to 4 years of age

Bacterial Food Poisoning

If the history and the stool examination indicate a noninflammatory etiology of diarrhea and there is evidence of a common-source outbreak, questions concerning the ingestion of specific foods and the time of onset of the diarrhea after a meal can provide clues to the bacterial cause of the illness Potential causes

of bacterial food poisoning are shown in Table 122-4

Table 122-4 Bacterial Food Poisoning

Incubation Period,

Organism

Sources

1–6 H

Staphylococcus

aureus

Nausea, vomiting, diarrhea

Ham, poultry, potato or egg salad, mayonnaise, cream pastries

Bacillus cereus Nausea, vomiting,

diarrhea

Fried rice

8–16 H

Clostridium

perfringens

Abdominal cramps, diarrhea (vomiting rare)

Beef, poultry, legumes, gravies

B cereus Abdominal

cramps, diarrhea (vomiting rare)

Meats, vegetables, dried beans, cereals

>16 H

Vibrio cholerae Watery diarrhea Shellfish

Enterotoxigenic

Escherichia coli

Watery diarrhea Salads, cheese,

meats, water

Enterohemorrhagic

E coli

Bloody diarrhea Ground beef, roast

beef, salami, raw milk, raw vegetables, apple juice

Salmonella spp Inflammatory

diarrhea

Beef, poultry, eggs, dairy products

Campylobacter

jejuni

Inflammatory diarrhea

Poultry, raw milk

Shigella spp Dysentery Potato or egg salad,

lettuce, raw vegetables

Vibrio

parahaemolyticus

Dysentery Mollusks,

crustaceans

Bacterial disease caused by an enterotoxin elaborated outside the host, such

as that due to Staphylococcus aureus or B cereus, has the shortest incubation

period (1–6 h) and generally lasts <12 h Most cases of staphylococcal food poisoning are caused by contamination from infected human carriers Staphylococci can multiply at a wide range of temperatures; thus, if food is left to cool slowly and remains at room temperature after cooking, the organisms will have the opportunity to form enterotoxin Outbreaks following picnics where potato salad, mayonnaise, and cream pastries have been served offer classic

examples of staphylococcal food poisoning Diarrhea, nausea, vomiting, and abdominal cramping are common, while fever is less so