Quiz: This Thanksgiving, Are You Prepared to Confront Food Poisoning?
Richard H. Sinert, DO
|November 23, 2015
Few American holidays center on food quite as much as Thanksgiving. Although our friends and family certainly mean well, any time that many dishes are prepared, food poisoning can be a concern. The symptoms, varying in degree and combination, include abdominal pain, vomiting, diarrhea, and headache; more serious cases can result in life-threatening neurologic, hepatic, and renal syndromes leading to permanent disability or death. This Thanksgiving, how much do you know about food poisoning? Test your knowledge with our short quiz.
Which of the following pathogens is more frequently associated with the consumption of poultry?
Leafy green vegetables were the most common cause of food poisoning (22%), primarily due to Norovirus species, followed by E coli O157.
Poultry was the most common cause of death from food poisoning (19%), with Listeria and Salmonella species being the main infectious organisms.
Dairy items were the second most frequent causes of foodborne illnesses (14%) and deaths (10%), with the main factors being contamination by Norovirus from food handlers and improper pasteurization resulting in contamination with Campylobacter species.
For more on the epidemiology of food poisoning, read here.
When vomiting is the major presenting symptom, which of the following pathogens is more likely responsible?
Shigella
Staphylococcus aureus
Yersinia
Campylobacter
The following are some of the salient features of food poisoning:
Acute diarrhea in food poisoning usually lasts less than 2 weeks. Diarrhea lasting 2-4 weeks is classified as persistent. Chronic diarrhea is defined by duration of more than 4 weeks.
The presence of fever suggests an invasive disease. However, sometimes fever and diarrhea may result from infection outside of the gastrointestinal tract, as in malaria.
A stool with blood or mucus indicates invasion of the intestinal or colonic mucosa.
When vomiting is the major presenting symptom, suspect S aureus, Bacillus cereus, or Norovirus.
For more on the presentation of food poisoning, read here.
Which of the following statements is false regarding food poisoning?
Most cases result from improper food handling
Bacteria are responsible for approximately 75% of the outbreaks of food poisoning
Inadequate reheating is a common cause of food poisoning
Most cases result from food prepared at home
The CDC estimates that 97% of all cases of food poisoning result from improper food handling; 79% of cases result from food prepared in commercial or institutional establishments, and 21% of cases result from food prepared at home.
For more on the workup of food poisoning, read here.
Bacterial culture is mandatory in which of the following scenarios?
The patient shows signs of dehydration
The patient has a notable inflammatory response at presentation
The patient has suspected antibiotic-associated diarrhea
The patient has fever or symptoms lasting longer than 3-4 days
Obtain the following laboratory studies in cases of suspected food poisoning:
Perform Gram staining and Loeffler methylene blue staining of the stool for white blood cells (WBCs) to help differentiate invasive disease from noninvasive disease.
Perform microscopic examination of the stool for ova and parasites.
Bacterial culture for enteric pathogens, such as Salmonella, Shigella, and Campylobacter organisms, becomes mandatory if a stool sample shows positive results for WBCs or blood or if patients have fever or symptoms persisting for longer than 3-4 days.
Perform blood culture if the patient is notably febrile.
Perform complete blood count with differential, serum electrolyte assessment, and blood urea nitrogen and creatinine levels to help assess the inflammatory response and the degree of dehydration.
Assay for Clostridium difficile to help rule out antibiotic-associated diarrhea in patients receiving antibiotics or in those with a history of recent antibiotic use.
For more on the workup of food poisoning, read here.
Antiperistaltics (opiate derivatives) are contraindicated in which of the following groups?
Patients who are dehydrated
Patients with bloody diarrhea
Patients with vomiting
Patients with comorbid otitis media
Absorbents (eg, Kaopectate, aluminum hydroxide) help patients have more control over the timing of defecation. However, they do not alter the course of the disease or reduce fluid loss. Note the following:
An interval of at least 1-2 hours should elapse when using other medications with absorbents.
Antisecretory agents, such as bismuth subsalicylate, may be useful. The dose is 30 mL every 30 minutes, not to exceed 8-10 doses.
Antiperistaltics (opiate derivatives) should not be used in patients with fever, systemic toxicity, or bloody diarrhea or in patients whose condition either shows no improvement or deteriorates.
Diphenoxylate with atropine is available in tablets (2.5 mg of diphenoxylate) and liquid (2.5 mg of diphenoxylate/5 mL). The initial dose for adults is 2 tablets 4 times a day (ie, 20 mg/d). The dose is tapered as diarrhea improves.
Loperamide is available over the counter as 2-mg capsules and as a liquid (1 mg/5 mL). It increases the intestinal absorption of electrolytes and water and decreases intestinal motility and secretion. The dose in adults is 4 mg initially, followed by 2 mg after each diarrhea stool, not to exceed 16 mg in a 24-hour period.
For more the treatment of food poisoning, read here.
A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.
I've commented that it was a wonder no one ever got food poisoning at our family reunion when I was growing up.
Everything, and I mean enough food for an army, was on make shift tables on a carport in August.
Nothing was iced, heated or in any other way, kept.
We munched it all day.
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A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.
I have had several bouts of gastroenteritis in the past, mostly from restaurants but once from food prepared at home. The majority were from buffets. One sent me to the E.D. The rest were handled with an anti-spasmodic and time.
As for T-Day, I did not have any turkey or fixings as planned so no worries about food poisoning there!
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“Instead of wondering WHY this is happening to you, consider why this is happening to YOU." - Dalai Lama XIV
“Make no judgments where you have no compassion.” - Anne McCaffrey
Keep it below 40 degrees, or above 140 degrees for safety! Also, when loading a dishwasher, put the silverware "mouth" down, so you don't handle the clean part of the silverware when unloading! And help your dishwasher perform at its best - don't start it until the water from your kitchen tap is at its hottest. Yeah, it may waste a gallon of water, but it helps the dishwasher.
When deciding the menu for a buffet, select foods that stay hot well, or that can be "iced" - ubiquitous "green bean casserole" is perfect for a chafing dish - lots of moisture that does well being on low heat; sushi on a plastic-wrap lined metal serving dish set on a block of commercial ice (commercial ice is frozen harder than your home freezer can get it).
All the precautions we take now and we seem to get sick easier.
I remember potato salad sitting out all day and eating it with chicken that had sat out all day.
On a carport, in August. And with dirty hands after playing in the fields and petting the calves.
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A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.