Saturday, March 10, 2012

On Food Poisoning

Chicken and potato salad  (Photo:

    Food poisoning is an amazingly common event.  For many of us, we get little enough of the offending agent, so that all we notice may be transient nausea or mild diarrhea.  However,  the other end of the spectrum may be quite severe.
                 Food poisoning may be caused by a variety of agents.  For anyone who has been to a chicken dinner at a church in the Southern US, which also served potato salad, chances are, you know something about salmonella.   Salmonella is a variety of closely related organisms, which may cause severe diarrhea, may cause vomiting, and may cause blood in stool. Sometimes, it will cause a frequent fluidy yellow stool.  A high temperature may occur, and the patient if young, old, or afflicted with another chronic illness, could die without intravenous rehydration.  Most of us fall in the middle of the spectrum with salmonella. We are sicker than the mild case I first described, yet not quite so ill as to absolutely require intravenous rehydration.  The sickness may persist from about 1-10 days, and most cases are self limiting. Our bodies simply flush out the salmonella over time, and we keep hydrating, first with clear liquids (that you can see through), then with full liquids, and when those are tolerated, on to bananas, rice, pudding, toast, etc.  Most family doctors are reluctant to prescribe antibiotics for salmonellosis because they were taught that they prolong the carrier state.  This is true, but Bactrim (Septra DS) or other sulfonamides do help eradicate the infection, and do not prolong the carrier state.   Salmonella infected body fluids have a distinctive odor, detected probably most often by nurses, which smells like a cross between chicken and detergent.  Although many foods may be contaminated with salmonella, because chickens and a number of other fowl have salmonella organisms as normal flora in their digestive systems, chicken and similar foods can readily become contaminated.  Since a lot of people, especially as they age, forget from time to time, the importance of keeping chicken, particularly uncooked, away from other foods, especially mayonnaise, a great bacterial breeding medium, potato salads, chicken salads, eggs,  and a lot of picnic foods can easily become contaminated.  Sometimes, we can notice that a food has turned bad, but often we cannot.  If your recovery from salmonella is longer than you believe is normal, you should see a physician.  It does not happen often, but salmonella infection in the colon, can seed to other areas of the body, and has triggered ulcerative colitis, an autoimmune reaction in the colon.  I have also had a couple of ICU patients who had a sub-hepatic abscess, from yes, salmonella.
                A lot of food poisoning is salmonella, but a number of organisms can cause it also.  Shigella, campylobacter species, norovirus, E-Coli, listeria, staphlococcus aureus, bacillus cereus,  and toxoplasmosis can also cause food poisoning.  There are many other organisms and causations also, which are beyond the scope of a single blog post.  Most people become ill 1-16 hours following ingestion of the offending agent.   Viruses tend to have a more rapid incubation period, and bacteria may have a longer one.  Sometimes we never can ascertain what the offending food really was.  Because we use antibiotics in animal foods routinely in many places in the world, the virulence of these organisms is increasing worldwide.
                About a week ago, my daughter had a quite large and excellent spinach salad for lunch while working.  Within about six hours, she had a fever and chills, stomach pain, nausea, vomiting, and diarrhea.  Since she is a Type I diabetic, insulin pump dependent since a viral infection at age nine, this was a serious issue.  Almost a week later, she is recovering, realizing how fortunate she is to have dodged a hospitalization.

intravenous fluid (photo:

Please see my prior post on Dehydration and Rehydration:

Many of us are working hard to stay healthy and trim, and this leads us to eating many more foods raw than perhaps we once did. However, in this small way, we are at more risk for food borne illness.  Keep in mind that spinach particularly, is grown outdoors, must be handpicked, and is exposed to animal and possibly human excreta.  Sometimes washing in water may not be enough.   Some of the commercially prepared mild detergents for lettuce washing might decrease bacterial counts, but many people, like myself, are sensitive to them.  Wendy's Restaurants for example, routinely uses a lettuce wash product.   

               Most of us have heard about botulism.    When clostridium botulinum contaminates food, which is often canned improperly, the results can be fatal.    People who have eaten food with botulism contamination are exposed to toxins manufactured by the organism, and as a result, endure a progressive flaccid paralysis.  They must receive medical care immediately.

                For this reason, I wanted to set out when you can follow the directions I provided in the link above on Dehydration and Rehydration and when you simply need to seek medical care.  You can try to continue to rehydrate, and try to slow vomiting or diarrhea with Over-the-Counter remedies UNLESS:

    1. You appear to have food poisoning in a child under six, then speak to or see their pediatrician.
    2. Temperature in excess of 102 F with food poisoning symptoms---See MD.
    3. A person with food poisoning with known other chronic illness needs to speak with or see their physician. (This would also include an elderly person with a chronic illness, and especially with dementia.)
    4.  Any patient with an altered level of awareness must see a physician immediately.
    5. Anyone with a heart/pulse rate in excess of 120 beats per minute,  anyone whose pulse jumps twenty beats per minute between lying down and standing up.  Anyone whose heart rate has become irregular when pulse is taken.  Learn to take a radial pulse (at the wrist) on each of your family members BEFORE they are ill.  This skill alone can be invaluable.  Anyone who meets any of the criteria in item 5 needs to be transported to their physician.
   6. Anyone who is pregnant or breast feeding must speak with their doctor if they develop food poisoning.
   7. Anyone with difficulty keeping their eyes open, difficulty speaking, or difficulty walking needs to have an ambulance called for transport to ER.
   8. Anyone who has not urinated within 6 hours, or has severe stomach cramping, has yellow skin or yellow sclerae (white portion of the eyes) or who vomits each time they ingest even clear fluids, or can't take prescribed medications or insulin, must be transported to a hospital at once.
   9. Anyone with blood in stool or vomitus must see their doctor.
  10. If you have had a recent trip to a foreign land, and you have gastrointestinal issues now, see a physician as soon as possible. They may need time to get labwork to ascertain the organism responsible.

     Use your judgement.  If you believe a physician is needed, then one probably is.

          Avoiding food poisoning may not be easy.   Of course keeping good hygiene in your home kitchen and your frij. is important, as is handwashing, and proper handling of food.   However, most of us eat in work, hospital, university cafeterias, church suppers, or in restaurants, on occasion.   As the economy has deteriorated, many restaurants are less likely to throw out food as it ages, than they once were. It is simply easier to get food poisoning than perhaps it once was.   Perhaps the answer is to eat out less often, and to handle what you have at home, from eggs from chickens at home, to sprouts from the kitchen window, very carefully.  Cook food as directed. Use a meat thermometer when necessary.   "When in doubt......throw it out". Use some sense about picnic gatherings at schools and at churches. Sometimes, the hygiene or refrigeration is not what it could be.  Sometimes, younger people who do not yet know as much about proper food handling make errors, and sometimes elderly people have taken on more than they can now do, in terms of safe food preparation. In addition, making enough chicken for a family of four, is a very different proposition from safely making a chicken dinner for a church of 100.  The hygiene techniques will need to be different, and if the adjustments are not made, the results could be disastrous.  Food from home is likely safer simply because fewer people are handling it, and are likely to be more careful.

(Photo:  blog of Dr. Stephen Wangen)


Tejas kirodiwal said...

Nice info, thanks for the awareness, i would like to add 9one to this, Mother's milk is the safest food for young infants. Breast-feeding may prevent many foodborne illnesses and other health problems.

food poisoning sharm el sheikh | sharm el sheikh food poisoning

JaneofVirginia said...

This post was focused on adults. Some time I should do a post on the value of breast feeding for young infants. A mother who is able to breast feed provides customized milk for her infant which is readjusted daily for his age, while it provides customized antibodies for him. Breast fed children do have different gastrointestinal flora than those who were not. If the mother is adequately hydrated and the infant nurses enough, dehydration is less likely for the infant. In the case of my own four biological children, who were all breast fed, they have all succumbed on occasion to food poisoning in our hot climate as adults.