CDC Foodborne Illnesses - Bacteria

Question 1

Bacillus anthracis
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 1

1. Incubation period: 2 days to weeks
2. Signs and symptoms: nausea, vomiting, malaise, bloody diarrhea, acute abdominal pain
3. Duration of illness: weeks
4. Associated foods: insufficiently cooked contaminated meat
5. Laboratory testing: blood
6. Treatment: penicillin for gastrointestinal anthrax, ciproflaxin 2nd option

Question 2

Bacillus cereus (diarrheal toxin)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 2

1. Incubation period: 10-16 hours
2. Signs and symptoms: abdominal cramps, watery diarrhea, nausea
3. Duration of illness: 24-48 hours
4. Associated foods: meats, stews, gravies, vanilla sauce
5. Laboratory testing: testing not necessary
6. Treatment: supportive care

Question 3

Bacillus cereus (preformed enterotoxin)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 3

1. Incubation period: 1-6 hours
2. Signs and symptoms: sudden onset of severe nausea and vomiting, diarrhea possible
3. Duration of illness: 24 hours
4. Associated foods: improperly refrigerated, cooked, and fried rice, meats
5. Laboratory testing: clinical dx, stool sample
6. Treatment: supportive care

Question 4

Brucella abortus, B. melitensis, and B. suis
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 4

1. Incubation period: 7-21 days
2. Signs and symptoms: Fever, chills, sweating, weakness, headache, muscle and joint pain, diarrhea, bloody stools during acute phase
3. Duration of illness: Weeks
4. Associated foods: Raw milk, goat cheese made from unpasteurized milk, contaminated meats
5. Laboratory testing: Blood culture and positive serology (blood serum study)
6. Treatment: acute: rifampin and doxycycline daily for 6 weeks, infections with complications require combo therapy with rifampin, tetracycline, and an aminoglycoside

Question 5

Campylobacter jejuni
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 5

1. Incubation period: 2-5 days
2. Signs and symptoms: diarrhea, cramps, fever, and vomiting; diarrhea may be bloody
3. Duration of illness: 2-10 days
4. Associated foods: raw and undercooked poultry, unpasteurized milk, contaminated water
5. Laboratory testing: routine stool culture; special media and incubation 42C required
6. Treatment: supportive care, severe cases - erythromycin and quinolones
   *Note: Guillain-Barre syndrome can be a sequela

Question 6

Clostridium botulinum (children and adults, preformed toxin)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 6

1. Incubation period: 12-72 hours
2. Signs and symptoms: vomiting, diarrhea, blurred vision, diplopia, dysphagia, descending muscle weakness
3. Duration of illness: variable - days to months. Can be fatal
4. Associated foods: home-canned foods with a low acid content, improperly canned commercial foods, home-canned or fermented fish, herb-infused oils, baked potatoes in aluminum foil, cheese sauce, bottled garlic, foods held warm for extended periods of time
5. Laboratory testing: stool, serum, and food - tested by state and federal labs
6. Treatment: supportive care. antitoxin is helpful if given in early stages

Question 7

Clostridium botulinum (infants)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 7

1. Incubation period: 3-30 days
2. Signs and symptoms: in infants less than 1 year old - lethargy, weakness, poor feeding, constipation, hypotonia, poor head control, poor gag and sucking reflex
3. Duration of illness: variable
4. Associated foods: honey, home-canned fruits and veggies, corn syrup
5. Laboratory testing: stool, serum, and food - tests done at state and federal labs
6. Treatment: Supportive care, botulism immune globulin can help, antitoxin not recommended

Question 8

Clostridium perfringens toxin
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 8

1. Incubation period: 8-16 hours
2. Signs and symptoms: watery diarrhea, nausea, abdominal cramps, fever is rare
3. Duration of illness: 24-48 hrs
4. Associated foods: meats, poultry, gravy, dried or precooked foods, time and/or temp-abused foods
5. Laboratory testing: stools - quantitative culture as it is already found in stool
6. Treatment: supportive care

Question 9

Enterohermorrhagic E. coli (EHEC) - includes E. coli 0157:H7 and other Shiga toxin-producing E. coli (STEC)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 9

1. Incubation period: 1-8 days
2. Signs and symptoms: severe diarrhea that is often bloody, abdominal pain and vomiting - little or no fever. More common in children under 4
3. Duration of illness: 5-10 days
4. Associated foods: undercooked beef especially hamburger, unpasteurized milk and juice, raw fruits and veggies, salami, contaminated water
5. Laboratory testing: stool culture, shiga toxin can be tested with commercial kit
6. Treatment: supportive care, monitor renal fxn, hemoglobin, and platelets

Question 10

Enterotoxigenic E. coli (ETEC)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 10

1. Incubation period: 1-3 days
2. Signs and symptoms: Watery diarrhea, abdominal cramps, some vomiting
3. Duration of illness: 3->7 days
4. Associated foods: Water or food contaminated with human feces
5. Laboratory testing: stool culture
6. Treatment: supportive care, antibiotics rarely needed

Question 11

Listeria monocytogenes
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 11

1. Incubation period: 9-48 hrs for gastrointestinal, 2-6 wks for invasive
2. Signs and symptoms: fever, muscle aches, nausea, diarrhea - pregnant women may have flu-like symptoms and experience premature delivery or stillbirth. Elderly patients may have bacteremia or meningitis
3. Duration of illness: variable
4. Associated foods: Fresh soft cheeses, unpasteurized milk, ready-to-eat deli meats, hot dogs
5. Laboratory testing: Blood or CSF cultures
6. Treatment: supportive care and antibiotics - intravenous ampicillin, penicillin, TMP-SMX

Question 12

Salmonella spp.
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 12

1. Incubation period: 1-3 days
2. Signs and symptoms: Diarrhea, fever, abdominal cramps, vomiting
3. Duration of illness: 4-7 days
4. Associated foods: contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruits and veggies
5. Laboratory testing: stool culture
6. Treatment: supportive care

Question 13

Shigella spp.
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 13

1. Incubation period: 24-48 hours
2. Signs and symptoms: Abdominal cramps, fever, diarrhea - stools may contain blood and mucus
3. Duration of illness: 4-7 days
4. Associated foods: Food or water contaminated with human fecal material.
5. Laboratory testing: stool cultures
6. Treatment: Supportive care. TMP-SMX anitbiotic

Question 14

Staphylococcus aureus (preformed enterotoxin)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 14

1. Incubation period: 1-6 hrs
2. Signs and symptoms: suddenonset of severe nausea and vomiting, abdominal cramps, diarrhea and fever possible
3. Duration of illness: 24-48 hrs
4. Associated foods: unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries
5. Laboratory testing: clinical dx - stool, vomit, or food sample
6. Treatment: supportive care

Question 15

Vibrio cholerae (toxin)
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 15

1. Incubation period: 24-72 hrs
2. Signs and symptoms: profuse watery diarrhea and vomiting - leads to dehydration
3. Duration of illness: 3-7 days
4. Associated foods: contaminated water, fish, shellfish, street-vendor food typically from Latin America or Asia
5. Laboratory testing: stool culture
6. Treatment: supportive care with aggressive oral or intravenous rehydration

Question 16

Vibrio parahaemolyticus
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 16

1. Incubation period: 2-48 hours
2. Signs and symptoms: watery diarrhea, abdominal cramps, nausea, vomiting
3. Duration of illness: 2-5 days
4. Associated foods: undercooked or raw seafood
5. Laboratory testing: stool culture
6. Treatment: supportive care and antibiotics in severe cases

Question 17

Vibrio vulnificus
1. Incubation period:
2. Signs and symptoms:
3. Duration of illness:
4. Associated foods:
5. Laboratory testing:
6. Treatment:

Answer 17

1. Incubation period: 1-7 days
2. Signs and symptoms: vomiting, diarrhea, abdominal pain, bacteremia, would infections
3. Duration of illness: 2-8 days
4. Associated foods: undercooked or raw shellfish, especially oysters; other contaminated seafood, open wounds exposed to sea water
5. Laboratory testing: stool, wound, or blood cultures
6. Treatment: supportive care and antibiotics - tetra- and doxycycline, ceftazidime