Foodborne Illnesses

What are foodborne illnesses?

Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that
contain harmful bacteria, parasites, viruses, or chemicals. The GI tract is a series of hollow organs joined in a long,
twisting tube from the mouth to the anus. Common symptoms of foodborne illnesses include vomiting, diarrhea,
abdominal pain, fever, and chills.

Most foodborne illnesses are acute, meaning they happen suddenly and last a short time, and most people recover on
their own without treatment. Rarely, foodborne illnesses may lead to more serious complications. Each year, an
estimated 48 million people in the United States experience a foodborne illness. Foodborne illnesses cause about
3,000 deaths in the United States annually.1

What causes foodborne illnesses?

The majority of foodborne illnesses are caused by harmful bacteria and viruses.2 Some parasites and chemicals also
cause foodborne illnesses.

Bacteria
Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans.

Some harmful bacteria may already be present in foods when they are purchased. Raw foods including meat, poultry,
fish and shellfish, eggs, unpasteurized milk and dairy products, and fresh produce often contain bacteria that cause
foodborne illnesses. Bacteria can contaminate food—making it harmful to eat—at any time during growth, harvesting
or slaughter, processing, storage, and shipping.

Foods may also be contaminated with bacteria during food preparation in a restaurant or home kitchen. If food
preparers do not thoroughly wash their hands, kitchen utensils, cutting boards, and other kitchen surfaces that come
into contact with raw foods, cross-contamination—the spread of bacteria from contaminated food to uncontaminated
food—may occur.

If hot food is not kept hot enough or cold food is not kept cold enough, bacteria may multiply. Bacteria multiply
quickly when the temperature of food is between 40 and 140 degrees. Cold food should be kept below 40 degrees and
hot food should be kept above 140 degrees. Bacteria multiply more slowly when food is refrigerated, and freezing food
can further slow or even stop the spread of bacteria. However, bacteria in refrigerated or frozen foods become active
again when food is brought to room temperature. Thoroughly cooking food kills bacteria.

Many types of bacteria cause foodborne illnesses. Examples include

 Salmonella, a bacterium found in many foods, including raw and undercooked meat, poultry, dairy
products, and seafood. Salmonella may also be present on egg shells and inside eggs.
 Campylobacter jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk.
 Shigella, a bacterium spread from person to person. These bacteria are present in the stools of people
who are infected. If people who are infected do not wash their hands thoroughly after using the
bathroom, they can contaminate food that they handle or prepare. Water contaminated with infected
stools can also contaminate produce in the field.
 Escherichia coli (E. coli), which includes several different strains, only a few of which cause illness in
humans. E. coli O157:H7 is the strain that causes the most severe illness. Common sources of E.
coli include raw or undercooked hamburger, unpasteurized fruit juices and milk, and fresh produce.
  Listeria monocytogenes (L. monocytogenes), which has been found in raw and undercooked meats,
unpasteurized milk, soft cheeses, and ready-to-eat deli meats and hot dogs.
 Vibrio, a bacterium that may contaminate fish or shellfish.
 Clostridium botulinum (C. botulinum), a bacterium that may contaminate improperly canned foods and
smoked and salted fish.

Viruses
Viruses are tiny capsules, much smaller than bacteria, that contain genetic material. Viruses cause infections that can
lead to sickness. People can pass viruses to each other. Viruses are present in the stool or vomit of people who are
infected. People who are infected with a virus may contaminate food and drinks, especially if they do not wash their
hands thoroughly after using the bathroom.

Common sources of foodborne viruses include

 food prepared by a person infected with a virus

 shellfish from contaminated water
 produce irrigated with contaminated water

Common foodborne viruses include

 norovirus, which causes inflammation of the stomach and intestines

 hepatitis A, which causes inflammation of the liver

Parasites
Parasites are tiny organisms that live inside another organism. In developed countries such as the United States,
parasitic infections are relatively rare.

Cryptosporidium parvum and Giardia intestinalis are parasites that are spread through water contaminated with the
stools of people or animals who are infected. Foods that come into contact with contaminated water during growth or
preparation can become contaminated with these parasites. Food preparers who are infected with these parasites can
also contaminate foods if they do not thoroughly wash their hands after using the bathroom and before handling food.

Trichinella spiralis is a type of roundworm parasite. People may be infected with this parasite by consuming raw or
undercooked pork or wild game.

Chemicals
Harmful chemicals that cause illness may contaminate foods such as

 fish or shellfish, which may feed on algae that produce toxins, leading to high concentrations of toxins in
their bodies. Some types of fish, including tuna and mahi mahi, may be contaminated with bacteria that
produce toxins if the fish are not properly refrigerated before they are cooked or served.
 certain types of wild mushrooms.
 unwashed fruits and vegetables that contain high concentrations of pesticides.

Who gets foodborne illnesses?

Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others,
including

 infants and children

 pregnant women and their fetuses
 older adults
 people with weak immune systems

These groups also have a greater risk of developing severe symptoms or complications of foodborne illnesses.

What are the symptoms of foodborne illnesses?

Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include

 vomiting
 diarrhea or bloody diarrhea
 abdominal pain
 fever
 chills

Symptoms can range from mild to serious and can last from a few hours to several days.

C. botulinum and some chemicals affect the nervous system, causing symptoms such as

 headache
 tingling or numbness of the skin
 blurred vision
 weakness
 dizziness
 paralysis

What are the complications of foodborne illnesses?

Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute
foodborne illnesses may also lead to chronic—or long lasting—health problems.

Dehydration
When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea,
dehydration can result. When dehydrated, the body lacks enough fluid and electrolytes—minerals in salts, including
sodium, potassium, and chloride—to function properly. Infants, children, older adults, and people with weak immune
systems have the greatest risk of becoming dehydrated.

Signs of dehydration are

 excessive thirst
 infrequent urination
  dark-colored urine
 lethargy, dizziness, or faintness

Signs of dehydration in infants and young children are

 dry mouth and tongue

 lack of tears when crying
 no wet diapers for 3 hours or more
 high fever
 unusually cranky or drowsy behavior
 sunken eyes, cheeks, or soft spot in the skull

Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched
and released.

Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause
serious health problems such as organ damage, shock, or coma—a sleeplike state in which a person is not conscious.

HUS
Hemolytic uremic syndrome is a rare disease that mostly affects children younger than 10 years of age. HUS develops
when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy
red blood cells, which help the blood to clot, and the lining of the blood vessels.

In the United States, E. coli O157:H7 infection is the most common cause of HUS, but infection with other strains
of E. coli, other bacteria, and viruses may also cause HUS. A recent study found that about 6 percent of people with E.
coli O157:H7 infections developed HUS. Children younger than age 5 have the highest risk, but females and people
age 60 and older also have increased risk.3

Symptoms of E. coli O157:H7 infection include diarrhea, which may be bloody, and abdominal pain, often
accompanied by nausea, vomiting, and fever. Up to a week after E. coli symptoms appear, symptoms of HUS may
develop, including irritability, paleness, and decreased urination. HUS may lead to acute renal failure, which is a
sudden and temporary loss of kidney function. HUS may also affect other organs and the central nervous system.
Most people who develop HUS recover with treatment. Research shows that in the United States between 2000 and
2006, fewer than 5 percent of people who developed HUS died of the disorder. Older adults had the highest mortality
rate—about one-third of people age 60 and older who developed HUS died.3

Studies have shown that some children who recover from HUS develop chronic complications, including kidney
problems, high blood pressure, and diabetes.

Other Complications
Some foodborne illnesses lead to other serious complications. For example, C. botulinum and certain chemicals in
fish and seafood can paralyze the muscles that control breathing. L. monocytogenes can cause spontaneous abortion
or stillbirth in pregnant women.

Research suggests that acute foodborne illnesses may lead to chronic disorders, including

 reactive arthritis, a type of joint inflammation that usually affects the knees, ankles, or feet. Some
people develop this disorder following foodborne illnesses caused by certain bacteria, including C.
jejuni and Salmonella. Reactive arthritis usually lasts fewer than 6 months, but this condition may recur
or become chronic arthritis.4
  irritable bowel syndrome (IBS), a disorder of unknown cause that is associated with abdominal
pain, bloating, and diarrhea or constipation or both. Foodborne illnesses caused by bacteria increase the
risk of developing IBS.5
 Guillain-Barré syndrome, a disorder characterized by muscle weakness or paralysis that begins in
the lower body and progresses to the upper body. This syndrome may occur after foodborne illnesses
caused by bacteria, most commonly C. jejuni. Most people recover in 6 to 12 months.6

A recent study found that adults who had recovered from E. coli O157:H7 infections had increased risks of high blood
pressure, kidney problems, and cardiovascular disease.7

When should people with foodborne illnesses see a

health care provider?
People with any of the following symptoms should see a health care provider immediately:

 signs of dehydration
 prolonged vomiting that prevents keeping liquids down
 diarrhea for more than 2 days in adults or for more than 24 hours in children
 severe pain in the abdomen or rectum
 a fever higher than 101 degrees
 stools containing blood or pus
 stools that are black and tarry
 nervous system symptoms
 signs of HUS

If a child has a foodborne illness, parents or guardia