Does Your Patient Have a Foodborne Disease?

David W.K. Acheson, MD, FRCP


April 01, 2002

In This Article


Foodborne disease has many different forms, involving a variety of bacteria, viruses, protozoa, chemicals, and other types of agents that can be transmitted through consumption of food. Although foodborne illness typically presents with gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and diarrhea, it is important to remember that these diseases can present in very different ways. Such manifestations include fever, neurologic symptoms (eg, headaches, paralysis, or paresthesia (tingling), hepatitis, or renal failure. Because foodborne disease may take many guises, one must ask what, if anything, can be done to reduce the number of clinical diagnoses. The physician must also determine whether all patients should have a stool culture, which patients presenting with symptoms of foodborne illness should be prescribed antimicrobial therapy, and what are the public health implications of potential foodborne illness.

More than 200 known diseases are capable of being transmitted through food.[1] Thus, no simple algorithm can be used to diagnose foodborne illness, but there are some clues that can point the physician in the right diagnostic direction. This article will address 3 key questions.

  • What are the likely microbial causes of foodborne disease?

  • What clues are provided by the time course and the types of symptoms?

  • How can a food history help to narrow the diagnosis?

The Centers for Disease Control and Prevention (CDC) estimate that more than 350 million episodes of diarrhea occur each year in the United States. Of these, some 75 million are thought to be caused by foodborne disease.[1] From the 75 million cases, there are an estimated 325,000 hospitalizations and 5000 deaths. On average, each person in the United States is likely to have diarrhea once or twice per year, and overall, close to 1 in 5 episodes of diarrhea in the United States results from a foodborne disease. Based on these numbers, each person will have a foodborne illness an average of once every 3-4 years. Five pathogens account for 90% of the deaths, with Salmonella species leading the list (Table 1).