Diarrhea From Food Contamination

Foodborne illness is a major problem. Over 40 million cases of foodborne illness occur in the US each year and most of the cases do not require seeing a doctor. Most of the episodes resolve with routine measures including drinking adequate fluids and changing your solid food intake to a complex carbohydrate diet for several days and then the gradual reintroduction of foods with more protein and fat. Young children under age 5 years are at highest risk and almost always do well and do not require hospitalization.
The elderly, on the other hand, have the highest risks of mortality and the highest complication rates. They are also at the greatest risk for hospitalization.
The most common cause is a norovirus infection. Other infections include bacterial infections due to Salmonella, C perfringes, Campylobacter and Staphylococcus aureus. The most common symptoms include crampy abdominal pain with vomiting and diarrhea. A low grade fever is common and the diarrhea mayor may not be bloody. If bloody diarrhea is present then the cause is most likely E coli, Campylobacter, Salmonella or Shigella.
The greatest risk from these illnesses is dehydration. Your child will become cranky and listless with dry mouth and lips, urination will decrease, skin color will be pale with a doughy turgor and heart rate will increase.
If these symptoms are mild then rehydration with an electrolyte containing sports drink is generally all that is needed. Stay in close contact with your pediatrician and monitor fluid intake and urine output as well as the amount of ongoing diarrhea and vomiting. If vomiting and diarrhea continue or the above symptoms continue or worsen then your child needs to be seen. Oral rehydration is the mainstay of treatment but intravenous fluids are also used. Medication to decrease vomiting, such as ondansetron, can be used but antidiarrheal medications are not recommended. Stool test are rarely needed unless symptoms are severe, prolonged or the child has underlying medical problems.
Various bacteria cause foodborne illness. Staphylococcus aureus produces a toxin that causes the rapid onset of symptoms within a few hours and can last for 1-2 days. No antibiotic treatment is usually needed. Illness due to Bacillus cereus is usually brief and may cause either predominately diarrhea or vomiting. Like those illnesses due to S. aureus it is usually self-limited and resolves in 24 hours. Salmonella is longer in duration and symptoms often last for up to 1 week. In young children the bacteria continues to be shed in feces for up to several weeks. Safe hygiene is very important for these children to prevent further spread. Shigella is another common illness and duration of symptoms is several days. Antibiotics can be helpful especially for young or immunocompromised children. Vibrio gastroenteritis is another bacterial infection that is spread through the ingestion of contaminated seafood, including raw oysters, and other foods. Most of the symptoms resolve within 5 days and are self-limited and do not require antibiotic treatment unless the child has severe symptoms or is immunocompromised. Campylobacter infections are commonly caused by the ingestion of contaminated water, poultry or unpasteurized milk. Bloody diarrhea and abdominal pain are common and symptoms can last longer than 1 week. Antibiotic treatment is not usually needed but can reduce the duration of illness.