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Each year in the United States there are approximately 9.4 million illnesses, 55,961 hospitalizations, and 1351 deaths from known foodborne agents, and 38.4 million gastroenteritis illnesses, 71,878 hospitalizations, and 1686 deaths from unspecified agents.39 Worldwide food distribution, large-scale national food preparation and distribution networks, limited food regulatory practices, and corporate greed place everyone at risk. Food poisoning causes morbidity and mortality by one or more of the following mechanisms: Infectious agents (bacteria, viruses, parasites) can be transmitted in food; toxins, produced by organisms, can be consumed in food; toxins or chemicals can be inadvertently or purposefully used to contaminate food and be ingested.

This chapter is organized into four major types of food poisoning: foodborne poisoning with neurologic effects, food poisoning with gastrointestinal symptoms, foodborne poisoning with anaphylaxislike effects, and food poisoning used for bioterrorism.


In recent years in the United States, Salmonella spp and Escherichia coli have become the major causes of food poisoning responsible for epidemics that afflict millions, hospitalize hundreds, and kill many unsuspecting people.

The most common causes of foodborne disease include bacteria—Salmonella spp, Campylobacter spp, Shigella spp, and E. coli66 (Table 44–1). In the last decade, large numbers of people have also suffered from food poisoning due to purposeful placement of chemicals in food,41 and staphylococcal toxin.154

TABLE 44–1.Epidemiology of Food Poisoning Reported to the US Centers for Disease Control and Prevention (2009–2010)66


The differential diagnosis of patients with foodborne poisoning presenting with neurologic symptoms is vast (Tables 44–2 and 44–3). The sources of many of these cases are ichthyosarcotoxic, involving toxins from the muscles, viscera, skin, gonads, and mucous surfaces of the fish; rarely, toxicity follows consumption of the fish blood or skeleton. Shellfish poisoning also must be considered. Most episodes of poisoning are not species specific, although particular forms of toxicity from Tetraodontiformes (puffer fish), Gymnothoraces (moray eel), and newts (Taricha and other species) are recognized.

TABLE 44–2.Differential Diagnosis of Possible Foodborne Poisoning Presenting with Neurologic Findingsa

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