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There are approximately 76 million cases of food poisoning in the United States every year, resulting in 325,000 hospitalizations and 5000 deaths.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 (eg, bacteria, viruses) can be transmitted in food; toxins, produced by organisms can be consumed in food; toxins or chemicals can inadvertently or purposefully contaminate food and be ingested.

This chapter is organized into four major types of food poisoning: foodborne poisoning with neurologic symptoms, foodborne poisoning with gastrointestinal symptoms, foodborne poisoning anaphylaxis-like symptoms, and foodborne 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 worry millions, poison and hospitalize hundreds, and kill many unsuspecting innocent people.

The most common causes of foodborne disease include bacteria—Salmonella spp, Campylobacter spp, Shigella spp, and E. coli.123 (Table 45–1). In the last decade, large numbers of people have also suffered from food poisoning due to purposeful placement of chemicals in food,41 and staphyloccal toxin.154

Table 45–1. Epidemiology of Foodborne Poisoning Reported to the CDC (1993–1997)

The differential diagnosis of patients with foodborne poisoning presenting with neurologic symptoms is vast (Tables 45–2 and 45–3). 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), ...

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