Bacillus anthracis |
2 days to weeks |
Nausea, vomiting, malaise, bloody diarrhea, acute abdominal pain. |
Weeks |
Insufficiently cooked contaminated meat. |
Blood. |
Penicillin is first choice for naturally acquired gastrointestinal anthrax. Ciprofloxacin is second option. |
Bacillus cereus (preformed enterotoxin) |
1 to 6 hours |
Sudden onset of severe nausea and vomiting. Diarrhea may be present. |
24 hours |
Improperly refrigerated cooked and fried rice, meats. |
Normally a clinical diagnosis. Clinical laboratories do not routinely identify this organism. If indicated, send stool and food specimens to reference laboratory for culture and toxin identification. |
Supportive care. |
Bacillus cereus (diarrheal toxin) |
10 to 16 hours |
Abdominal cramps, watery diarrhea, nausea. |
24 to 48 hours |
Meats, stews, gravies, vanilla sauce. |
Testing not necessary, self-limiting (consider testing food and stool for toxin in outbreaks). |
Supportive care |
Brucella abortus, Brucella melitensis, and Brucella suis |
7 to 21 days |
Fever, chills, sweating, weakness, headache, muscle and joint pain, diarrhea, bloody stools during acute phase. |
Weeks |
Raw milk, goat cheese made from unpasteurized milk, contaminated meats. |
Blood culture and positive serology. |
Acute: Rifampin and doxycycline daily for >6 weeks. Infections with complications require combination therapy with rifampin, tetracycline and an aminoglycoside. |
Campylobacter jejuni |
2 to 5 days |
Diarrhea, cramps, fever, and vomiting; diarrhea may be bloody. |
2 to 10 days |
Raw and undercooked poultry, unpasteurized milk, contaminated water. |
Routine stool culture; Campylobacter requires special media and incubation at 42 degrees C to grow. |
Supportive care. For severe cases, antibiotics such as erythromycin and quinolones may be indicated early in the diarrheal disease. Guillain-Barré syndrome can be a sequelae. |
Clostridium botulinum-children and adults (preformed toxin) |
12 to 72 hours |
Vomiting, diarrhea, blurred vision, diplopia, dysphagia, and descending muscle weakness. |
Variable (from days to months). Can be complicated by respiratory failure and death. |
Home-canned foods with a low acid content, improperly canned commercial foods, home-canned or fermented fish, herb-infused oils, baked potatoes in aluminum foil, cheese sauce, bottled garlic, foods held warm for extended periods of time (e.g. in a warm oven). |
Stool, serum, and food can be tested for toxin. Stool and food can also be cultured for the organism. These tests can be performed at some state health department laboratories and the Centers for Disease Control and Prevention (CDC). |
Supportive care. Botulinum antitoxin is helpful if given early in the course of the illness. |
Clostridium botulinum-infants |
3 to 30 days |
In infants <12 months, lethargy, weakness, poor feeding, constipation, hypotonia, poor head control, poor gag and sucking reflex. |
Variable |
Honey, home-canned vegetables and fruits, corn syrup. |
Stool, serum, and food can be tested for toxin. Stool and food can also be cultured for the organism. These tests can be performed at some state health department laboratories and the CDC. |
Supportive care. Botulism immune globulin can be obtained from the Infant Botulism Prevention Program, Health and Human Services, California. Botulinum antitoxin is generally not recommended for infants. |
Clostridium perfringens toxin |
8 to 16 hours |
Watery diarrhea, nausea, abdominal cramps; fever is rare. |
24 to 48 hours |
Meats, poultry, gravy, dried or precooked foods, time- and/or temperature-abused food. |
Stools can be tested for enterotoxin and cultured for organism. Because Clostridium perfringens can normally be found in stool, quantitative cultures must be done. |
Supportive care. Antibiotics not indicated. |
Enterohemorrhagic Escherichia coli (EHEC) including Escherichia coli 0157:H7 and other Shiga toxin-producing Escherichia coli (STEC) |
1 to 8 days |
Severe diarrhea that is often bloody, abdominal pain and vomiting. Usually little or no fever is present. More common in children <4 years. |
5 to 10 days |
Undercooked beef especially hamburger, unpasteurized milk and juice, raw fruits and vegetables (e.g. sprouts), salami (rarely), and contaminated water. |
Stool culture; Escherichia coli 0157:H7 requires special media to grow. If Escherichia coli 0157:H7 is suspected, specific testing must be requested. Shiga toxin testing may be done using commercial kits; positive isolates should be forwarded to public health laboratories for confirmation and serotyping. |
Supportive care, monitor renal function, hemoglobin, and platelets closely. Studies indicate that antibiotics may be harmful. Escherichia coli 0157:H7 infection is also associated with hemolytic uremic syndrome (HUS), which can cause lifelong complications. Studies indicate that antibiotics may promote the development of HUS. |
Enterotoxigenic Escherichia coli (ETEC) |
1 to 3 days |
Watery diarrhea, abdominal cramps, some vomiting. |
3 to >7 days |
Water or food contaminated with human feces. |
Stool culture. ETEC requires special laboratory techniques for identification. If suspected, must request specific testing. |
Supportive care. Antibiotics are not needed except in rare cases. Recommended antibiotics include TMP-SMX and quinolones. |
Listeria monocytogenes |
9 to 48 hours for gastrointestinal symptoms, 2 to 6 weeks for invasive disease. |
Fever, muscle aches, and nausea or diarrhea. Pregnant women may have mild flu-like illness, and infection can lead to premature delivery or stillbirth. Elderly or immunocompromised patients may have bacteremia or meningitis. |
Variable |
Fresh soft cheeses, unpasteurized milk, inadequately pasteurized milk, ready-to-eat deli meats, hot dogs. |
Blood or cerebrospinal fluid cultures. Asymptomatic fecal carriage occurs; therefore, stool culture usually not helpful. Antibody to listeriolysin O may be helpful to identify outbreak retrospectively. |
Supportive care and antibiotics; Intravenous ampicillin, penicillin, or TMP-SMX are recommended for invasive disease. |
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At birth and infancy |
Infants infected from mother at risk for sepsis or meningitis. |
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Salmonella species |
1 to 3 days |
Diarrhea, fever, abdominal cramps, vomiting. Salmonella typhi and Salmonella paratyphi produce typhoid with insidious onset characterized by fever, headache, constipation, malaise, chills, and myalgia; diarrhea is uncommon, and vomiting is usually not severe. |
4 to 7 days |
Contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruits and vegetables (alfalfa sprouts, melons). Salmonella typhi epidemics are often related to fecal contamination of water supplies or street-vended foods. |
Routine stool cultures. |
Supportive care. Other than for Salmonella typhi, antibiotics are not indicated unless there is extra-intestinal spread, or the risk of extra-intestinal spread, of the infection. Consider ampicillin, gentamicin, TMP-SMX, or quinolones if indicated. A vaccine exists for Salmonella typhi. |
Shigella species |
24 to 48 hours |
Abdominal cramps, fever, and diarrhea. Stools may contain blood and mucus. |
4 to 7 days |
Food or water contaminated with fecal material. Usually person-to-person spread, fecal-oral transmission. Ready-to-eat foods touched by infected food workers(e.g., raw vegetables, salads, sandwiches). |
Routine stool cultures. |
Supportive care. TMP-SMX recommended in the United States if organism is susceptible; nalidixic acid or other quinolones may be indicated if organism is resistant, especially in developing countries. |
Staphylococcus aureus (preformed enterotoxin) |
1 to 6 hours |
Sudden onset of severe nausea and vomiting. Abdominal cramps. Diarrhea and fever may be present. |
24 to 48 hours |
Unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries. |
Normally a clinical diagnosis. Stool, vomitus, and food can be tested for toxin and cultured if indicated. |
Supportive care. |
Vibrio cholerae (toxin) |
24 to 72 hours |
Profuse watery diarrhea and vomiting, which can lead to severe dehydration and death within hours. |
3 to 7 days. Causes life-threatening dehydration. |
Contaminated water, fish, shellfish, street-vended food typically from Latin America or Asia. |
Stool culture; Vibrio cholerae requires special media to grow. If Vibrio cholerae is suspected, must request specific testing. |
Support care with aggressive oral and intravenous rehydration. In cases of confirmed cholera, tetracycline or doxycycline is recommended for adults and TMP-SMX for children (<8 years). |
Vibrio parahaemolyticus |
2 to 48 hours |
Watery diarrhea, abdominal cramps, nausea, vomiting. |
2 to 5 days |
Undercooked or raw seafood, such as fish, shellfish. |
Stool cultures. Vibrio parahaemolyticus requires special media to grow. If Vibrio parahaemolyticus is suspected, must request specific testing. |
Supportive care. Antibiotics are recommended in severe cases: tetracycline, doxycycline, gentamicin, and cefotaxime. |
Vibrio vulnificus |
1 to 7 days |
Vomiting, diarrhea, abdominal pain, bacteremia, and wound infections. More common in the immunocompromised, or in patients with chronic liver disease (presenting with bullous skin lesions). Can be fatal in patients with liver disease and the immunocompromised. |
2 to 8 days |
Undercooked or raw shellfish, especially oysters; other contaminated seafood, and open wounds exposed to seawater. |
Stool, wound, or blood cultures. Vibrio vulnificus requires special media to grow. If Vibrio vulnificus is suspected, must request specific testing. |
Supportive care and antibiotics; tetracycline, doxycycline, and ceftazidime are recommended. |
Yersinia enterocolitica and Yersinia pseudotuberculosis |
24 to 48 hours |
Appendicitis-like symptoms (diarrhea and vomiting, fever, and abdominal pain) occur primarily in older children and young adults. May have a scarlatiniform rash with Yersinia pseudotuberculosis. |
1 to 3 weeks, usually self-limiting |
Undercooked pork, unpasteurized milk, tofu, contaminated water. Infection has occurred in infants whose caregivers handled chitterlings. |
Stool, vomitus or blood culture. Yersinia requires special media to grow. If suspected, must request specific testing. Serology is available in research and reference laboratories. |
Supportive care, usually self-limiting. If septicemia or other invasive disease occurs, antibiotic therapy with gentamicin or cefotaxime (doxycycline and ciprofloxacin also effective). |