What are the complicationsof foodborne illnesses?Foodborne illnesses may lead to dehydration,hemolytic uremic syndrome (HUS), andother complications. Acute foodborneillnesses may also lead to chronic—or longlasting—health problems.DehydrationWhen someone does not drink enoughfluids to replace those that are lost throughvomiting and diarrhea, dehydration canresult. When dehydrated, the body lacksenough fluid and electrolytes—mineralsin salts, including sodium, potassium, andchloride—to function properly. Infants,children, older adults, and people with weakimmune systems have the greatest risk ofbecoming dehydrated.Signs of dehydration are• excessive thirst• infrequent urination• dark-colored urine• lethargy, dizziness, or faintnessSigns of dehydration in infants and youngchildren are• dry mouth and tongue• lack of tears when crying• no wet diapers for 3 hours or more• high fever• unusually cranky or drowsy behavior• sunken eyes, cheeks, or soft spot in theskullAlso, when people are dehydrated, their skindoes not flatten back to normal right awayafter being gently pinched and released.Severe dehydration may require intravenousfluids and hospitalization. Untreatedsevere dehydration can cause serious healthproblems such as organ damage, shock, orcoma—a sleeplike state in which a person isnot conscious.HUSHemolytic uremic syndrome is a rare diseasethat mostly affects children younger than10 years of age. HUS develops when E. colibacteria lodged in the digestive tract maketoxins that enter the bloodstream. Thetoxins start to destroy red blood cells, whichhelp the blood to clot, and the lining of theblood vessels.In the United States, E. coli O157:H7infection is the most common cause of HUS,but infection with other strains of E. coli,other bacteria, and viruses may also causeHUS. A recent study found that about6 percent of people with E. coli O157:H7infections developed HUS. Childrenyounger than age 5 have the highest risk, butfemales and people age 60 and older alsohave increased risk. 3Symptoms of E. coli O157:H7 infectioninclude diarrhea, which may be bloody,and abdominal pain, often accompanied bynausea, vomiting, and fever. Up to a weekafter E. coli symptoms appear, symptomsof HUS may develop, including irritability,paleness, and decreased urination. HUS maylead to acute renal failure, which is a sudden3Gould HL, Demma L, Jones TF, et. al. Hemolyticuremic syndrome and death in persons with Escherichiacoli O157:H7 infection, Foodborne Diseases ActiveSurveillance Network sites, 2000–2006. ClinicalInfectious Diseases. 2009:49(10):1480–1485.4 Foodborne Illnesses
and temporary loss of kidney function. HUSmay also affect other organs and the centralnervous system. Most people who developHUS recover with treatment. Researchshows that in the United States between 2000and 2006, fewer than 5 percent of peoplewho developed HUS died of the disorder.Older adults had the highest mortality rate—about one-third of people age 60 and olderwho developed HUS died. 3Studies have shown that some childrenwho recover from HUS develop chroniccomplications, including kidney problems,high blood pressure, and diabetes.Other ComplicationsSome foodborne illnesses lead to otherserious complications. For example,C. botulinum and certain chemicals in fishand seafood can paralyze the muscles thatcontrol breathing. L. monocytogenes cancause spontaneous abortion or stillbirth inpregnant women.• irritable bowel syndrome (IBS), adisorder of unknown cause that isassociated with abdominal pain,bloating, and diarrhea or constipationor both. Foodborne illnesses caused bybacteria increase the risk of developingIBS. 5• Guillain-Barré syndrome, a disordercharacterized by muscle weakness orparalysis that begins in the lower bodyand progresses to the upper body. Thissyndrome may occur after foodborneillnesses caused by bacteria, mostcommonly C. jejuni. Most peoplerecover in 6 to 12 months. 6A recent study found that adults who hadrecovered from E. coli O157:H7 infectionshad increased risks of high blood pressure,kidney problems, and cardiovasculardisease. 7Research suggests that acute foodborneillnesses may lead to chronic disorders,including• reactive arthritis, a type of jointinflammation that usually affects theknees, ankles, or feet. Some peopledevelop this disorder followingfoodborne illnesses caused by certainbacteria, including C. jejuni andSalmonella. Reactive arthritis usuallylasts fewer than 6 months, but thiscondition may recur or become chronicarthritis. 45Spiller R, Aziz Q, Creed F. Guidelines on theirritable bowel syndrome: mechanisms and practicalmanagement. Gut. 2007;56(12):1770–1798.6Andary MT. Guillain-Barré syndrome. Emedicine.http://emedicine.medscape.com/article/315632-overview. Updated August 26, 2011. Accessed May16, 2012.4Burns B. Reactive arthritis in emergency medicine.Emedicine. http://emedicine.medscape.com/article/808833-overview. Updated February 1, 2010.Accessed May 16, 2012.7Clark WF, Sontrop JM, Macnab JJ, et al. Longterm risk for hypertension, renal impairment, andcardiovascular disease after gastroenteritis fromdrinking water contaminated with Escherichia coliO157:H7: a prospective cohort study. British MedicalJournal. 2010;341:c6020.5 Foodborne Illnesses
When should people withfoodborne illnesses see ahealth care provider?People with any of the following symptomsshould see a health care providerimmediately:• signs of dehydration• prolonged vomiting that prevents keeping liquids down• diarrhea for more than 2 days in adultsor for more than 24 hours in children• severe pain in the abdomen or rectum• a fever higher than 101 degrees• stools containing blood or pus• stools that are black and tarry• nervous system symptoms• signs of HUSIf a child has a foodborne illness, parents orguardians should not hesitate to call a healthcare provider for advice.How are foodborne illnessesdiagnosed?To diagnose foodborne illnesses, health careproviders ask about symptoms, foods andbeverages recently consumed, and medicalhistory. Health care providers will alsoperform a physical examination to look forsigns of illness.Diagnostic tests for foodborne illnesses mayinclude a stool culture, in which a sample ofstool is analyzed in a laboratory to check forsigns of infections or diseases. A sample ofvomit or a sample of the suspected food, ifavailable, may also be tested. A health careprovider may perform additional medicaltests to rule out diseases and disorders thatcause symptoms similar to the symptoms offoodborne illnesses.If symptoms of foodborne illnesses are mildand last only a short time, diagnostic tests areusually not necessary.6 Foodborne Illnesses
How are foodborne illnessestreated?The only treatment needed for mostfoodborne illnesses is replacing lost fluidsand electrolytes to prevent dehydration.Over-the-counter medications such asloperamide (Imodium) and bismuthsubsalicylate (Pepto-Bismol and Kaopectate)may help stop diarrhea in adults. However,people with bloody diarrhea—a sign ofbacterial or parasitic infection—should notuse these medications. If diarrhea is causedby bacteria or parasites, over-the-countermedications may prolong the problem.Medications to treat diarrhea in adults canbe dangerous for infants and children andshould only be given with a health careprovider’s guidance.If the specific cause of the foodborne illnessis diagnosed, a health care provider mayprescribe medications, such as antibiotics, totreat the illness.Hospitalization may be required to treat lifethreateningsymptoms and complications,such as paralysis, severe dehydration, andHUS.Eating, Diet, and NutritionThe following steps may help relieve thesymptoms of foodborne illnesses and preventdehydration in adults:• drinking plenty of liquids such as fruitjuices, sports drinks, caffeine-free softdrinks, and broths to replace fluids andelectrolytes• sipping small amounts of clear liquids orsucking on ice chips if vomiting is still aproblem• gradually reintroducing food, startingwith bland, easy-to-digest foods suchas rice, potatoes, toast or bread, cereal,lean meat, applesauce, and bananas• avoiding fatty foods, sugary foods, dairyproducts, caffeine, and alcohol untilrecovery is completeInfants and children present specialconcerns. Infants and children are likelyto become dehydrated more quickly fromdiarrhea and vomiting because of theirsmaller body size. The following stepsmay help relieve symptoms and preventdehydration in infants and children:• giving oral rehydration solutions suchas Pedialyte, Naturalyte, Infalyte, andCeraLyte to prevent dehydration• giving food as soon as the child is hungry• giving infants breast milk or fullstrengthformula, as usual, along withoral rehydration solutionsOlder adults and adults with weak immunesystems should also drink oral rehydrationsolutions to prevent dehydration.7 Foodborne Illnesses
Traveler’s DiarrheaPeople who visit certain foreign countries are at risk for traveler’s diarrhea, which iscaused by eating food or drinking water contaminated with bacteria, viruses, or parasites.Traveler’s diarrhea can be a problem for people traveling to developing countries in Africa,Asia, Latin America, and the Caribbean. Visitors to Canada, most European countries,Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.To prevent traveler’s diarrhea, people traveling from the United States to developingcountries should avoid• drinking tap water, using tap water to brush their teeth, or using ice made from tapwater• drinking unpasteurized milk or milk products• eating raw fruits and vegetables, including lettuce and fruit salads, unless they peel thefruits or vegetables themselves• eating raw or rare meat and fish• eating meat or shellfish that is not hot when served• eating food from street vendorsTravelers can drink bottled water, bottled soft drinks, and hot drinks such as coffee or tea.People concerned about traveler’s diarrhea should talk with a health care provider beforetraveling. The health care provider may recommend that travelers bring medication withthem in case they develop diarrhea during their trip. Health care providers may advisesome people—especially people with weakened immune systems—to take antibioticsbefore and during a trip to help prevent traveler’s diarrhea. Early treatment withantibiotics can shorten a bout of traveler’s diarrhea.9 Foodborne Illnesses
Points to Remember• Foodborne illnesses are infectionsor irritations of the gastrointestinal(GI) tract caused by food orbeverages that contain harmfulbacteria, parasites, viruses, orchemicals.• Anyone can get a foodborne illness.However, some people are morelikely to develop foodborne illnessesthan others, including infants andchildren, pregnant women and theirfetuses, older adults, and peoplewith weakened immune systems.• Symptoms of foodborne illnessesdepend on the cause. Commonsymptoms of many foodborneillnesses include vomiting, diarrheaor bloody diarrhea, abdominal pain,fever, and chills.• Foodborne illnesses may lead todehydration, hemolytic uremicsyndrome (HUS), and othercomplications. Acute foodborneillnesses may also lead to chronic—or long lasting—health problems.• The only treatment needed for mostfoodborne illnesses is replacing lostfluids and electrolytes to preventdehydration.• Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods.Hope through ResearchThe Division of Digestive Diseasesand Nutrition at the National Instituteof Diabetes and Digestive and KidneyDiseases (NIDDK) supports basic andclinical research into GI diseases, includingfoodborne illnesses. Researchers areinvestigating the relationship betweenfoodborne illnesses and digestive disorderssuch as IBS. Researchers are also studyingways to prevent foodborne illnesses. Clinicaltrials include• The Role of Intestinal Inflammation inIrritable Bowel Syndrome, funded bythe NIDDK under National Institutesof Health (NIH) clinical trial numberNCT01072903• Shigella Sonnel O-SPC/rBRUConjugate Vaccine, funded under NIHclinical trial number NCT01369927• Phase I Safety and Efficacy Study ofCVD 1902, a Live, Attenuated OralVaccine to Prevent Salmonella EntericaSerovar Paratyphi A Infection, fundedunder NIH clinical trial numberNCT01129453Participants in clinical trials can play a moreactive role in their own health care, gainaccess to new research treatments beforethey are widely available, and help othersby contributing to medical research. Forinformation about current studies, visitwww.ClinicalTrials.gov.10 Foodborne Illnesses
For More InformationCenter for Food Safety and Applied NutritionU.S. Food and Drug Administration5100 Paint Branch ParkwayCollege Park, MD 20740Phone: 1–888–SAFEFOOD(1–888–723–3366)Email: firstname.lastname@example.orgInternet: www.fda.gov/FoodCenters for Disease Control and Prevention1600 Clifton RoadAtlanta, GA 30333Phone: 1–800–CDC–INFO (1–800–232–4636)TTY: 1–888–232–6348Email: email@example.comInternet: www.cdc.govFoodSafety.govU.S. Department of Health and HumanServices200 Independence Avenue SWWashington, D.C. 20201Internet: www.foodsafety.govPartnership for Food Safety Education2345 Crystal Drive, Suite 800Arlington, VA 22202Phone: 202–220–0651Fax: 202–220–0873Email: firstname.lastname@example.orgInternet: www.fightbac.orgU.S. Department of Agriculture1400 Independence Avenue SWWashington, D.C. 20250Phone: 202–720–2791Meat and Poultry Hotline:1–888–MPHotline (1–888–674–6854)Email: email@example.comInternet: www.usda.govU.S. Food and Drug Administration10903 New Hampshire AvenueSilver Spring, MD 20993Phone: 1–888–INFO–FDA(1–888–463–6332)Internet: www.fda.govAcknowledgmentsPublications produced by the Clearinghouseare carefully reviewed by both NIDDKscientists and outside experts. Thispublication was originally reviewedby Howard Trachtman, M.D., LongIsland Jewish Medical Center; PeterMcNally, M.D., American College ofGastroenterology; and Howard Sutter, U.S.Food and Drug Administration. Paul N.Maton, M.D., Digestive Disease Specialists,Oklahoma City, OK, reviewed the updatedversion of the publication.You may also find additional information about thistopic by visiting MedlinePlus at www.medlineplus.gov.This publication may contain information aboutmedications. When prepared, this publicationincluded the most current information available.For updates or for questions about any medications,contact the U.S. Food and Drug Administration tollfreeat 1–888–INFO–FDA (1–888–463–6332) or visitwww.fda.gov. Consult your health care provider formore information.The U.S. Government does not endorse or favor anyspecific commercial product or company. Trade,proprietary, or company names appearing in thisdocument are used only because they are considerednecessary in the context of the information provided.If a product is not mentioned, the omission does notmean or imply that the product is unsatisfactory.11 Foodborne Illnesses
National Digestive DiseasesInformation Clearinghouse2 Information WayBethesda, MD 20892–3570Phone: 1–800–891–5389TTY: 1–866–569–1162Fax: 703–738–4929Email: firstname.lastname@example.orgInternet: www.digestive.niddk.nih.govThe National Digestive Diseases InformationClearinghouse (NDDIC) is a service of theNational Institute of Diabetes and Digestiveand Kidney Diseases (NIDDK). TheNIDDK is part of the National Institutes ofHealth of the U.S. Department of Healthand Human Services. Established in 1980,the Clearinghouse provides informationabout digestive diseases to people withdigestive disorders and to their families,health care professionals, and the public.The NDDIC answers inquiries, develops anddistributes publications, and works closelywith professional and patient organizationsand Government agencies to coordinateresources about digestive diseases.This publication is not copyrighted. TheClearinghouse encourages users of this publication toduplicate and distribute as many copies as desired.This publication is available atwww.digestive.niddk.nih.gov.U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of HealthNIH Publication No. 12–4730July 2012The NIDDK prints on recycled paper with bio-based ink.