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U.S. Food &
Drug Administration Center for Food Safety & Applied Nutrition Foodborne Pathogenic Microorganisms and Natural Toxins Handbook |
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Onset, Duration, and Symptoms of Foodborne Illness
| Approximate onset time to symptoms | Predominant symptoms | Associated organism or toxin |
| Upper gastrointestinal tract symptoms (nausea, vomiting) occur first or predominate | ||
| Less than 1 h | Nausea, vomiting, unusual taste, burning of mouth. | Metallic salts |
| 1-2 h | Nausea, vomiting, cyanosis, headache, dizziness, dyspnea, trembling, weakness, loss of consciousness. | Nitrites |
| 1-6 h mean 2-4 h | Nausea, vomiting, retching, diarrhea, abdominal pain, prostration. | Staphylococcus aureus and its enterotoxins |
| 8-16 h (2-4 h emesis possible) | Vomiting, abdominal cramps, diarrhea, nausea. | Bacillus cereus |
| 6-24 h | Nausea, vomiting, diarrhea, thirst, dilation of pupils, collapse, coma. | Amanita species mushrooms |
| Sore throat and respiratory symptoms occur | ||
| 12-72 h | Sore throat, fever, nausea, vomiting, rhinorrhea, sometimes a rash. | Streptococcus pyogenes |
| 2-5 days | Inflamed throat and nose, spreading grayish exudate, fever, chills, sore throat, malaise, difficulty in swallowing, edema of cervical lymph node. | Corynebacterium diphtheriae |
| Lower gastrointestinal tract symptoms (abdominal cramps, diarrhea) occur first or predominate | ||
| 2-36 h, mean 6-12 h | Abdominal cramps, diarrhea, putrefactive diarrhea associated with C. perfringens, sometimes nausea and vomiting. | Clostridium perfringens, Bacillus cereus, Streptococcus faecalis, S. faecium |
| 12-74 h, mean 18-36 h | Abdominal cramps, diarrhea, vomiting, fever, chills, malaise, nausea, headache, possible. Sometimes bloody or mucoid diarrhea, cutaneous lesions associated with V. vulnificus. Yersinia enterocolitica mimics flu and acute appendicitis. | Salmonella species (including S. arizonae), Shigella, enteropathogenic Escherichia coli, other Enterobacteriacae, Vibrio parahaemolyticus, Yersinia enterocolitica, Pseudomonas aeruginosa (?),Aeromonas hydrophila, Plesiomonas shigelloides, Campylobacter jejuni, Vibrio cholerae (O1 and non-O1) V.vulnificus, V. fluvialis |
| 3-5 days | Diarrhea, fever, vomiting abdominal pain, respiratory symptoms. | Enteric viruses |
| 1-6 weeks | Mucoid diarrhea (fatty stools) abdominal pain, weight loss. | Giardia lamblia |
| 1 to several weeks | Abdominal pain, diarrhea, constipation, headache, drowsiness, ulcers, variable -- often asymptomatic. | Entamoeba histolytica |
| 3-6 months | Nervousness, insomnia, hunger pains, anorexia, weight loss, abdominal pain, sometimes gastroenteritis. | Taenia saginata, T. solium |
| Neurological symptoms (visual disturbances, vertigo, tingling, paralysis) occur | ||
| Less than 1 h | *** SEE GASTROINTESTINAL AND/OR NEUROLOGIC SYMPTOMS (Shellfish Toxins) (this Appendix) | Shellfish toxin |
| Gastroenteritis, nervousness, blurred vision, chest pain, cyanosis, twitching, convulsions. | Organic phosphate | |
| Excessive salivation, perspiration, gastroenteritis, irregular pulse, pupils constricted, asthmatic breathing. | Muscaria-type mushrooms | |
| Tingling and numbness, dizziness, pallor, gastro- hemmorrhage, and desquamation of skin, fixed eyes, loss of reflexes, twitching, paralysis. | Tetradon (tetrodotoxin) toxins | |
| 1-6 h | Tingling and numbness, gastroenteritis, dizziness, dry mouth, muscular aches, dilated pupils, blurred vision, paralysis. | Ciguatera toxin |
| Nausea, vomiting, tingling, dizziness, weakness, anorexia, weight loss, confusion. | Chlorinated hydrocarbons | |
| 2 h to 6 days, usually 12-36 h | Vertigo, double or blurred vision, loss of reflex to light, difficulty in swallowing. speaking, and breathing, dry mouth, weakness, respiratory paralysis. | Clostridium botulinum and its neurotoxins |
| More than 72 h | Numbness, weakness of legs, spastic paralysis, impairment of vision, blindness, coma. | Organic mercury |
| Gastroenteritis, leg pain, ungainly high-stepping gait, foot and wrist drop. | Triorthocresyl phosphate | |
| Allergic symptoms (facial flushing, itching) occur | ||
| Less than 1 h | Headache, dizziness, nausea, vomiting, peppery taste, burning of throat, facial swelling and flushing, stomach pain, itching of skin. | Histamine (scombroid) |
| Numbness around mouth, tingling sensation, flushing, dizziness, headache, nausea. | Monosodium glutamate | |
| Flushing, sensation of warmth, itching, abdominal pain, puffing of face and knees. | Nicotinic acid | |
| Generalized infection symptoms (fever, chills, malaise, prostration, aches, swollen lymph nodes) occur | ||
| 4-28 days, mean 9 days | Gastroenteritis, fever, edema about eyes, perspiration, muscular pain, chills, prostration, labored breathing. | Trichinella spiralis |
| 7-28 days, mean 14 days | Malaise, headache, fever, cough, nausea, vomiting, constipation, abdominal pain, chills, rose spots, bloody stools. | Salmonella typhi |
| 10-13 days | Fever, headache, myalgia, rash. | Toxoplasma gondii |
| 10-50 days, mean 25-30 days | Fever, malaise, lassitude, anorexia, nausea, abdominal pain, jaundice. | Etiological agent not yet isolated -- probably viral |
| Varying periods (depends on specific illness) | Fever, chills, head- or joint ache, prostration, malaise, swollen lymph nodes, and other specific symptoms of disease in question. | Bacillus anthracis, Brucella melitensis, B. abortus, B. suis, Coxiella burnetii, Francisella tularensis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium species, Pasteurella multocida, Streptobacillus moniliformis, Campylobacter jejuni, Leptospira species. |
| Gastrointestinal and/or Neurologic Symptoms - (Shellfish Toxins) | ||
| 0.5 to 2 h | Tingling, burning, numbness, drowsiness, incoherent speech, respiratory paralysis | Paralytic Shellfish Poisoning (PSP) (saxitoxins) |
| 2-5 min to 3-4 h | Reversal of hot and cold sensation, tingling; numbness of lips, tongue & throat; muscle aches, dizziness, diarrhea, vomiting | Neurotoxic Shellfish Poisoning (NSP) (brevetoxins) |
| 30 min to 2-3 h | Nausea, vomiting, diarrhea, abdominal pain, chills, fever | Diarrheic Shellfish Poisoning (DSP) (dinophysis toxin, okadaic acid, pectenotoxin, yessotoxin) |
| 24 h (gastrointestinal) to 48 h (neurologic) | Vomiting, diarrhea, abdominal pain, confusion, memory loss, disorientation, seizure, coma | Amnesic Shellfish Poisoning (ASP) (domoic acid) |
January 1992
mow@cfsan.fda.gov
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