1086 APPENDIX VII–CLINICAL SYNDROMES ASSOCIATED WITH FOODBORNE DISEASES Appendix VII Clinical Syndromes Associated With Foodborne Diseases1,2 Foodborne disease results from consumption of contaminated foods or beverages and causes morbidity and mortality in children and adults. The epidemiology of foodborne disease is complex and dynamic because of numerous possible pathogens, the variety of disease manifestations, the increasing prevalence of immunocompromised children and adults, dietary habits changes, and trends toward centralized food production and wide- spread distribution. The cultural diversity of foods and food practices likely is another issue impacting the epidemiology of foodborne disease. Consideration of a foodborne etiology is important in any patient with a gastrointesti- nal tract illness, as well as those with certain acute neurologic findings. A detailed history is invaluable, with important questions including time of onset of symptoms, history of recent travel or antimicrobial use, and presence of blood or mucus in stool. To aid in di- agnosis, foodborne disease syndromes have been categorized by incubation period, pre- dominant symptoms, causative agent, and foods commonly associated with specific etio- logic agents (food vehicles) (see Table). Diagnosis can be confirmed by laboratory testing of stool, vomitus, or blood, depending on the causative agent. Sporadic (ie, non-outbreak associated) cases account for the majority of foodborne illnesses. In localized outbreaks that affect individuals who shared a common meal, the incubation period can be estimat- ed. In more widely dispersed outbreaks and in sporadic cases, the incubation period typi- cally is unknown. An outbreak should be considered when 2 or more people who have ingested the same food develop an acute illness characterized by nausea, vomiting, diarrhea, or neuro- logic signs or symptoms. If an outbreak is suspected, public health officials should be noti- fied immediately to initiate an epidemiologic investigation, including diagnostic and man- agement interventions, to curtail the outbreak. 1Centers for Disease Control and Prevention. Surveillance for foodborne-disease outbreaks—United States, 2008. MMWR Morb Mortal Wkly Rep. 2011 60(35):1197-1202. Additional information can be found at www.cdc.gov/foodsafety and www.fsis.usda.gov/wps/portal/fsis/home 2Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States, 1998–2008. MMWR Morb Mortal Wkly Rep. 2013 62(SS-2):1-34
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