Appendix VI 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 habit changes, and trends toward centralized food production and widespread distribution. The cultural diversity of foods and food practices and international travel are also likely impacting the epidemiology of foodborne disease. Widespread availability of multiplex molecular diagnostic tests for gastrointestinal ill- ness may lead to co-identification of multiple potential pathogens, complicating evalu- ation and treatment of diarrhea. Consideration of a foodborne etiology is important in any patient with a gastroin- testinal tract illness, as well as those with certain acute neurologic findings. Obtaining a detailed history is essential to assess time of onset and duration of symptoms, his- tory of recent travel or antimicrobial use, food and water exposures, and presence of blood or mucus in stool. To aid in diagnosis, foodborne disease syndromes have been categorized by incubation period, predominant symptoms (other symptoms also occur), causative agent, and foods commonly associated with specific etiologic agents (food vehicles) (see Table 1 also gating-outbreaks/confirming_diagnosis.html). Diagnosis can be confirmed by laboratory testing of stool, vomitus, or blood, depending on the causative agent. Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea can be found at https://academic.oup. com/cid/article/65/12/e45/4557073. 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 estimated. In more widely dispersed outbreaks and in spo- radic cases, the incubation period typically 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 neurologic signs or symptoms. If an outbreak is suspected, public health officials should be notified immediately to initiate an epidemiologic investigation, including diagnostic and management interventions, to curtail the outbreak. 1 Centers 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 and 2 Centers 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 APPENDIX VI—CLINICAL SYNDROMES ASSOCIATED WITH 1041 FOODBORNE DISEASES Red_Book_2020_APPENDIX_1027-1060.indd 1041 19/02/21 10:05 AM
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