Illness caused by consumption of food or water contaminated by certain pathogenic microorganisms - usually affects large numbers of people, after ingestion of communal food in homes, hospitals, hotels, etc

Causes

• Can be infective or toxic
• Infective: by bacteria, eg. Salmonella typhimurium, Campylobacter jejuni, Bacillus cereus
• Toxic: by toxins from Staphylococcus aureus, and Clostridium botulinum

Clinical features

• Nausea, vomiting
• Intermittent abdominal pain (colic) with associated diarrhoea.
• Botulism: paralysis of skeletal, ocular, pharyngeal and respiratory muscles
• Fever (especially if poisoning is the infective type)
• May be self-limiting - features disappear without specific treatment

Differential diagnosis

• Cholera
• Dysentery
• Other causes of stomach and intestinal infections

Investigations

Good history and examination is important for diagnosis
Stool: examination for C&S

Management:
HC2

Establish the cause and treat accordingly
Give oral or IV fluids for rehydration as required (see p332 and p336)
For pain, give paracetamol 1g every 4-6 hours - max daily dose: 4g child: 10mg/kg per dose

If the poisoning is bacterial in origin and diarrhoea persists or is severe (ie. >5 stools/day, bloody and/or fever):

Give an antibiotic for 3-7 days, depending on response:
cotrimoxazole 960mg every 12 hours
child: 24mg/kg per dose
or erythromycin 500mg every 6 hours
child: 10mg/kg per dose

or ciprofloxacin 500mg every 12 hours

contraindicated in pregnancy child: 10mg/kg per dose

Follow up patients and manage accordingly

Prevention

• Heat cooked foods thoroughly before eating and avoid eating cold left-over cooked foods
• Ensure adequate personal and domestic hygiene