Several disorders may present as a foodborne illness that presents within 6 hours of eating.
Mechanisms involved:
(1) preformed bacterial enterotoxin (example: Staphyloccous aureus, Bacillus cereus)
(2) histamine release (example: niacin, scombroid fish)
(3) gastric irritation (example: heavy metal poisoning)
(4) direct toxic effect (example: MSG, mushroom poisoning)
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Presentation |
Consider |
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nausea and vomiting lasting less than 12 hours, with or without abdominal cramps and diarrhea |
Staphylococcus aureus or Bacillus cereus (preformed toxins) |
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nausea, vomiting and abdominal cramps within 1 hour of eating |
heavy metal poisoning |
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paresthesias within 1 hour with flushing |
niacin intoxication, scombroid fish (histamine fish) |
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paresthesias within 1 hour, often with headache |
monosodium glutamate (MSG) |
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paresthesias within 1 hour |
shellfish poisoning |
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paresthesias in 1 to 6 hours |
ciguartera fish poisoning or shellfish poisoning |
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disulfiram reaction (triggered by alcohol) |
mushroom poisoning |
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gastroenteritis (nausea, vomiting, diarrhea, abdominal cramping) |
mushroom poisoning |
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parasympathetic hyperactivity |
mushroom poisoning |
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delirium or hallucinations |
mushroom poisoning |
Differential diagnosis:
(1) exposure to tyramine while taking an MAO inhibitor
(2) other toxic plants
(3) toxic contamination of food
(4) disulfiram or drug with disulfiram-like effect
Purpose: To evaluate a patient who developed evidence of a foodborne illness within 6 hours of eating.
Specialty: Infectious Diseases, Nutrition
Objective: differential diagnosis and mimics, red flags
ICD-10: A05,
