Manual of Naval Preventive Medicine
Chapter 1: Food Service Sanitation
X: Foodborne Illnesses

1-71. Foodborne Illnesses.

Department of the Navy
Bureau of Medicine and Surgery

1. Foodborne illness can affect one person or it can incapacitate large numbers of personnel in a short period of time. Symptoms can range from nausea or diarrhea to death.

2. Some foods are poisonous at the time they are harvested. Many of the poisons in these foods tend to attack the nervous system resulting in such symptoms as weakness or paralysis, numbness, tingling of the ears, apprehension and even death. Some fish and shellfish concentrate poisons produced by toxic plankton. Tropical reef fish (grouper, snapper, jack, and barracuda) concentrate ciguatoxin, while mollusks (clams, oysters, scallops, and mussels) concentrate the toxin associated with "red tide." Naturally poisonous foods include certain mushroom species and certain tropical fish (puffer type fish and ocean sunfish).

3. Chemical poisonings may be caused by arsenic as residue of spray on fruits or vegetables; cadmium or zinc dissolved by acid foods, such a lemonade gelatin, tomatoes etc., cadmium plated or galvanized pitchers or cans or exposure of food and food service equipment to insecticides or other chemical products such as cleaning compounds. Chemical poisonings usually cause violent nausea, vomiting, and diarrhea very shortly after ingestion.

4. Foods most commonly incriminated in outbreaks of foodborne illness other than those caused by chemical or natural poisons are meat and seafood mixtures such as hash, hamburger, creamed meat pies, crab, lobster, chicken, and turkey salads, turkey, turkey stuffing or dressing, chicken, and ham. Milk and egg products, such as custards and cream puffs, and sliced cold meats have also been involved in foodborne illnesses. These foods have common characteristics in that they provide moisture, a good protein food supply and warmth. Given sufficient time, these factors promote an ideal environment for the growth and multiplication of microorganisms. It is important to remember that these organisms do not necessarily cause any alteration in the normal appearance, odor, or taste of the food.

5. Foodborne illnesses (other than those caused by chemical or natural poisons) are divided into two types: foodborne intoxication and foodborne infection.

a. Foodborne Intoxication

(1) Certain bacteria under favorable growth conditions produce chemicals (toxins) in food which when ingested will cause food intoxication. Enterotoxins produced by Staphylococcus aureus are heat stable (i.e., not destroyed by normal cooking temperatures) and are the cause of one of the most frequently reported foodborne illnesses: staphylococcal intoxication. This disease is characterized by an abrupt onset (2 to 4 hours after ingestion) with symptoms of severe nausea, projectile vomiting, diarrhea, and prostration with little or no fever.

(2) The type of food associated with such outbreaks varies considerably. Pork (including ham and salami) and poultry products are commonly involved. Ham may become contaminated with staphylococci because of the common practices of boning and slicing then holding without adequate refrigeration for several hours before serving. In addition, highly salted ham permits staphylococcal growth but inhibits many other bacteria. Other foods commonly involved are canned or potted meat or fish, pressed tongue, beef, cheese, other milk products, cream or custard filled pastries, potato salad, and pasta salads. The usual source of the pathogens, which cause this form of food intoxication, may be the nose, throat, boils, pimples, or infected cuts on the hands of food service personnel.

(3) Exotoxins produced by Clostridium botulinum causes a highly publicized but an increasingly rare disease called botulism. This disease, which causes death in about 18% of patients even with adequate treatment, is most frequently associated with home-canned low-acid foods (vegetables and fruits) which have been improperly processed. Ingestion of the toxin-containing food without adequate cooking, which destroys the toxin, leads to nerve paralysis manifested by symptoms of weakness, headache, and dizziness, followed by death due to respiratory or cardiac failure. Cases of botulism have also resulted from home-canned meats and fish, smoked fish, and improperly prepared commercial products, such as vichyssoise soup and potpies.

(4) Toxins produced in food contaminated by Bacillus cereus, Clostridium perfringens, and Vibrio parahaemolyticus also cause foodborne illness outbreaks.

b. Foodborne Infection

(1) A foodborne infection is caused by ingestion of food containing a bacteria, virus or parasite which must multiply within the gastrointestinal tract before causing symptoms by producing toxins or invading the intestinal mucosa. The diverse microorganisms which can cause foodborne infections include several Salmonella and Shigella species, Escherichia cold and Entamoeba histolytica These infections have longer incubation periods than those experienced with food intoxications, usually commencing from 6 to 24 hours or longer after ingestion. Symptoms may include fever, headache, nausea, vomiting, diarrhea, abdominal pain or distress, and prostration. The causative organism may be revealed by laboratory examination of the vomitus, feces, or blood and the suspected food, when available.

(2) These pathogens can contaminate a wide variety of food products. For example, infections due to Salmonella are frequently associated with poultry products, particularly turkey and egg products. Listeriosis is associated with contaminated milk products, while amebiasis is acquired from eating contaminated raw vegetables.

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