Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 7) Age Most of the morbidity and mortality from enteric pathogens involves children <5 years of age. Breast-fed infants are protected from contaminated food and water and derive some protection from maternal antibodies, but their risk of infection rises dramatically when they begin to eat solid foods. Infants and younger children are more likely than adults to develop rotavirus disease, while older children and adults are more commonly infected with norovirus. Other organisms with higher attack rates among children than among adults include enterotoxigenic, enteropathogenic, and enterohemorrhagic E. coli; C. jejuni; and G. lamblia. In children, the incidence of Salmonella infections is highest among those <1 year of age, while the attack rate for Shigella infections is greatest among those 6 months to 4 years of age. Bacterial Food Poisoning If the history and the stool examination indicate a noninflammatory etiology of diarrhea and there is evidence of a common-source outbreak, questions concerning the ingestion of specific foods and the time of onset of the diarrhea after a meal can provide clues to the bacterial cause of the illness. Potential causes of bacterial food poisoning are shown in Table 122-4. Table 122-4 Bacterial Food Poisoning Incubation Period, Organism Symptoms Common Food Sources 1–6 H Staphylococcus aureus Nausea, vomiting, diarrhea Ham, poultry, potato or egg salad, mayonnaise, cream pastries Bacillus cereus Nausea, vomiting, diarrhea Fried rice 8–16 H Clostridium perfringens Abdominal cramps, diarrhea (vomiting rare) Beef, poultry, legumes, gravies B. cereus Abdominal cramps, diarrhea (vomiting rare) Meats, vegetables, dried beans, cereals >16 H Vibrio cholerae Watery diarrhea Shellfish Enterotoxigenic Escherichia coli Watery diarrhea Salads, cheese, meats, water Enterohemorrhagic E. coli Bloody diarrhea Ground beef, roast beef, salami, raw milk, raw vegetables, apple juice Salmonella spp. Inflammatory diarrhea Beef, poultry, eggs, dairy products Campylobacter jejuni Inflammatory diarrhea Poultry, raw milk Shigella spp. Dysentery Potato or egg salad, lettuce, raw vegetables Vibrio parahaemolyticus Dysentery Mollusks, crustaceans Bacterial disease caused by an enterotoxin elaborated outside the host, such as that due to Staphylococcus aureus or B. cereus, has the shortest incubation period (1–6 h) and generally lasts <12 h. Most cases of staphylococcal food poisoning are caused by contamination from infected human carriers. Staphylococci can multiply at a wide range of temperatures; thus, if food is left to cool slowly and remains at room temperature after cooking, the organisms will have the opportunity to form enterotoxin. Outbreaks following picnics where potato salad, mayonnaise, and cream pastries have been served offer classic examples of staphylococcal food poisoning. Diarrhea, nausea, vomiting, and abdominal cramping are common, while fever is less so. . Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 7) Age Most of the morbidity and mortality from enteric pathogens. specific foods and the time of onset of the diarrhea after a meal can provide clues to the bacterial cause of the illness. Potential causes of bacterial food poisoning are shown in Table 122- 4 among those 6 months to 4 years of age. Bacterial Food Poisoning If the history and the stool examination indicate a noninflammatory etiology of diarrhea and there is evidence of a common-source