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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Appendix B
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Etiologic agent | Incubation period | Clinical syndrome | Confirmation |
Bacterial | |||
1. Bacillus cereus | |||
a. Vomiting toxin | 1-6 hrs | Vomiting; some patients with diarrhea; fever uncommon | Isolation of organism from stool of two or more ill persons and not from stool of control patients |
OR | |||
Isolation of 105 organisms/g from epidemiologically implicated food, provided specimen is properly handled | |||
b. Diarrheal toxin | 6-24 hrs | Diarrhea, abdominal cramps, and vomiting in some patients; fever uncommon | Isolation of organism from stool of two or more ill persons and not from stool of control patients |
OR | |||
Isolation of 105 organisms/g from epidemiologically implicated food, provided specimen is properly handled | |||
2. Brucella | Several days to several mos; usually >30 days | Weakness, fever, headache, sweats, chills, arthralgia, weight loss, splenomegaly | Two or more ill persons and isolation of organism in culture of blood or bone marrow; greater than fourfold increase in standard agglutination titer (SAT) over several wks, or single SAT 1:160 in person who has compatible clinical symptoms and history of exposure |
3. Campylobacter jejuni/coli | 2-10 days; usually 2-5 days | Diarrhea (often bloody), abdominal pain, fever | Isolation of organism from clinical specimens from two or more ill persons |
OR | |||
Isolation of organism from epidemiologically implicated food | |||
4. Clostridiumbotulinum | 2 hrs-8 days; usually 12-48 hrs | Illness of variable severity; common symptoms are diplopia, blurred vision, and bulbar weakness; paralysis, which is usually descending and bilateral, might progress rapidly | Detection of botulinal toxin in serum, stool, gastric contents, or implicated food |
OR | |||
Isolation or organism from stool or intestine | |||
5. Clostridium perfringens | 6-24 hrs | Diarrhea, abdominal cramps; vomiting and fever uncommon | Isolation of 105 organisms/g from stool of two or more ill persons, provided specimen is properly handled. |
OR | |||
Demonstration of enterotoxin in the stool of two or more ill persons | |||
OR | |||
Isolation of 105 organisms/g from epidemiologically implicated food, provided specimen is properly handled | |||
6. Escherichia coli | |||
a. Enterohemorrhagic (E. coli O157:H7 and others) | 1-10 days; usually 3-4 days | Diarrhea (often bloody), abdominal cramps (often severe), little or no fever | Isolation of E. coli O157:H7 or other Shiga-like toxin-producing E. coli from clinical specimen from two or more ill persons |
OR | |||
Isolation of E. coli O157:H7 or other Shiga-like toxin-producing E. coli from epidemiologically implicated food | |||
b. Enterotoxigenic (ETEC) | 6-48 hrs | Diarrhea, abdominal cramps, nausea; vomiting and fever less common | Isolation of organism of same serotype, demonstrated to produce heat-stable (ST) and/or heat-labile (LT) enterotoxin, from stool of two or more ill persons |
c. Enteropathogenic (EPEC) | Variable | Diarrhea, fever, abdominal cramps | Isolation of organism of same enteropathogenic serotype from stool of two or more ill persons |
d. Enteroinvasive (EIEC) | Variable | Diarrhea (might be bloody), fever, abdominal cramps | Isolation of same enteroinvasive serotype from stool of two or more ill persons |
7. Listeria monocytogenes | |||
a. Invasive disease | 2-6 wks | Meningitis, neonatal sepsis, fever | Isolation of organism from normally sterile site |
b. Diarrheal disease | Unknown | Diarrhea, abdominal cramps, fever | Isolation of organism of same serotype from stool of two or more ill persons exposed to food that is epidemiologically implicated or from which organism of same serotype has been isolated |
8. Nontyphoidal Salmonella | 6 hrs-10 days; usually 6-48 hrs | Diarrhea, often with fever and abdominal cramps | Isolation of organism of same serotype from clinical specimens from two or more ill persons |
OR | |||
Isolation of organism from epidemiologically implicated food | |||
9. Salmonella Typhi | 3-60 days; usually 7-14 days | Fever, anorexia, malaise, headache, and myalgia; sometimes diarrhea or constipation | Isolation of organism from clinical specimens from two or more ill persons |
OR | |||
Isolation of organism from epidemiologically implicated food | |||
10. Shigella spp. | 12 hrs-6 days; usually 2-4 days | Diarrhea (often bloody), often accompanied by fever and abdominal cramps | Isolation of organism of same serotype from clinical specimens from two or more ill persons |
OR | |||
Isolation of organism from epidemiologically implicated food | |||
11. Staphylococcus aureus | 30 min-8 hrs; usually 2-4 hrs | Vomiting, diarrhea | Isolation of organism of same phage type from stool or vomitus of two or more ill persons |
OR | |||
Detection of enterotoxin in epidemiologically implicated food | |||
OR | |||
Isolation of 105 organisms/g from epidemiologically implicated food, provided specimen is properly handled | |||
12. Streptococcus, group A | 1-4 days | Fever, pharyngitis, scarlet fever, upper respiratory infection | Isolation of organism of same M- or T-type from throats of two or more ill persons |
OR | |||
Isolation of organism of same M- or T-type from epidemiologically implicated food | |||
13. Vibrio cholerae | |||
a. O1 or O139 | 1-5 days | Watery diarrhea, often accompanied by vomiting | Isolation of toxigenic organism from stool or vomitus of two or more ill persons |
OR | |||
Significant rise in vibriocidal, bacterial-agglutinating, or antitoxin antibodies in acute- and early convalescent-phase sera among persons not recently immunized | |||
OR | |||
Isolation of toxigenic organism from epidemiologically implicated food | |||
b. non-O1 and non-O139 | 1-5 days | Watery diarrhea | Isolation of organism of same serotype from stool of two or more ill persons |
14. Vibrio parahaemolyticus | 4-30 hrs | Diarrhea | Isolation of Kanagawa-positive organism from stool of two or more ill persons |
OR | |||
Isolation of 105 Kanagawa-positive organisms/g from epidemiologically implicated food, provided specimen is properly handled | |||
15. Yersinia enterocolitica | 1-10 days; usually 4-6 days | Diarrhea, abdominal pain (often severe) | Isolation of organism from clinical specimen from two or more ill persons |
OR | |||
Isolation of pathogenic strain of organism from epidemiologically implicated food | |||
Chemical | |||
1. Marine toxins | |||
a. Ciguatoxin | 1-48 hrs; usually 2-8 hrs | Usually gastrointestinal symptoms followed by neurologic symptoms(including paresthesia of lips, tongue, throat, or extremities) and reversal of hot and cold sensation | Demonstration of ciguatoxin in epidemiologically implicated fish |
OR | |||
Clinical syndrome among persons who have eaten a type of fish previously associated with ciguatera fish poisoning (e.g., snapper, grouper, or barracuda) | |||
b. Scombroid toxin (histamine) | 1 min-3 hrs; usually <1 hr | Flushing, dizziness, burning of mouth and throat, headache, gastrointestinal symptoms, urticaria, and generalized pruritis | Demonstration of histamine in epidemiologically implicated fish |
OR | |||
Clinical syndrome among persons who have eaten a type of fish previously associated with histamine fish poisoning (e.g., mahi-mahi or fish of order Scomboidei) | |||
c. Paralytic or neurotoxic shellfish | 30 min-3 hrs | Paresthesia of lips, mouth or face, and extremities; intestinal symptoms or weakness, including respiratory difficulty | Detection of toxin in epidemiologically implicated food |
OR | |||
Detection of large numbers of shellfish-poisoning-associated species of dinoflagellates in water from which epidemiologically implicated mollusks are gathered | |||
d. Puffer fish, tetrodotoxin | 10 min-3 hrs; usually 10-45 min | Paresthesia of lips, tongue, face, or extremities, often following numbness; loss of proprioception or floating sensations | Demonstration of tetrodotoxin in epidemiologically implicated fish |
OR | |||
Clinical syndrome among persons who have eaten puffer fish | |||
2. Heavy metals | 5 min-8 hrs; usually <1 hr | Vomiting, often metallic taste | Demonstration of high concentration of metal in epidemiologically implicated food |
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3. Monosodium glutamate (MSG) | 3 min-2 hrs; usually <1 hr | Burning sensation in chest, neck, abdomen, or extremities; sensation of lightness and pressure over face or heavy feeling in chest | Clinical syndrome among persons who have eaten food containing MSG (e.g., usually 1.5 g MSG) |
4. Mushroom toxins | |||
a. Shorter-acting toxins | 2 hrs | Usually vomiting and diarrhea, other symptoms differ with toxin | Clinical syndrome among persons who have eaten mushroom identified as toxic type |
|
|
OR | |
Demonstration of toxin in epidemiologically implicated mushroom or food containing mushroom | |||
b. Longer-acting toxins (e.g., Amanitaspp.) | 6-24 hrs | Diarrhea and abdominal cramps for 24 hrs followed by hepatic and renal failure | Clinical syndrome among persons who have eaten mushroom identified as toxic type |
OR | |||
Demonstration of toxin in epidemiologically implicated mushroom or food containing mushrooms | |||
Parasitic | |||
1. Cryptosporidium parvum | 2-28 days; median: 7 days | Diarrhea, nausea, vomiting; fever | Demonstration of organism or antigen in stool or in small-bowel biopsy of two or more ill persons |
OR | |||
Demonstration of toxin in epidemiologically implicated food | |||
2. Cyclospora cayetanensus | 1-11 days; median: 7 days | Fatigue, protracted diarrhea, often relapsing | Demonstration of organism in stool of two or more ill persons |
3. Giardia lamblia | 3-25 days; median: 7 days | Diarrhea, gas, cramps, nausea, fatigue | Two or more ill persons and detection of antigen in stool or demonstration of organism in stool, duodenal contents, or small-bowel biopsy specimen |
4. Trichinellaspp. | 1-2 days for intestinal phase; 2-4 wks for systemic phase | Fever, myalgia, periorbital edema, high eosinophil count | Two or more ill persons and positive serologic test or demonstration of larvae in muscle biopsy |
OR | |||
Demonstration of larvae in epidemiologically implicated meat | |||
Viral | |||
1. Hepatitis A | 15-50 days; median: 28 days | Jaundice, dark urine, fatigue, anorexia, nausea | Detection of immunoglobulin M anti-hepatitis A virus in serum from two or more persons who consumed epidemiologically implicated food |
2. Norwalk family of viruses, small round-structured viruses (SRSV) | 15-77 hrs; usually 24-48 hrs | Vomiting, cramps, diarrhea, headache | More than fourfold rise in antibody titer to Norwalk virus or Norwalk-like virus in acute and convalescent sera in most serum pairs |
OR | |||
Visualization of small, round-structured viruses that react with patient’s convalescent sera but not acute sera — by immune-electron microsopy (assays based on molecular diagnostics [e. g., polymerase-chain reaction, probes, or assays for antigen and antibodies from expressed antigen] are available in reference laboratories) | |||
3. Astrovirus, calicivirus, others | 15-77 hrs; usually 24-48 hrs | Vomiting, cramps, diarrhea, headache | Visualization of small, round-structured viruses that react with patient’s convalescent sera but not acute sera — by immune-electron microsopy (assays based on molecular diagnostics [e. g., polymerase-chain reaction, probes, or assays for antigen and antibodies from expressed antigen] are available in reference laboratories) |
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