Staphylococcal food intoxication

Staphylococcal food intoxication has an incubation period of 1-6 hours. Symptoms last <12 hours and include diarrhea, vomiting, and abdominal cramping, usually without fever. Common food sources are unrefrigerated meats, potato and egg salads, inadequately cured ham and salami, and cream pastries.

CASES/YEAR
241,148 (US); 4,822,960 (Global)
AGENT TYPE
Toxins
OTHER NAMES
Staphylococcus aureus enterotoxins; Staphylococcal enterotoxin B (SEB);
ACUITY
Acute-Severe
INCUBATION
1-6 hours; [Harrisons, p. 404]
INITIAL SYMPTOMS
Duration is <12 hours and symptoms include diarrhea, vomiting, and abdominal cramping, usually without fever; [Harrisons, p. 404]
PRECAUTIONS
Standard; "Not transmitted from person to person." [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
This common foodborne intoxication causes the sudden onset of vomiting and abdominal cramping. Diarrhea may be present. Common food sources are unrefrigerated meats, potato and egg salads, inadequately cured ham and salami, and cream pastries. Reservoirs include dogs, fowl, cows (infected udders), and humans. Transmission may occur by contaminated milk or cheese. The illness usually resolves spontaneously within 24-48 hours. Staphylococci can multiply in foods and produce toxin even in foods with low water content. [CCDM, p. 217-20] A heat-stable staphylococcal enterotoxin causes staphylococcal food poisoning. Food may be contaminated by food preparers who are carriers or have active skin infections. [Merck Manual, p. 1603] Hematemesis and blood in stool are possible findings in severe cases. [ID, p. 692] Symptoms are vomiting (87%), diarrhea (89%), abdominal pain (72%), and fever (9%). [PPID, p. 1382]
DIAGNOSTIC
The toxin can be identified in food, and toxin-producing S. aureus can be identified in stool and vomitus. Testing is usually reserved for outbreaks; [CDC website: Staphylococcal Food Poisoning]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fatigue, weakness
  • >fever
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G hematemesis
  • G nausea, vomiting
ANTIMICROBIC

No

VACCINE

No

ENTRY
Inhalation, Ingestion
SOURCE
Person-to-Person, Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Dogs, Human
RISK FACTORS
  • Consume unpasteurized milk/cheese
  • Eat undercooked meat or fish
  • Ingest toxins in food or water
  • Victim--air release of toxins
  • Victim--water/food release
TREATMENT
No specific treatment;
REFERENCES FOR CASES/YEAR
1. (US) Estimated at 185,060 cases/year; [Mead1999: PMID 10511517] The CDC FoodNet showed a decline in the incidence of several pathogens between 1996 and 2007 due to improvements in food safety: Campylobacter (31%), Listeria (42%), Yersinia (49%), Shigella (36%), and Salmonella (8%). [PPID 7th Ed., p. 1413] If assume a 40% decrease, then 185,060 X 0.6 = 111,036; The 2011 CDC estimate was 241,148; [http://www.cdc.gov/foodborneburden/2011-foodborne-estimates.html]
2. (Global) Estimate global cases/yr as 20 X US cases/yr = 241,148 X 20 = 4,822,960;