How SaFe is Our Food?
Diagnosing and Treating Foodborne Illnesses
By Doug Scott
The latest 10 Most Unwanted List includes: Salmonella, E. coli O157:H7, Listeria, Botulism, Staphylococcus, Vibrio vulnificus, Hepatitis A, Ciguatera, Scombroid, and Mercury.
No, this is not the latest list of criminals at your local post office, but the 10 foodborne illness that are important to all of us who eat, either because they are common, changing, or particularly severe according to Stephen J. Playe, MD, an attending emergency physician at MediQuick Urgent Care in Palm Coast, Fla.
Playe explained that one of the most important things a medical provider such as a PA should be aware of when it comes to public health issues is being able to properly diagnose and treat a patient who comes into your practice complaining of gastrointestinal symptoms. Playe believes that PAs are in a unique position to help their patients interpret what is in the news and know how to react to health issues like Salmonella or Ciguatera, in addition to educating them on proper food preparation.
“I am not so naive as to think that most PAs have enough leisure time with their patients to be able to spend a lot of time telling them how to prepare their food,” said Playe, who had a CME session at annual conference in San Diego in May, entitled, How Safe is Your Food. “You certainly can remind your patients to do things like wash their hands. But beyond that, the trick to addressing foodborne illness in your practice is being able to identify clinical patterns, know which other diagnosis to think about, know the initial treatment, and know when to initiate diagnostic studies.”The reason Playe believes this level of understanding of foodborne illness is important to PAs is because a large percentage of patients who present to emergency departments, clinics or health care facilities with gastrointestinal symptoms are seen by a PA.
“For the most part, these are patients who come into your practice with gastrointestinal symptoms — specifically vomiting and diarrhea — who have not been previously evaluated,” notes Playe. “These are acute symptoms in otherwise healthy outpatients and so I think in most cases, the PA will be the first health care provider to see and treat them.
“In this circumstance, PAs have the opportunity to perform a good initial evaluation, and initiate therapy with rehydration. It is important for them to know when to order more expensive testing modalities instead of ordering a stool culture on everyone with diarrhea.”
Playe believes that PAs are often in the best position to identify clusters of people in the community who are suffering from similar gastrointestinal syndromes and should know when and how to report that health issue to their state or local board of health.
“For example, if a PA is able to identify a cluster of scombriod from fish at a local restaurant, the outbreak could be stopped,” notes Playe. “We must differentiate between acute infectious viral diarrhea and foodborne illness.”
Playe continued, “Several historical findings can help differentiate between the two. Viral syndromes often include myalgias and arthralgias. Blood in the diarrhea, especially early in the course, suggests foodborne illness.
“The combination of neurological and gastrointestinal symptoms suggests some kind of poisoning — foodborne or otherwise.”
If you do diagnose foodborne illness, Playe said the initial treatment is rehydration, which can be oral or IV.
“Frequently the treatment for these illnesses is simply oral rehydration. It does not entail invasive treatment, hospital admission, and might not entail even seeking health care,” said Playe. “But the thing you want to make sure of is not missing something else that would entail, for example, an operative treatment of appendicitis. So the differential diagnosis becomes important because there are certainly other things that can be causing diarrhea, abdominal pain and vomiting. You have to make sure not to miss more dangerous diagnoses.”
One thing Playe stressed is that PAs should avoid treating foodborne illness with anti-diarrheal and anti-motility agents such as loperamide (Imodium), or diphenoxylate and atropine (Lomotil).
“The first rule of medicine is do no harm, so we should not use anti-motility agents because there are reports of rather devastating complications with toxic mega colon, which can be fatal when these agents are used in a patient who has something other than uncomplicated viral gastroenteritis.”
For more information about diagnosing and treating foodborne illness Playe suggests PAs refer to the Centers for Disease control resource entitled, Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals.
