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BBB - Onset, duration, and symptoms of foodborne illness - Epidemiology summary table

Bad Bug Book:
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook
Onset, Duration, and Symptoms of Foodborne Illness

A new version of the Bad Bug Book was released in 2012, below is a previous version.


Approximate onset time to symptomsPredominant symptomsAssociated organism or toxin
Upper gastrointestinal tract symptoms (nausea, vomiting) occur first or predominate
Less than 1 hNausea, vomiting, unusual taste, burning of mouth.Metallic salts
1-2 hNausea, vomiting, cyanosis, headache, dizziness, dyspnea, trembling, weakness, loss of consciousness.Nitrites
1-6 h mean 2-4 hNausea, vomiting, retching, diarrhea, abdominal pain, prostration.Staphylococcus aureus and its enterotoxins
8-16 h (2-4 h emesis possible)Vomiting, abdominal cramps, diarrhea, nausea.Bacillus cereus
6-24 hNausea, vomiting, diarrhea, thirst, dilation of pupils, collapse, coma.Amanita species mushrooms
Sore throat and respiratory symptoms occur
12-72 hSore throat, fever, nausea, vomiting, rhinorrhea, sometimes a rash.Streptococcus pyogenes
2-5 daysInflamed throat and nose, spreading grayish exudate, fever, chills, sore throat, malaise, difficulty in swallowing, edema of cervical lymph node.Corynebacterium diphtheriae
Lower gastrointestinal tract symptoms (abdominal cramps, diarrhea) occur first or predominate
2-36 h, mean 6-12 hAbdominal cramps, diarrhea, putrefactive diarrhea associated with C. perfringens, sometimes nausea and vomiting.Clostridium perfringens, Bacillus cereus, Streptococcus faecalis, S. faecium
12-74 h, mean 18-36 hAbdominal cramps, diarrhea, vomiting, fever, chills, malaise, nausea, headache, possible. Sometimes bloody or mucoid diarrhea, cutaneous lesions associated with V. vulnificus. Yersinia enterocolitica mimics flu and acute appendicitis.Salmonella species (including S. arizonae), Shigella, enteropathogenic Escherichia coli, other Enterobacteriacae, Vibrio parahaemolyticus, Yersinia enterocolitica, Aeromonas hydrophila, Plesiomonas shigelloides, Campylobacter jejuni, Vibrio cholerae (O1 and non-O1) V.vulnificus, V. fluvialis
3-5 daysDiarrhea, fever, vomiting abdominal pain, respiratory symptoms.Enteric viruses
1-6 weeksMucoid diarrhea (fatty stools) abdominal pain, weight loss.Giardia lamblia
1 to several weeksAbdominal pain, diarrhea, constipation, headache, drowsiness, ulcers, variable -- often asymptomatic.Entamoeba histolytica
3-6 monthsNervousness, insomnia, hunger pains, anorexia, weight loss, abdominal pain, sometimes gastroenteritis.Taenia saginata, T. solium
Neurological symptoms (visual disturbances, vertigo, tingling, paralysis) occur
Less than 1 h*** SEE GASTROINTESTINAL AND/OR NEUROLOGIC SYMPTOMS (Shellfish Toxins) (this Appendix)Shellfish toxin
Gastroenteritis, nervousness, blurred vision, chest pain, cyanosis, twitching, convulsions.Organic phosphate
Excessive salivation, perspiration, gastroenteritis, irregular pulse, pupils constricted, asthmatic breathing.Muscaria-type mushrooms
Tingling and numbness, dizziness, pallor, gastro- hemmorrhage, and desquamation of skin, fixed eyes, loss of reflexes, twitching, paralysis.Tetradon (tetrodotoxin) toxins
1-6 hTingling and numbness, gastroenteritis, dizziness, dry mouth, muscular aches, dilated pupils, blurred vision, paralysis.Ciguatera toxin
Nausea, vomiting, tingling, dizziness, weakness, anorexia, weight loss, confusion.Chlorinated hydrocarbons
2 h to 6 days, usually 12-36 hVertigo, double or blurred vision, loss of reflex to light, difficulty in swallowing. speaking, and breathing, dry mouth, weakness, respiratory paralysis.Clostridium botulinum and its neurotoxins
More than 72 hNumbness, weakness of legs, spastic paralysis, impairment of vision, blindness, coma.Organic mercury
Gastroenteritis, leg pain, ungainly high-stepping gait, foot and wrist drop.Triorthocresyl phosphate
Allergic symptoms (facial flushing, itching) occur
Less than 1 hHeadache, dizziness, nausea, vomiting, peppery taste, burning of throat, facial swelling and flushing, stomach pain, itching of skin.Histamine (scombroid)
Numbness around mouth, tingling sensation, flushing, dizziness, headache, nausea.Monosodium glutamate
Flushing, sensation of warmth, itching, abdominal pain, puffing of face and knees.Nicotinic acid
Generalized infection symptoms (fever, chills, malaise, prostration, aches, swollen lymph nodes) occur
4-28 days, mean 9 daysGastroenteritis, fever, edema about eyes, perspiration, muscular pain, chills, prostration, labored breathing.Trichinella spiralis
7-28 days, mean 14 daysMalaise, headache, fever, cough, nausea, vomiting, constipation, abdominal pain, chills, rose spots, bloody stools.Salmonella typhi
10-13 daysFever, headache, myalgia, rash.Toxoplasma gondii
10-50 days, mean 25-30 daysFever, malaise, lassitude, anorexia, nausea, abdominal pain, jaundice.Etiological agent not yet isolated -- probably viral
Varying periods (depends on specific illness)Fever, chills, head- or joint ache, prostration, malaise, swollen lymph nodes, and other specific symptoms of disease in question.Bacillus anthracis, Brucella melitensis, B. abortus, B. suis, Coxiella burnetii, Francisella tularensis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium species, Pasteurella multocida, Streptobacillus moniliformis, Campylobacter jejuni, Leptospira species.
Gastrointestinal and/or Neurologic Symptoms - (Shellfish Toxins)
0.5 to 2 hTingling, burning, numbness, drowsiness, incoherent speech, respiratory paralysisParalytic Shellfish Poisoning (PSP) (saxitoxins)
2-5 min to 3-4 hReversal of hot and cold sensation, tingling; numbness of lips, tongue & throat; muscle aches, dizziness, diarrhea, vomitingNeurotoxic Shellfish Poisoning (NSP) (brevetoxins)
30 min to 2-3 hNausea, vomiting, diarrhea, abdominal pain, chills, feverDiarrheic Shellfish Poisoning (DSP) (dinophysis toxin, okadaic acid, pectenotoxin, yessotoxin)
24 h (gastrointestinal) to 48 h (neurologic)Vomiting, diarrhea, abdominal pain, confusion, memory loss, disorientation, seizure, comaAmnesic Shellfish Poisoning (ASP) (domoic acid)