Recognizing foodborne or waterborne illness can be extremely challenging for emergency physicians. Symptoms associated with foodborne illness are very common and nonspecific except for syndromes associated with chemical agents. Physical examination should be directed at identifying toxic or dehydrated patients, identifying the presence of blood in the stool, and excluding other diarrheal illnesses. A variety of diagnostic tests are available for confirmation of pathogens in suspected outbreaks, but routine testing of patients with infectious diarrhea for ova and parasites and stool cultures is not cost effective. 20 The majority of patients will have a self-limited illness that resolves by the time culture results are available. Diagnostic studies and cultures should be directed toward patients with blood or mucus in the stool, fever or other signs of toxicity, or significant historical risk factors for foodborne illness. When fecal leukocytes are present, the culture yield is higher for bacterial pathogens, but the absence of fecal leukocytes does not exclude a bacterial etiology and limits its diagnostic efficacy. 20

Obtaining a complete history of an acute diarrheal illness is important. In a presumed foodborne illness, determining the exact time of exposure can help direct the evaluation to particular causative agents, although significant overlap exists between syndromes of foodborne illness ( IabJe,144:1) 3 Extending a history beyond 3 or 4 days will provide only limited benefit in identifying pathogens—such as hepatitis A, Cryptosporidium, and Salmonella—with prolonged incubation periods.

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