Gastroenteritis caused by Bacillus cereus

The same serotype of B. cereus in stool samples of the majority of patients, but not from the controls; or in patients and the epidemiologically implicated food

Isolation of >10⁵ cells of B. cereus per gm of epidemiologically incriminated food.

Detection of the enterotoxin

Brucellosis

Brucella spp. in the blood of the patients or in the epidemiologically implicated food

Quadruple increase in the agglutination titer for blood samples taken during acute phase and 3-6 weeks after the onset of the disease.

Campylobacteri-osis

Campylobacter jejuni in stool of almost all patients or in epidemiologically implicated food

The same serotypes in patients and in the implicated food found through DNA techniques

Quadruple or greater increase in the agglutination titer for blood samples taken during acute phase and 2 - 4 weeks after onset of the disease.

Botulism

Clostridium botulinum in patient’s stool or in epidemiologically implicated food.

Detection of botulin in sera, feces, or food: there frequently is a history of ingestion of home-canned foods or home-fermented fish, roe, or meat of marine mammals.

Gastroenteritis caused by Clostridium perfríngens

The same serotype of C. perfringens in specimens from almost all the patients but not from the controls; or in patients and in the food: epidemiologically implicated food.

Isolation of >10⁶ cells of C. perfringens per gm of epidemiologically implicated food. > 10⁵ colonies of C. perfringens per gm of feces from patients is presumptive proof

Evidence of toxin in feces using the appropriate techniques

Gastroenteritis caused by Escherichia coli spp

The same serotype of E. coli in almost all patients, but not in the controls or in patients and the epidemiologically implicated food. Isolation of E. Coli O157:H7 or shiga (vero)toxigenic in the epidemiologically implicated food .

Detection of enterotoxin by culture in intestinal loop, suckling mouse assay, tissue culture, or by other biological technique, or invasion through the production of conjunctivitis in the eye of the guinea pig or another technique.

Histamine as substance

Detection of levels of Histamine higher than 50 mg/100 g in the muscles of fish

Suspicion arising from typical syndrome and background of having consumed scombroid fish

Listeria Infection

Isolation of L. Monocytógenes in autopsy of fetal material or fatal cases

Isolation of the same phage type in the same group of patients and in epidemiologically implicated food

The virulence of the strains is checked through tests in rabbits, and inoculation in mice and fertilized eggs.

Salmonellosis

Salmonella in stool or rectal swab (or urine or blood, if there are septicemic symptoms) or in epidemiologically implicated food

The same serotype of Salmonella in patients and in epidemiologically implicated food

Shigellosis

Shigela spp in stool or rectal swab from patient or in epidemiologically implicated food.

The same serotype of Shigella in patients and in epidemiologically implicated food

Staphylococcal enterotoxicosis

Isolation of 10⁵//g in S.aureus in the epidemiologically implicated food

The same phage type in the vomit or stool of patients and in the epidemiologically implicated food, and in skin, nose, or lesion of food handlers

Detection of enterotoxin in epidemiologically implicated food, through serological tests

Streptococcal sore throat or scarlet fever

The same M and T types of Group A or G streptococci in the throat of patients and in epidemiologically implicated food

Cholera

Increase of the serum titer during the acute or early convalescent phase of the disease, and drop in titer during the last phase of convalescence in non-immunized people

Detection of enterotoxin by culture or filtrate in intestinal loop, suckling mouse assay, tissue culture or other biological technique

Diarrheal diseases caused by Vibrio cholerae O1, O139

Isolation of V. cholerae in the same O1 serotype in stool of patients or in epidemiologically implicated food

Gastroenteritis caused by Vibrio parahaemolyticus

Isolation of >10⁵ cells of V. parahaemolyticus in the epidemiologically implicated food

The same serotype of Kanagawa-positive V. parahaemolyticus in the stool of almost all the patients

Suspected when an adult has a recent history of ingestion of raw fish or shellfish.

Infection caused by Vibrio vulnificus

Isolation of V. vulnificus in blood of the patient

Usually the patients have a chronic disease related to the liver or the blood. History of having recently ingested raw shellfish.

Yersiniosis

Yersinia enterocolitica or Y. pseudotuberculosis in most of patients or in epidemiologically implicated food

Quadruple or greater increase in the agglutination titer for blood samples taken during the acute disease phase and 2-4 weeks after onset of the disease

Other bacterial diseases

The criteria vary, depending on the clinical and laboratory assessment of each case .

VIRAL DISEASE

Hepatitis A

Detection of IgM antihepatitis A virus in people who consumed the implicated food

Liver tests, often with history of ingestion of raw shellfish

Norwalk and related viral diseases (Virus with round small structure)

Serological evidence of the virus. Observation through electron microscope

Fourfold increase in antibody titer in serum in acute convalescent phase.

Suspicion when the patients have a syndrome, incubation period and duration of the disease compatible with the disease described.

Parasitic

Cryptosporidi-osis

Detection of oocytes C. Parvum in stool of sick people and in the food. Detection of advanced stage in biopsy of implied or associated intestines

Cyclosporosis

Detection of oocytes of C. Cayetanensis in stool of patients by microscopy and in association with the implicated food. Evidence of oocyte sporulation in the food

Giardiasis

Evidence of G. Lambia in stool, duodenal contents or in small intestine biopsy. Evidence of organism in the implicated food

Evidence of antigen in patient’s stool

Toxoplasmosis

Recovery of the agent in the incriminated meat

Serological evidence of exposure

Trichinosis

Evidence of larvae in the food, evidence of cysts in muscle tissue biopsy

Serological evidence of infection

Suspected patients with a typical profile including marked eosinophilia and history of having consumed raw or undercooked pork or wild animal meat

Diarrheal shellfish poisoning

Detection of the toxin in the shellfish epidemiologically involved through test with mouse

Evidence of large number of Dinophysis in the water from which the epidemiologically implicated mollusks come.

Paralytic shellfish poisoning (saxitoxin)

Detection of saxitoxins and related toxins in the epidemiologically implicated mollusks

Detection of large number of toxigenic species of dinoflagellates in the water from which the epidemiologically incriminated mollusks come. History of ingestion of raw shellfish or presence of red tide in the area where the shellfish were caught.

Ciguatera

Evidence of ciguatoxin in epidemiologically implicated fish

Typical clinical syndrome in people who have previously consumed fish associated with ciguatera.

Puffer poisoning (tetrodotoxism)

Evidence of tetrodotoxin in puffer fish

History of ingestion of puffer fish

Poisoning caused by group of mushrooms that produces amatoxin, phallotoxin, or gyromotrin

Evidence of amanitotoxin, Phallotoxin, phalloidin, amantine in epidemiologically implicated mushrooms or in the urine

History of ingestion of toxic species of mushrooms

Gastroenteritis caused by toxic mushrooms

Evidence of toxic chemicals in the implicated fungi or morphological and color characteristics of the fungi

Poisoning by ibotenic acid or muscimol

Evidence of ibotenic acid or muscimol in the epidemiologically implicated food

History of the patient having eaten mushrooms

Alcohol intolerance caused by ingestion of mushrooms

Evidence of toxic chemicals in the epidemiologically implicated mushrooms or in the urine

History of having ingested species of fungi that have disulfiram-like effect after drinking alcohol

Poisoning caused by mushrooms of the muscarine group (muscarism)

Evidence of muscarine in epidemiologically implied mushrooms, or in the urine

History of ingestion of toxic species of mushrooms

Poisoning by plants in general

Evidence of toxic substances in fruits, flowers, seeds, or bulbs or any part of the plant

History of ingestion of toxic plants

Monosodium glutamate

Evidence of high concentrations of MSG in the epidemiologically implicated food

Suspected when typical syndrome occurs and high concentrations of MSG have been added to the implicated food

Poisoning caused by heavy metals

Evidence of high concentration of metallic ions in the epidemiologically implicated food or beverage

History of storage or preservation of very acid foods or beverages in metal containers or tubing

Poisoning caused by other chemicals or chemical products

High concentrations of chemical in the epidemiologically implicated food or beverage

History of use or storage of the suspected chemical near the implicated food.