The old grandmother's warning, “be careful what you put in your mouth,” turns out to be very reasonable advice. Although there are many foodborne illnesses one can contract at home, traveling introduces new risks. Meals one eats away from home, especially in less technologically developed locales, may not be safeguarded in the same way as food in the United States. Access to refrigeration may be limited, and public health regulations governing shellfish harvesting and food preparation in restaurants vary from place to place.

Most illnesses transmitted through food cause some type of gastroenteritis. Although many of these illnesses are self-limited and require only symptomatic therapy, others involve the nervous system and can cause long-term disability or death without proper treatment. Illness is transmitted through food in two basic ways, through infectious or toxic agents. Infectious causes, including viruses, bacteria, and parasites, account for most outbreaks where the cause can be identified<sup>8 Bean N.H., Griffin P.M., Goulding J.S. , y al. Foodborne disease outbreaks, 5-year summary, 1983–1987 MMWR 1990 ;  39 (Surveill Summ 1) : 15

Haga clic aquí para ir a la sección de Referencias</sup> and are discussed by Larson elsewhere in this issue. Toxic causes are generally subdivided into those naturally intrinsic to food (as in Amanita mushrooms) and extrinsic toxins, often produced by microorganisms, that contaminate otherwise healthy food. This chapter focuses on toxin-mediated illnesses and emphasizes those associated with extragastrointestinal manifestations, as they tend to be more dangerous to patients and less well understood by physicians.

The Centers for Disease Control (CDC) reported more than 90,000 cases of food poisoning in the United States for the 1983 to 1987 period, but the true incidence is certainly higher.<sup>8 Bean N.H., Griffin P.M., Goulding J.S. , y al. Foodborne disease outbreaks, 5-year summary, 1983–1987 MMWR 1990 ;  39 (Surveill Summ 1) : 15

Haga clic aquí para ir a la sección de Referencias, 59 Todd E. Epidemiology of foodborne illness: North America Lancet 1990 ;  336 : 788

Haga clic aquí para ir a la sección de Referencias</sup> Both in the United States and overseas, food poisoning often goes unrecognized and underreported.<sup>5 Bacillus cereus food poisoning associated with fried rice at two child day care centers—Virginia, 1993 MMWR 1994 ;  43 : 43-177

Haga clic aquí para ir a la sección de Referencias, 32 Hughes J.M., Potter M.E. Socmbroid-fish poisoning: From pathogenesis to prevention N Engl J Med 1991 ;  324 : 766  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 60 Tranter H.S. Foodborne staphylococcal illness Lancet 1990 ;  336 : 1044

Haga clic aquí para ir a la sección de Referencias</sup> Patients do not always seek medical care, doctors may misdiagnose such illness as “viral,” and reporting is often voluntary and incomplete. Food poisoning can be difficult to diagnose unless one sees a cluster of patients with similar acute symptoms after a shared meal. On the other hand, specific syndromes, such as scombroid, ciguatera, and botulism, may present with a sufficiently distinctive clinical picture to permit diagnosis in a single individual.

There are many ways to organize a discussion about food poisoning.<sup>9 Bishai W.R., Sears C.L. Food poisoning syndromes Gastroenterol Clin North Am 1993 ;  22 : 579

Haga clic aquí para ir a la sección de Referencias</sup> One can approach the subject from the point of view of presenting symptoms (vomiting, diarrhea, neurologic, dermatologic), causative agent (intrinsic plant toxins, toxins from microorganisms that contaminate other foods), or food source. Each approach has its limitations. The following discussion is organized into three sections. First, common and dangerous illnesses caused by bacterial toxins are described. Next, a variety of toxic syndromes acquired by eating fish or seafood are reviewed. Finally, poisonous plants are briefly considered.