Most bacterial toxin-induced food poisoning leads to self-limited GI symptoms, whereas foodborne botulism and ingestion of contaminated seafood may also lead to neurologic and cardiorespiratory symptoms In addition to drugs and medications and household products and plants, toxic ingestions may occur through normal diet when the ingested product contains a toxin that is preformed by microorganisms Mycotoxins are important food contaminants worldwide Major bacterial enterotoxins include those produced by Shigella, Salmonella, Yersinia, Escherichia coli, Staphylococcus, Bacillus cereus, Clostridium, Vibrio, and Clostridium botulinum After this large group of toxins, the next most common cause of foodborne intoxications results from the ingestion of contaminated marine life When similar GI symptoms occur in a group of persons who share the same meal or the same food on separate occasions, the emergency physician may consider the possibility of foodborne disease Detailed epidemiologic investigations are usually beyond the capacity of the ED setting, but the hospital infection control officer and/or local health department can often be helpful TABLE 102.14 COMMON CAUSES OF DIARRHEAL FOOD POISONING IN THE UNITED STATES Organism Onset (hours) Effect of heat Typical sources Staphylococcal 1–6 Stable Meats, potato/egg salads, creamfilled desserts Bacillus cereus Emetic type 1–6 Stable Fried rice Diarrheal type Clostridia 12–16 12–24 Labile Spores, stable Cooked meats Meats/poultry a 12–24 Toxin labile Toxin labile Raw shellfish Cholera/other Vibrio spp a In context of inadequate refrigeration