What can I expect when I seek medical help?
You can expect detailed questions about your symptoms and specific foods eaten in the last few days. You’ll likely be asked:
You will be given a physical exam and checked for signs of dehydration, severity of abdominal pain, and neurological status.
Most importantly, you should expect that your doctor will order diagnostic tests to identify the etiology, or cause of your illness. Today’s standard of care dictates that if any of the following signs and symptoms occur in patients, laboratory testing should be done to provide important diagnostic clues, particularly for very young, elderly, or immunocompromised patients, all of whom are more vulnerable:
If diagnostic tests to identify pathogens are not automatically ordered you should specifically request them in order to identify the cause, confirm a diagnosis, and start appropriate and timely medical care.
If testing is still discouraged, you are entitled to a second opinion, and you should confidently pursue one. Too often patients are sent home, only to be hospitalized later, wasting precious time in identifying the infectious organism and beginning appropriate treatment.
Testing is a large, complex, and rapidly changing issue. There is great disparity in how it is applied within different medical settings.
For more information to help yourself or your loved one, as well as supporting references that you may want to share with your doctor, please go to the ABC’s of Laboratory + Imaging Studies.
The Emergency Room (or Emergency Department) is where you can get initial answers and evaluation.
Patients with severe symptoms will likely end up going directly to the emergency room (ER), or will be sent there by their pediatrician or family physician.
If your community has more than one hospital, give careful consideration to the question of which hospital would have the most resources and capability. If you don’t know the answer, ask your pediatrician or family doctor, or any contact you might have in the medical community.
When you arrive in the ER, a registered triage nurse will ask questions about the patient’s general health and symptoms. He or she may assign a priority level based on your medical history and current condition according its level of urgency. If symptoms worsen while you wait to see a doctor, notify the emergency technician or triage nurse immediately.
You will also be registered. Registration gathers information for your patient record and obtains your consent for treatment. Both are necessary to allow the ER doctor to order diagnostic tests and determine treatment.
You may have to spend time in the waiting room – depending on how busy it is and the urgency of other patients’ conditions which may take precedence over yours. It is not unusual to wait for hours to be seen by a doctor, so try to understand that the ER staff is doing its best with other patients’ oftentimes life-threatening situations.
Should the patient need to use the bathroom, let the ER staff know first. Ask them if they can give you the supplies to collect a urine and/or stool sample. The patient should not eat or drink unless hospital staff say it is okay to do so.
Once the patient is moved from the waiting room to the treatment area, symptoms will be assessed again. During treatment, the Emergency Department staff in this area will help keep you comfortable and informed.
An IV line may be inserted in the arm or hand to administer fluids and medicines. Tests will be ordered. It is common for patients suspected of having food poisoning to receive blood and urine tests to look for dehydration, infection and kidney function.
An abdominal X-ray or other imaging tests may be ordered of the colon and appendix. It is very important that the Emergency Department (ED) collect a stool sample and test for foodborne pathogens. Ask the doctor or nurse to be sure that pathogen testing is done. Results of the pathogen testing will be very important to determine the cause of the illness.
For more detailed information, see: ABC’s of Laboratory + Imaging Studies
Your condition will be reevaluated after initial test results come in, and the ED physician will determine whether you should be admitted to the hospital or discharged.
If you are sent home:
Why is it important to know what is making me sick?
Because there are more than 250 different viruses, bacteria, and parasites that can cause food poisoning, it’s imperative that accurate testing be conducted early, not only for your individual case, but to help investigate and prevent other illnesses in the event that your infection may be part of an outbreak. If foodborne illness is suspected, your doctor should submit appropriate specimens for laboratory testing.
The most common lab tests are stool cultures which may take several days to render results.
These cultures grow bacterial isolates which reveal critical information: which organism is making you sick, what its DNA fingerprint is, and which if any antibiotics can be used to treat your infection.
From a public health respective, DNA fingerprinting is crucial to our national surveillance system (PulseNet) which is designed to detect clusters of foodborne illnesses and to stop implicated food from being further consumed. Legally, DNA fingerprinting allows the victims of foodborne pathogens to learn if their illness was part of an outbreak, and to identify the commercial source of their contaminated food.
There are also faster laboratory tests that can reveal the cause of your illness within hours, instead of days. These are Culture-Independent Diagnostic Tests (CIDTs). Although their speed presents a clinical advantage for you, they do not reveal the organism’s DNA or its antibiotic resistance. This poses a large disadvantage for public health workers who need that information to stop outbreaks and contain antibiotic resistant strains.
Ideally, both types of testing will be available to you:
It would certainly help you personally, and it would advance the larger public health objective for you to ask your Emergency Room doctor for both forms of these tests.
The following are very helpful links to share with your caregiver, if necessary.
It is unlikely that you will encounter any reluctance to test and to test thoroughly; but if you do, you may want to print out a page from the Guidelines (below) and request that it be entered into your official medical record.
Blood tests will probably also be ordered to test for bacteria like Listeria and viruses like Hepatitis A.
A blood test can also reveal inflammation and dehydration to show how sick you are.
Laboratory tests can render false negative results if the patient stops “shedding” the organism by the time he or she is sick enough to seek medical care. Nonetheless, they can help explain the cause, and steer the management, of an illness.
What happens with my test results?
Once laboratory testing results are available, your doctor or hospital should inform the local health department if testing detects a reportable pathogen.
It is not your responsibility as a patient or family member to report cases of foodborne illness to your county, city, or state health department.
However, you should be aware that almost everywhere in the United States infections with the following pathogens are reportable :
The authority of reporting diseases rests on the state level, and states voluntarily notify the Centers for Disease Control and Prevention (CDC) of infections. This list of pathogens and diseases is annually updated by a national council of epidemiologists with input from the CDC.
Once the test results are reported to the local health department, someone from the health department may contact you, most likely a public health nurse. You may be interviewed to gather information that could possibly help health officials identify the source of infection.
You’ll be asked about recent travel, activities and the food eaten by the patient in the previous days and weeks. It generally takes a number of patients to track infections back to a common source.
If you do not hear from the health department, ask your doctor if the diagnostic laboratory or clinical microbiologist have definitely reported your positive lab results to the health department. This way you can help public health workers connect the dots more quickly and possibly prevent more families from getting sick.
Your case deserves to be entered into the national network of public health agency laboratories that conduct surveillance, helping them to detect possible outbreaks, intervene early, and prevent others illnesses.