CIPHI BOC STUDY QUESTIONS & ANSWERS
Hepatitis A - Incubation period - Answers- 15-50 days
Usually 28-30 days
Hepatitis A - Symptoms - Answers- loss of appetite, fatigue, nausea, vomiting,
abdominal pain, fever, malaise and yellow skin (jaundice)
Hepatitis A - transmission - Answers- fecal-oral route
Infective: up to 2 weeks before onset to 1 week post-jaundice.
Humans are reservoir.
Hepatitis A - suspect foods - Answers- Ice, shellfish contaminated with sewage.
Hepatitis A - exclusion criteria - Answers- 14 days if no jaundice. 7 days after jaundice
onset.
Life-long immunity following recovery.
Last 2 - 6 months.
Norovirus - incubation period - Answers- 24-48 hours
Norovirus - symptoms - Answers- Sudden onset, watery diarrhea, vomiting, cramp,
nausea, low fever.
Norovirus - transmission - Answers- Very contagious. Low infective dose. Fecal-oral.
Person-Person. Humans only reservoir.
Norovirus - most at risk - Answers- o Children
o Older Adults
o Those with weakened immune systems.
o These higher risk groups are more likely to experience dehydration as a result of
severe vomiting and diarrhea
Salmonellosis types - Answers- S. enteritis
S. typhimurium
Salmonellosis incubation - Answers- 6-72 hours
Usually 12-36 hours
Salmonellosis symptoms - Answers- Sudden onset, cramp, diarrhea, nausea,
headache, possible vomit.
Salmonellosis transmission - Answers- Bacterial. Usually contaminated food, raw bean
sprouts. Human and animal reservoir. Pet contact.
,Salmonellosis suspect foods - Answers- Raw egg, unpasteurized milk, unwashed
fruit/veg. Raw meat.
Shigellosis IP - Answers- 12-96 hours (usually 1-3 days)
Shigellosis symptoms - Answers- Diarrhea, fever, cramp. Nausea.
Possible bloody diarrhea.
May cause HUS in kids.
Shigellosis transmission - Answers- Bacterial. Fecal-oral. Sexual contact
Humans only reservoir.
Possibly via mechanical vectors (flies, cockroaches)
Low infectious dose.
Shigellosis suspect foods - Answers- Shigella is not naturally present on foods, but can
contaminate food through cross contamination during handling, or from exposure to
polluted water
Food is most often contaminated with Shigella from water polluted by human sewage.
IP - 1-90 days (usually 3-70 days)
Symptoms - Most cases asymptomatic. Fever, headache. <5% vomit & diarrhea.
Transmission: Environmental bacteria. Gets in raw product (between cooking &
packaging) & spreads via cross-contamination.
** Psychrotroph. Hardy.
Suspect Foods: Soft cheeses, deli meats, hot dogs, ready to eat meats, unpasteurized
milk.
Concern for pregnant women - Answers- Listeriosis
L. monocytogenes
IP - 0.5-6 hours
Symptoms - Nausea, vomiting, rarely fever and diarrhea
Transmission - Bacterial. Grows and produces heat stable enterotoxin in food.
Suspect foods - Cooked rice left at room temperature - Answers- Bacillus Cereus
(emetic)
IP - 4-96 hours (usually 12-24)
Symptoms - Severe cramp, watery diarrhea, nausea, vomiting, headache, fever.
Transmission - Bacterial. Marine organism. More wound infections than FBI.
Suspect foods - raw shellfish - Answers- Vibrio parahemolyticus
IP - 6-24 hours
Symptoms - Cramp, diarrhea, nausea, rarely vomit and fever.
Transmission - Bacterial. Grows and produces heat labile enterotoxin in food.
Suspect foods - Meat and vegetable soups, cooked meat, desserts, starches. -
Answers- Bacillus Cereus (diarrheal)
,IP - 0.5 - 8 hours (usually 2-4 hours)
Symptoms - Vomiting, cramp, diarrhea, nausea.
Transmission - Bacterial. Humans main reservoir. Carried in nares.
Produces heat stable enterotoxin as grows in food.
Suspect foods - Pork, ham, custard, cream desserts.
Raw meat rarely associated with OB b/c poor competitor. - Answers- Staphylococcus
S. aureus
IP - 1-10 days (usually 2-5 days)
Symptoms - Sudden onset cramp, fever, nausea and/or vomit, possible bloody diarrhea,
greenish stool. (Appendicitis like)
Transmission - Bacterial.
Microaerophilic - grows in gut, not at room temperature.
Fecal-oral. Water/food.
Most raw poultry contamination.
Suspect foods - Contaminated food, water, raw poultry, contact with infected animals.
Non-chlorinated water. - Answers- Campylobacter enteritis
C. jejuni
C. coli
IP - 3-7 days
Symptoms - Cramp, fever, headache, diarrhea, vomiting, nausea, lower right quadrant
pain
Transmission - Bacterial. Psychrotroph.
High infectious dose. Animals (pigs) are the main reservoir.
Fecal-oral.
Suspect foods - Pork and milk products. Chocolate milk. - Answers- Yersiniosis
Y. Enterocolitica
IP - 2-10 days (usually 3-4 days)
Symptoms - Diarrhea, fever, possible headache, cramp, possible bloody diarrhea. HUS
possible in kids <5yrs.
Transmission - Bacterial. Fecal-oral.
Some strains produce enterotoxin. Usually harmless gut flora.
0157:H7 linked to beef
Suspect foods - Contaminated food, unpasteurized product. Raw beef, raw milk and
apple cider, sprouts. - Answers- E-coli
(STEC, EHEC, VTEC)
(STEC: 0157:H7)
IP - 6-36 hours (earlier symptoms = increased severity)
Symptoms - Fatigue, weakness, vertigo. Nausea, vomiting, diarrhea. Neurological
symptoms (flaccid paralysis).
Transmission - Bacterial.
4 clinical forms.
, Produces a heat labile neurotoxin in food.
Anaerobic.
Suspect foods - Carrot juice, baked potatoes, improper canning, fermented meat
(Muktuk), honey, corn syrup. Meat, bacon. - Answers- Botulism
Clostridium botulinum
IP - 6-24 hours (usually 10-12)
Symptoms - Sudden onset nausea, bloating, severe cramp, profuse diarrhea. Usually
no fever, vomit, headache.
Transmission - Bacterial. Spores common in GIT of animals and people, dust soil - may
survive cooking and sporulate in gut.
Suspect foods - Large chunks of meat - difficult to cool so interior anaerobic. - Answers-
Clostridium perfringens
IP - 1-14 days (usually 7 days)
Symptoms - Profuse watery diarrhea, nausea, vomiting, anorexia, weight loss, bloating,
cramping. 50% get low-grade fever.
Transmission - Protozoan. Oocysts passed in stool. Fecal-oral via contaminated food or
water. Humans only known reservoir.
Suspect foods - Fresh produce and fruit. OB associated with Guatemalan raspberries. -
Answers- Cyclosporiasis
C. cayetanensis
IP - 5-60 days (usually 1-2 months)
Symptoms - Fever, headache, weakness, profuse sweating, chills, aching, weight loss.
Transmission - Bacterial. Reservoir cattle, swine, ovine. Transmitted via ingestion of raw
milk/dairy. (also breaks in skin with infected fluids)
Suspect foods - Raw milk and other dairy products, unpasteurized cheese. - Answers-
Brucellosis
B. abortus
B. melitensis
B. suis
IP - 3-25 days (usually 7-10 days)
Symptoms - Often asymptomatic. Diarrhea, cramp, bloating, pale & greasy stool,
fatigue, weight loss.
Transmission - Protozoan. Fecal-oral. Drinking unfiltered or contaminated water.
Contaminated food, recreational water. Reservoir is human/beaver.
Suspect foods - Drinking unfiltered water or from shallow wells. Contaminated food,
recreational water. - Answers- Giardiasis
Giardia lamblia
"Beaver Fever"
IP - 1-12 days (usually 7 days)
Symptoms - Often asymptomatic. Diarrhea (possibly watery), preceded by anorexia and
vomiting in children, cramp. Rarely fever, nausea and vomiting.
Hepatitis A - Incubation period - Answers- 15-50 days
Usually 28-30 days
Hepatitis A - Symptoms - Answers- loss of appetite, fatigue, nausea, vomiting,
abdominal pain, fever, malaise and yellow skin (jaundice)
Hepatitis A - transmission - Answers- fecal-oral route
Infective: up to 2 weeks before onset to 1 week post-jaundice.
Humans are reservoir.
Hepatitis A - suspect foods - Answers- Ice, shellfish contaminated with sewage.
Hepatitis A - exclusion criteria - Answers- 14 days if no jaundice. 7 days after jaundice
onset.
Life-long immunity following recovery.
Last 2 - 6 months.
Norovirus - incubation period - Answers- 24-48 hours
Norovirus - symptoms - Answers- Sudden onset, watery diarrhea, vomiting, cramp,
nausea, low fever.
Norovirus - transmission - Answers- Very contagious. Low infective dose. Fecal-oral.
Person-Person. Humans only reservoir.
Norovirus - most at risk - Answers- o Children
o Older Adults
o Those with weakened immune systems.
o These higher risk groups are more likely to experience dehydration as a result of
severe vomiting and diarrhea
Salmonellosis types - Answers- S. enteritis
S. typhimurium
Salmonellosis incubation - Answers- 6-72 hours
Usually 12-36 hours
Salmonellosis symptoms - Answers- Sudden onset, cramp, diarrhea, nausea,
headache, possible vomit.
Salmonellosis transmission - Answers- Bacterial. Usually contaminated food, raw bean
sprouts. Human and animal reservoir. Pet contact.
,Salmonellosis suspect foods - Answers- Raw egg, unpasteurized milk, unwashed
fruit/veg. Raw meat.
Shigellosis IP - Answers- 12-96 hours (usually 1-3 days)
Shigellosis symptoms - Answers- Diarrhea, fever, cramp. Nausea.
Possible bloody diarrhea.
May cause HUS in kids.
Shigellosis transmission - Answers- Bacterial. Fecal-oral. Sexual contact
Humans only reservoir.
Possibly via mechanical vectors (flies, cockroaches)
Low infectious dose.
Shigellosis suspect foods - Answers- Shigella is not naturally present on foods, but can
contaminate food through cross contamination during handling, or from exposure to
polluted water
Food is most often contaminated with Shigella from water polluted by human sewage.
IP - 1-90 days (usually 3-70 days)
Symptoms - Most cases asymptomatic. Fever, headache. <5% vomit & diarrhea.
Transmission: Environmental bacteria. Gets in raw product (between cooking &
packaging) & spreads via cross-contamination.
** Psychrotroph. Hardy.
Suspect Foods: Soft cheeses, deli meats, hot dogs, ready to eat meats, unpasteurized
milk.
Concern for pregnant women - Answers- Listeriosis
L. monocytogenes
IP - 0.5-6 hours
Symptoms - Nausea, vomiting, rarely fever and diarrhea
Transmission - Bacterial. Grows and produces heat stable enterotoxin in food.
Suspect foods - Cooked rice left at room temperature - Answers- Bacillus Cereus
(emetic)
IP - 4-96 hours (usually 12-24)
Symptoms - Severe cramp, watery diarrhea, nausea, vomiting, headache, fever.
Transmission - Bacterial. Marine organism. More wound infections than FBI.
Suspect foods - raw shellfish - Answers- Vibrio parahemolyticus
IP - 6-24 hours
Symptoms - Cramp, diarrhea, nausea, rarely vomit and fever.
Transmission - Bacterial. Grows and produces heat labile enterotoxin in food.
Suspect foods - Meat and vegetable soups, cooked meat, desserts, starches. -
Answers- Bacillus Cereus (diarrheal)
,IP - 0.5 - 8 hours (usually 2-4 hours)
Symptoms - Vomiting, cramp, diarrhea, nausea.
Transmission - Bacterial. Humans main reservoir. Carried in nares.
Produces heat stable enterotoxin as grows in food.
Suspect foods - Pork, ham, custard, cream desserts.
Raw meat rarely associated with OB b/c poor competitor. - Answers- Staphylococcus
S. aureus
IP - 1-10 days (usually 2-5 days)
Symptoms - Sudden onset cramp, fever, nausea and/or vomit, possible bloody diarrhea,
greenish stool. (Appendicitis like)
Transmission - Bacterial.
Microaerophilic - grows in gut, not at room temperature.
Fecal-oral. Water/food.
Most raw poultry contamination.
Suspect foods - Contaminated food, water, raw poultry, contact with infected animals.
Non-chlorinated water. - Answers- Campylobacter enteritis
C. jejuni
C. coli
IP - 3-7 days
Symptoms - Cramp, fever, headache, diarrhea, vomiting, nausea, lower right quadrant
pain
Transmission - Bacterial. Psychrotroph.
High infectious dose. Animals (pigs) are the main reservoir.
Fecal-oral.
Suspect foods - Pork and milk products. Chocolate milk. - Answers- Yersiniosis
Y. Enterocolitica
IP - 2-10 days (usually 3-4 days)
Symptoms - Diarrhea, fever, possible headache, cramp, possible bloody diarrhea. HUS
possible in kids <5yrs.
Transmission - Bacterial. Fecal-oral.
Some strains produce enterotoxin. Usually harmless gut flora.
0157:H7 linked to beef
Suspect foods - Contaminated food, unpasteurized product. Raw beef, raw milk and
apple cider, sprouts. - Answers- E-coli
(STEC, EHEC, VTEC)
(STEC: 0157:H7)
IP - 6-36 hours (earlier symptoms = increased severity)
Symptoms - Fatigue, weakness, vertigo. Nausea, vomiting, diarrhea. Neurological
symptoms (flaccid paralysis).
Transmission - Bacterial.
4 clinical forms.
, Produces a heat labile neurotoxin in food.
Anaerobic.
Suspect foods - Carrot juice, baked potatoes, improper canning, fermented meat
(Muktuk), honey, corn syrup. Meat, bacon. - Answers- Botulism
Clostridium botulinum
IP - 6-24 hours (usually 10-12)
Symptoms - Sudden onset nausea, bloating, severe cramp, profuse diarrhea. Usually
no fever, vomit, headache.
Transmission - Bacterial. Spores common in GIT of animals and people, dust soil - may
survive cooking and sporulate in gut.
Suspect foods - Large chunks of meat - difficult to cool so interior anaerobic. - Answers-
Clostridium perfringens
IP - 1-14 days (usually 7 days)
Symptoms - Profuse watery diarrhea, nausea, vomiting, anorexia, weight loss, bloating,
cramping. 50% get low-grade fever.
Transmission - Protozoan. Oocysts passed in stool. Fecal-oral via contaminated food or
water. Humans only known reservoir.
Suspect foods - Fresh produce and fruit. OB associated with Guatemalan raspberries. -
Answers- Cyclosporiasis
C. cayetanensis
IP - 5-60 days (usually 1-2 months)
Symptoms - Fever, headache, weakness, profuse sweating, chills, aching, weight loss.
Transmission - Bacterial. Reservoir cattle, swine, ovine. Transmitted via ingestion of raw
milk/dairy. (also breaks in skin with infected fluids)
Suspect foods - Raw milk and other dairy products, unpasteurized cheese. - Answers-
Brucellosis
B. abortus
B. melitensis
B. suis
IP - 3-25 days (usually 7-10 days)
Symptoms - Often asymptomatic. Diarrhea, cramp, bloating, pale & greasy stool,
fatigue, weight loss.
Transmission - Protozoan. Fecal-oral. Drinking unfiltered or contaminated water.
Contaminated food, recreational water. Reservoir is human/beaver.
Suspect foods - Drinking unfiltered water or from shallow wells. Contaminated food,
recreational water. - Answers- Giardiasis
Giardia lamblia
"Beaver Fever"
IP - 1-12 days (usually 7 days)
Symptoms - Often asymptomatic. Diarrhea (possibly watery), preceded by anorexia and
vomiting in children, cramp. Rarely fever, nausea and vomiting.
