Food-borne viral or bacterial disease typically causes a gastroenteritis-like syndrome. The onset of symptoms may be within hours if preformed toxins are present (e.g., Staph enterotoxin B and Bacillus cereus), hours to days if viral (e.g., Norwalk agent) or due to toxins formed within the alimentary tract by bacteria (e.g., enterotox-igenic E. coli), or days if caused by invasive bacteria (Salmonella, Shigella, Cam-pylobacter, and E. coli spp.). Infection with Salmonella typhi may cause enteric fevers and generate a prolonged carrier state. Enteric bacteria and viruses also are spread silently among close contacts, food handlers, and caregivers, making their area of impact even broader.
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