This patient has rapid onset vomiting suggestive of food poisoning due to S. aureus enterotoxin.
Food poisoning generally presents with nausea/vomiting and diarrhea 2-6 hours following ingestion of toxin. The onset of symptoms is rapid, and symptoms quickly abate. In food poisoning, bacteria grow in contaminated food and release enterotoxins. This preformed toxin is consumed with the food, resulting in rapid symptom onset. Frequently implicated bacteria include B. cereus (classically in re-heated rice) and S. aureus (often in custards, mayonnaise, potato salad, or canned meats).
Scorza et al. describe history features that help differentiate causes of acute onset vomiting in an adult. Abrupt onset vomiting suggests food poisoning, gastroenteritis, pancreatitis, cholecystitis, or drug-related causes. If the patient has pain, obstructive causes should be considered. The presence of viral symptoms is suggestive of an infectious process. A detailed history of food ingestions should be obtained, as certain foods are strongly associated with food poisoning.
Kadariya et al. review S. aureus related food poisoning. S. aureus is a ubiquitous organism that can cause a wide spectrum of disease, including food poisoning. S. aureus is not a spore forming organism (unlike B. cereus), but can be directly introduced into the food preparation process. S. aureus can grow at a wide range of temperatures and pH levels, high salt concentrations, and a wide range of moisture levels. This makes the organism well suited to survive in a wide range of food products.
Illustration A is a gram stain of S. aureus, which shows gram positive cocci in clusters. As a comparison, Illustration B shows a gram stain of a Bacillus species, which can also cause food poisoning from pre-formed enterotoxins. The gram stain shows gram positive rods.
Answer 1: Viral infection may cause gastroenteritis, including vomiting and often diarrhea, but her presentation and recent food consumption is highly suggestive of food poisoning.
Answer 2: Hepatitis A virus can cause nausea and vomiting that is self-limited, but the course usually lasts for weeks not hours.
Answer 3: Symptomatic gallstones often present with colicky pain. Moreover, her history of recent potato salad consumption, with rapid onset and offset vomiting, is more consistent with food poisoning.
Answer 4: B. cereus is a spore forming organism that can cause food poisoning. B. cereus causes food poisoning when spores germinate in poorly reheated food (often rice), and then release pre-formed toxin. S. aureus is more commonly found in food like potato salad.
Scorza K1, Williams A, Phillips JD, Shaw J. Evaluation of nausea and vomiting. Am Fam Physician. 2007 Jul 1;76(1):76-84.
PMID:17668843 (Link to Abstract)
Kadariya J1, Smith TC1, Thapaliya D1. Staphylococcus aureus and staphylococcal food-borne disease: an ongoing challenge in public health. Biomed Res Int. 2014;2014:827965. doi: 10.1155/2014/827965. Epub 2014 Apr 1.
PMID:24804250 (Link to Abstract)