Rarely, diarrhea caused by bacterial food poisoning may be accompanied or followed by nose bleeding, body swelling, painful joints, muscle paralysis due to exaggerated body reaction to harmful bacteria.
Hemolytic Uremic Syndrome (HUS)
Hemolytic uremic syndrome (HUS) may appear in children having diarrhea caused by food poisoning with Escherichia coli 0157:H7 or other bacteria. From the intestine, bacteria may enter the blood and break down red blood cells (hemolysis) that clog kidney vessels what may result in kidney failure. (Uremia refers to increased blood urea (a product of protein breakdown), which can not be successfully removed by impaired kidneys, so it builds up in the blood). Symptoms of HUS include: nose bleeding, pale skin with bruises, profound fatigue, fever, swelling of the face or limbs and decreased urination or blood in the urine usually develop several days after the start of diarrhea, mostly in children under 10 years of age. A child with the mentioned symptoms has to be admitted to hospital promptly. Diagnosis is made by blood test that reveal low level of red cells and platelets, and presence of bacteria. Treatment with blood transfusion and kidney dialysis usually results in full recovery (1). Without proper treatment, permanent kidney damage or even death may occur.
Reactive Arthritis (Reiter’s Syndrome)
Reactive arthritis may appear 1-3 weeks after start of diarrhea due to food poisoning with salmonella, shigella or other bacteria as:
- Painful knees, ankles and feet (arthritis)
- Burning red eyes (conjunctivitis)
- Skin rash
- Mouth ulcers
- Fever, weight loss
Symptoms may last from 3 to 12 months. Diagnosis is confirmed by blood tests (elevated sedimentation rate, bacteria, HLA B-27 markers), stool tests (bacteria) and X-ray of affected joints (2). Treatment by non-steroid anti-inflammatory drugs (Advil, Motrin), corticosteroids, antibiotics and physical therapy usually results in full recovery in few months. Disorder may reoccur, supposedly due to subsequent infection.
Rarely, few weeks to months after food poisoning, antibodies that attack microorganisms also cause inflammation of nerves. Weakness, numbness, painful muscle cramps or paralysis, starting in feet or arms and traveling toward the upper body, develop in some weeks and then slowly fade away in the opposite direction. Sometimes symptoms start in the head. Vision, breathing, or urination may also be affected and artificial respiration may be needed. Occasionally, the syndrome fully develops in only few hours. Diagnosis is made from the history of diarrhea followed by neurological symptoms (when neurological symptoms appear, diarrhea is usually already healed). There is no known treatment, but plasma exchange or intravenous immunoglobulins may speed up recovery. Patients usually survive without any consequences, even in severe cases.
- Hemolytic uremic syndrome (kidney.niddk.nih.gov)
- Reactive arthritis (Reiter’s syndrome) (mayoclinic.com)
- Guillain-Barre Syndrome (cdc.gov)