Food for Thought: Could You Recognize a Foodborne Illness?

An infant presents with constipation, poor feeding, sluggish pupils, diminished suck and gag reflexes. His mother also reports that his cries are unusually soft at night, making him hard to hear. These symptoms could lead clinicians in several directions, but one question about nutrition may provide an important clue: What is the infant eating? If the answer includes formula, a possible foodborne exposure may need to be considered.

The recent widespread Cyclospora outbreak demonstrated just how varied foodborne illnesses can be and raised questions about food safety. The outbreak, linked to contaminated iceberg lettuce, was declared over by the CDC on September 11, 2026, after 12,883 illnesses were reported across 21 states, resulting in at least 570 hospitalizations and two deaths. In addition to Cyclospora, outbreaks in the United States have involved organisms including Salmonella, Shiga toxin-producing Escherichia coli (STEC), Listeria, and Clostridium botulinum, associated with foods ranging from produce and cheese to infant formula.

Why food outbreaks matter

Foodborne illness remains a significant public health concern. According to the CDC, there have been multiple outbreaks associated with food in the last few months. Symptoms can range from relatively mild gastrointestinal illness to severe complications requiring hospitalization. Young children, older adults, pregnant women, and individuals with weakened immune systems may be particularly vulnerable to serious illness.

CDC scales back surveillance of outbreaks

In addition, the way some foodborne diseases are monitored is changing. For nearly 30 years, the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) conducted active surveillance for eight foodborne pathogens across participating sites in 10 states. FoodNet surveillance has now been reduced to two pathogens, Salmonella and Shiga toxin–producing Escherichia coli (STEC). CDC representatives have stated that the change allows the agency to prioritize available resources and focus on two pathogens that are leading causes of foodborne illness, hospitalization, and death.

Other pathogens continue to be tracked, but those systems rely more heavily on passive reporting rather than FoodNet’s active case-finding approach. According to the Lancet, experts have raised concerns that reduced active surveillance could make it more difficult to identify changes in disease trends and recognize emerging foodborne threats.

Nurses’ Role

When formal surveillance systems have limitations, the observations made by frontline clinicians become even more important. Nurses may be among the first to encounter patients whose symptoms represent part of a larger foodborne outbreak. Recognizing unusual patterns, asking targeted questions about food and other potential exposures, documenting those findings, and communicating concerns to the health care team can provide important pieces of the surveillance puzzle.

Recognize. Foodborne illness does not always present as nausea, vomiting, and diarrhea. Some pathogens primarily affect the gastrointestinal tract, while others can cause neurologic symptoms or affect renal function. For example, botulism can cause muscle weakness, difficulty swallowing, blurred vision, and descending paralysis, while Shiga toxin-producing Escherichia coli (STEC) can lead to hemolytic uremic syndrome and acute kidney injury. Recognizing which body systems are affected can help narrow down potential causes and guide further assessment and diagnostic testing.

According to CDC, clinical presentation can also vary by age. In adults, foodborne botulism may present with neurologic symptoms such as blurred or double vision, difficulty swallowing, muscle weakness, and slurred speech. Infants may present very differently, with constipation, poor feeding, a weak cry, less facial expression, and slower pupil reaction. These differences make age and clinical presentation important considerations when assessing a possible foodborne illness.

Ask. A targeted food and exposure history can provide important diagnostic clues. In the case of the infant in the opening scenario, it would be beneficial to determine if the infant is taking formula for his nutrition. This question is especially relevant following a recent multistate outbreak of infant botulism linked to contaminated powdered infant formula. According to the CDC, 48 infants were identified in the outbreak, and all were hospitalized. Infant botulism can be life-threatening if not identified and treated quickly, making questions about an infant’s nutrition and specific formula products an important part of the assessment.

Document. Specific exposure information should be documented clearly so other members of the health care team can use it when determining diagnostic testing and treatment. Details such as brand names, restaurants, grocery stores, dates of consumption, and whether others became ill may also become important during an outbreak investigation.

Report. Individual cases can provide pieces of a much larger puzzle. When a reportable foodborne illness is suspected or confirmed, timely communication with the appropriate infection prevention or public health professionals can help identify related cases and potentially trace the source of an outbreak.

Moving forward

With the continued risk of foodborne illness in the United States, the initial nursing assessment is imperative. Foodborne illness may present with gastrointestinal symptoms, but neurologic changes, renal complications, or an unusual presentation in an infant can also provide important clues. Recognizing these less obvious presentations and asking targeted exposure questions can help nurses identify potential foodborne illness, guide timely diagnosis and treatment, and potentially uncover a larger outbreak.

Missy Travis, RN, MSN, CIC, FAPIC, is the founder of IP&C Consulting, LLC, a consulting business that supports infection preventionists, health care organizations, business owners, and professional sports teams in developing and sustaining effective infection prevention programs.