Story
Foodborne Illness · what actually hurts people in the kitchen
Last updated
In one pass The same meal can floor you by two opposite mechanisms: sometimes live bacteria get into the gut and keep multiplying; sometimes the bacteria died long ago and only the toxin they left in the food remains.
Educational content, not medical advice — consult a clinician.
Story path
Chapter 1
Three routes to getting sick
The same meal can floor you by two opposite mechanisms: sometimes live bacteria get into the gut and keep multiplying; sometimes the bacteria died long ago and only the toxin they left in the food remains. That is why cooking a dish thoroughly sometimes cannot save you.
In the infection route, you swallow live bacteria. They multiply generation after generation on the gut wall, and you fall ill only once there are enough of them, often hours to days later; Salmonella, Vibrio parahaemolyticus and Campylobacter take this route. Heat kills live bacteria. In the intoxication route, you swallow a toxin that is already made — staphylococcal enterotoxin and bongkrekic acid belong here — and symptoms often start within half an hour to a few hours; processing temperatures can kill the bacteria but do not remove toxin that has already formed (Regenthal 2017; Han 2023). A third route sits between the two: the bacteria start making toxin only once they are in your gut, and Clostridium perfringens loves a big pot of food that was cooked and then left warm to cool slowly.
A few cases can kill: after eating wood ear mushrooms soaked for a long time at room temperature or wet rice noodles kept too long, any symptom at all — or blurred vision, trouble swallowing, or weak arms and legs — means seek medical care immediately; a child or older person vomiting and with diarrhea who cannot keep fluids down and is passing little urine should not wait at home either.
In the infection route, you swallow live bacteria. They multiply generation after generation on the gut wall, and you fall ill only once there are enough of them, often hours to days later; Salmonella, Vibrio parahaemolyticus and Campylobacter take this route. Heat kills live bacteria. In the intoxication route, you swallow a toxin that is already made — staphylococcal enterotoxin and bongkrekic acid belong here — and symptoms often start within half an hour to a few hours; processing temperatures can kill the bacteria but do not remove toxin that has already formed (Regenthal 2017; Han 2023). A third route sits between the two: the bacteria start making toxin only once they are in your gut, and Clostridium perfringens loves a big pot of food that was cooked and then left warm to cool slowly.
A few cases can kill: after eating wood ear mushrooms soaked for a long time at room temperature or wet rice noodles kept too long, any symptom at all — or blurred vision, trouble swallowing, or weak arms and legs — means seek medical care immediately; a child or older person vomiting and with diarrhea who cannot keep fluids down and is passing little urine should not wait at home either.
Numbers · How common foodborne illness is
On a global scale, the World Health Organization made its first systematic estimate in 2015: 31 foodborne hazards caused about 600 million illnesses in 2010 (roughly 1 in every 10 people), 420,000 deaths and 33 million disability-adjusted life years (DALYs, a measure of health lost that adds together years lost to early death and years lived with illness). Of the deaths, 125,000 were children under 5, and children under 5 carried about 40% of the whole burden (WHO 2015).In China, the lead actor is different from Europe and North America. According to laboratory surveillance data since 2011, Vibrio parahaemolyticus is the leading cause of infectious diarrhea in China, especially among adults in coastal areas; it accounts for 42.3% of outbreak cases (Liu 2018). Salmonella is widespread and carries a heavy social and economic burden; Shigella mainly affects children under 5 in the less-developed northwest and inland regions.
The same surveillance holds a contrast that is easy to miss: from 2011 to 2016, poisonous mushrooms accounted for 54.7% of deaths caused by poisonous animals and plants, concentrated in remote parts of the southwest (Liu 2018). In other words, what makes the most people ill and what kills the most people are often not the same thing. The same lesson comes up again in the chapter Bongkrekic acid · the kind heat can't fix.
who-2015-ferg-foodborne-burden
Chapter 2
Why lukewarm food is riskiest
A plate of food sitting on the table can look perfectly still while something is happening inside it. For bacteria to grow, only three things need to stack up: warmth, moisture and time.
Hot or cold is fine; lukewarm is the worst. A big pot of soup cooling slowly on the stove after the heat is off stays warm and wet, and for longest of all. Bacteria grow by doubling, and doubling behaves like this: for a while nothing seems to happen, then the curve shoots straight up. Things do not get worse gradually; they are fine, and then suddenly they are not.
So hot food should get through that dangerous temperature range quickly: split it into small portions, spread it in shallow containers, and do not wait until it is completely cold before it goes in the fridge. The US Department of Agriculture's rule is that food should spend no more than 2 hours in total between 4 and 60°C, cut to 1 hour when it is hotter than 32°C.
Hot or cold is fine; lukewarm is the worst. A big pot of soup cooling slowly on the stove after the heat is off stays warm and wet, and for longest of all. Bacteria grow by doubling, and doubling behaves like this: for a while nothing seems to happen, then the curve shoots straight up. Things do not get worse gradually; they are fine, and then suddenly they are not.
So hot food should get through that dangerous temperature range quickly: split it into small portions, spread it in shallow containers, and do not wait until it is completely cold before it goes in the fridge. The US Department of Agriculture's rule is that food should spend no more than 2 hours in total between 4 and 60°C, cut to 1 hour when it is hotter than 32°C.
Numbers · Where the two-hour rule comes from
The temperature range in which bacteria grow fastest is what the US Department of Agriculture's Food Safety and Inspection Service calls the danger zone: 4-60°C (40-140°F). Within that range, under the right conditions, the number of bacteria can double as often as every 20 minutes (USDA FSIS).Lay that number out. Start with a single bacterium:
Left out 1 hour: 3 doublings, 8 bacteriaLeft out 2 hours: 6 doublings, 64 bacteriaLeft out 4 hours: 12 doublings, 4,096 bacteriaLeft out 6 hours: 18 doublings, about 260,000 bacteria
For the first two hours nothing seems to happen; after that the curve goes straight up. The two-hour rule is not a round number someone made up — it is the line drawn while the curve is still flat.
So the rule is: food should spend no more than 2 hours in total in the danger zone; if the surrounding temperature is above 32°C (90°F — a car in summer, an open courtyard), cut that to 1 hour (USDA FSIS).
Get out of the danger zone at both ends: keep hot food hot, above 60°C, and cold food cold, below 4°C.
Chapter 3
The fridge is not a safe
A refrigerator does one thing: it slows the bacterial clock. It does not stop the clock, and it certainly does not sterilize.
Most disease-causing bacteria nearly stall at fridge temperatures. One does not: Listeria (Listeria monocytogenes) can keep growing slowly in the fridge. So the dangerous combination is chilled, ready-to-eat and kept a long time: cold cuts, soft cheeses and ready-made cold salads will not be heated again once they go in the fridge, and Listeria has all the time it needs.
Freezing does not sterilize either; it just presses pause. After thawing, the bacteria carry on growing from where they left off. To thaw food, let it thaw slowly in the fridge rather than spread out on the counter at room temperature. The fridge deals with the infection route; against toxin that has already formed, the fridge is as powerless as the cooking pot.
Most disease-causing bacteria nearly stall at fridge temperatures. One does not: Listeria (Listeria monocytogenes) can keep growing slowly in the fridge. So the dangerous combination is chilled, ready-to-eat and kept a long time: cold cuts, soft cheeses and ready-made cold salads will not be heated again once they go in the fridge, and Listeria has all the time it needs.
Freezing does not sterilize either; it just presses pause. After thawing, the bacteria carry on growing from where they left off. To thaw food, let it thaw slowly in the fridge rather than spread out on the counter at room temperature. The fridge deals with the infection route; against toxin that has already formed, the fridge is as powerless as the cooking pot.
Mechanism · Why Listeria still grows in the fridge
Researchers have measured the lowest temperature at which Listeria can grow: about -0.1 to -0.4°C, colder than a fridge's main compartment. At 5°C it needs 1-3 days to get going, and after that it divides once every 13-24 hours (Walker 1990). Slow, but it never stops. Over a week, that is enough for it to reach a meaningful number in ready-to-eat food.That is why the US Food and Drug Administration specifically advises pregnant people to avoid soft cheeses made from unpasteurized milk (FDA). In a healthy adult Listeria is often just a bout of gastroenteritis, but for pregnant people, newborns, older adults and people with weakened immunity it can be far more dangerous — which is why this advice is written for groups of people, not for foods.
A few things you can use directly:
Keep the fridge below 4°C, do not pack it too full, and let the cold air circulatePut raw food on the lower shelves and cooked or ready-to-eat food above, so drips from raw meat cannot land on itDivide leftovers into small portions while still warm and get them into the fridge quickly, instead of leaving them on the counter overnight to coolCheck the dates on ready-to-eat food; once it is opened, it keeps for less time than the date printed on the package
Chapter 4
Cross-contamination · it's the board
In many cases of food poisoning, the real problem is not the dish you suspect but the cutting board that touched it.
People tend to think of food poisoning as eating something that had gone bad. The real mechanism is dose: raw food already carries a small number of bacteria, few enough for stomach acid and the immune system to handle. Trouble starts when those bacteria get a chance to multiply.
A knife that just cut raw chicken goes on to slice cucumber; a board that held raw shrimp is then used to plate a cold dish. The bacteria move onto food that will not be heated again, which often then waits at room temperature until the meal. That is where the multiplication in the chapter Why lukewarm food is riskiest begins. In a Chinese kitchen, the combination to watch most closely is summer, seafood, and cold or raw-marinated dishes: together they hit all three at once — no heating, holding at room temperature, and tools shared with raw ingredients.
People tend to think of food poisoning as eating something that had gone bad. The real mechanism is dose: raw food already carries a small number of bacteria, few enough for stomach acid and the immune system to handle. Trouble starts when those bacteria get a chance to multiply.
A knife that just cut raw chicken goes on to slice cucumber; a board that held raw shrimp is then used to plate a cold dish. The bacteria move onto food that will not be heated again, which often then waits at room temperature until the meal. That is where the multiplication in the chapter Why lukewarm food is riskiest begins. In a Chinese kitchen, the combination to watch most closely is summer, seafood, and cold or raw-marinated dishes: together they hit all three at once — no heating, holding at room temperature, and tools shared with raw ingredients.
In practice · Summer seafood and cold dishes
Zhejiang province reported 383 outbreaks of Vibrio parahaemolyticus from 2010 to 2022, with 4,382 people falling ill (Chen 2023). Break down the causes: for seafood and other aquatic products, the main failure was improper processing (58.19%); for ready-to-eat foods, 52.08% were caused directly by cross-contamination between raw and cooked food. The timing is extremely concentrated: July to September accounted for 77.54% of all outbreaks, with August the peak. Nationwide, surveillance recorded 23,818 Vibrio parahaemolyticus infections from 2013 to 2022, concentrated on the coast and concentrated in summer (Jiang 2024).Raw-marinated seafood and cold dishes are hit hardest not because they are dirty, but because they meet three conditions at once: no heating, holding at room temperature, and tools shared with raw ingredients.
A few things you can use directly:
Use two cutting boards, one for raw and one for cooked; if you only have one, cut the cooked food first, then the raw, and wash it thoroughly in betweenWash your hands with soap and running water before and after handling raw meat and seafoodDo not rinse raw chicken under the tap: the splashes spread bacteria in a ring around the sinkCook through what needs cooking: poultry to 74°C at the center, ground meat to 71°C, and whole cuts of pork to 63°C followed by a 3-minute rest (USDA FSIS)Do not leave cold dishes and cooked food waiting at room temperature for long, especially in summer
Mechanism · Why norovirus sidesteps these rules
Norovirus deserves a note of its own, because it sidesteps almost every rule above. It is the leading cause of acute gastroenteritis worldwide, and it is not a bacterium: it does not need to multiply in the food, and a very small number of virus particles is enough to make someone ill. That means the danger-zone multiplication does not apply to it: the food does not need to sit out warm or for long; it only needs to be touched by a hand carrying the virus.So against norovirus the main defense is not temperature but hands. The US Centers for Disease Control and Prevention is direct about it: wash with soap and running water for at least 20 seconds. Alcohol hand sanitizer works poorly against norovirus; it can supplement handwashing but cannot replace it (CDC). This is counterintuitive, because alcohol sanitizer works well against most bacteria and against viruses with an outer envelope — and norovirus happens to have no envelope.
Two more points. Shellfish are a major source, because filter feeders such as oysters concentrate viruses from the water in their digestive glands; so cook oysters and other shellfish thoroughly, to at least 63°C (145°F) at the center, rather than just steaming them briefly (CDC). And do not cook for other people while you have diarrhea or vomiting, or for a few days after you feel better. The classic outbreak chain in the restaurant trade is a single cook who came to work sick.
cdc-norovirus-prevention
Chapter 5
Bongkrekic acid · the kind heat can't fix
Wood ear mushrooms soaked overnight at room temperature, wet rice noodles bought and then left for two days: these are among the few things in a Chinese kitchen that can truly kill, and temperature will not save you.
A bacterium, Burkholderia gladioli pathovar cocovenenans, likes damp, warm, starchy surroundings. Once it has grown, it releases bongkrekic acid. This molecule gets into the mitochondria of your cells and jams the gate that ships the energy molecule out (adenine nucleotide translocase, ANT): the workshop keeps running, but the goods cannot leave. The organs that use the most energy fail first: liver, brain and kidneys (Anwar 2017; Han 2023).
Three things stack up: it is heat-stable, so you cannot count on your pot to cook it away; it has no color, taste or smell, and your nose is not a detector; and there is no antidote, so treatment can only support the body (Anwar 2017; Han 2023). So the conclusion is not be a bit careful but do not let it happen. After eating suspect wood ear or wet rice noodles, any symptom at all means seek medical care immediately.
A bacterium, Burkholderia gladioli pathovar cocovenenans, likes damp, warm, starchy surroundings. Once it has grown, it releases bongkrekic acid. This molecule gets into the mitochondria of your cells and jams the gate that ships the energy molecule out (adenine nucleotide translocase, ANT): the workshop keeps running, but the goods cannot leave. The organs that use the most energy fail first: liver, brain and kidneys (Anwar 2017; Han 2023).
Three things stack up: it is heat-stable, so you cannot count on your pot to cook it away; it has no color, taste or smell, and your nose is not a detector; and there is no antidote, so treatment can only support the body (Anwar 2017; Han 2023). So the conclusion is not be a bit careful but do not let it happen. After eating suspect wood ear or wet rice noodles, any symptom at all means seek medical care immediately.
Numbers · How deadly bongkrekic acid poisoning is
China's National Foodborne Disease Outbreak Surveillance System recorded 19 outbreaks of bongkrekic acid poisoning from 2010 to 2020: 146 people fell ill, 139 were hospitalized and 43 died, a case-fatality rate of 29.5% (Zhang 2023). The absolute numbers are small, but that fatality rate stands out sharply among foodborne illnesses: for most bacterial food poisoning, the case-fatality rate is a few per thousand or lower.Broken down by the food involved, the differences are enormous:
Rehydrated wood ear: 5 cases, 3 deaths, 60%Homemade fermented corn flour products (such as suantangzi): 65 cases, 33 deaths, 50.8%Wet rice noodles: 21 cases, 7 deaths, 33.3%Tremella (silver ear): 52 cases, 0 deaths, 0%
The single most important number is elsewhere: 79% of outbreaks happened at home, and only 21% in restaurants (Zhang 2023). That sentence changes the nature of the whole problem: this is not a question of restaurant regulation, but of kitchen knowledge. No inspector reaches the soaking bowl in your home.
One more contrast shows that intervention works: China banned traditional homemade fermented corn flour products, and together with better recognition and early treatment by front-line doctors, the case-fatality rate has been falling (Zhang 2023). In other words, this is preventable: knowing prevents it, and not knowing does not. That is why this story takes the time to explain it.
Safety · Handling wood ear and wet rice noodles
Hong Kong's Center for Food Safety gives a set of very concrete steps (CFS 2024):Wood ear and tremella: do not soak them at room temperature for long periods. If a long soak really is needed, soak them in the refrigerator: the cold keeps the bacterium from growing, so no toxin is produced. Use them soon after they are rehydrated, and do not leave leftovers sitting at room temperature overnight.Throw away anything that smells or tastes off. But keep this separate from the point above: if it smells off, definitely do not eat it; if it does not smell off, that does not mean it is safe. The toxin itself has no smell; any odd smell you notice comes from other microbes.Wet rice noodles, flat rice noodles and rice noodle rolls: buy them and eat them the same day; products with a shelf life longer than one day must be kept refrigerated throughout transport, storage and sale; refrigerate leftovers immediately, or throw them away.Homemade fermented corn flour products: do not make them. China has banned the traditional homemade versions of these foods, because historically they are the food that has killed the most people (Zhang 2023).Watch for one trap: some preservatives can hide the signs of spoilage without stopping this bacterium from growing (CFS 2024). Still looking fresh does not mean still safe.
The last point matters most: if you feel anything wrong after eating suspect wood ear, wet rice noodles or homemade fermented corn flour products — even just nausea, weakness or feeling like vomiting — go to a hospital immediately and tell the doctor what you ate. Early bongkrekic acid poisoning can look mild and unremarkable, then deteriorate sharply within hours to a day or two. At the same time, have everyone at the table stop eating, and keep the leftover food for the doctor or public health authorities, both to confirm the diagnosis and to protect the people who have not yet fallen ill.
cfs-2024-bongkrekic-food-safety-focus
Chapter 6
What to do · when you must see a doctor
Most food poisoning clears up on its own within a day or two, with fluids and rest. But if any one of the following appears, see a doctor, and do not wait it out at home (CDC):
Bloody stools, or black stoolsA persistent high fever, above 38.9°C (102°F)Vomiting so much you cannot keep fluids downPassing much less urine, a dry mouth, feeling dizzy when you stand upDiarrhea lasting more than 3 days
Blurred vision, drooping eyelids, slurred speech, trouble swallowing, weak arms and legs, or difficulty breathing are the face of botulism: go to the emergency department immediately (CDC). After eating suspect rehydrated wood ear, wet rice noodles or homemade fermented corn flour products, the bar for seeking care should be as low as it gets. Pregnant people, children under 5, adults over 65, people with weakened immunity and people with chronic illnesses should see a doctor early once they have symptoms.
Bloody stools, or black stoolsA persistent high fever, above 38.9°C (102°F)Vomiting so much you cannot keep fluids downPassing much less urine, a dry mouth, feeling dizzy when you stand upDiarrhea lasting more than 3 days
Blurred vision, drooping eyelids, slurred speech, trouble swallowing, weak arms and legs, or difficulty breathing are the face of botulism: go to the emergency department immediately (CDC). After eating suspect rehydrated wood ear, wet rice noodles or homemade fermented corn flour products, the bar for seeking care should be as low as it gets. Pregnant people, children under 5, adults over 65, people with weakened immunity and people with chronic illnesses should see a doctor early once they have symptoms.
In practice · At home, it comes down to fluids
At home, the core of it is one thing: fluids. Diarrhea and vomiting lose both water and electrolytes, and plain water does not replace the salt; oral rehydration solution (ORS) is the first choice (CDC). Small, frequent sips stay down more easily than gulping a lot at once.Do not take anti-diarrhea medicine on your own, especially if there is blood in the stool or a high fever: whether to stop the diarrhea is for a doctor to decide. This story is about acute problems caused by food; long-running stomach trouble, recurring diarrhea or abdominal pain is a different matter (see Irritable Bowel Syndrome). This story is popular science to help you understand the why; it is not a diagnosis and does not replace a doctor.
Myth · Which common claims hold up
The fridge keeps food fresh and kills germs? A fridge only slows things down; it does not sterilize. Listeria grows just fine at 4°C, and freezing is only a pause button (Walker 1990).If it does not smell bad, it is fine to eat? This is the most dangerous one. Bongkrekic acid and botulinum toxin both have no color, taste or smell (Anwar 2017), and the food in China's wet rice noodle outbreaks looked, smelled and tasted completely normal (Zhang 2023). The reverse does hold: if it smells bad, definitely do not eat it.High heat kills everything? It kills bacteria, but not heat-stable toxins. Staphylococcal enterotoxin can survive food-processing temperatures (Regenthal 2017); bongkrekic acid is heat-stable, and you cannot count on home cooking to destroy it (Han 2023). Cooking is a good habit, but what it deals with is the infection route.Soaking wood ear overnight is fine? The more accurate version: soaking it overnight or longer at room temperature carries a risk, and if you need a long soak, do it in the fridge (CFS 2024). Most people who soak it overnight are indeed fine; but when rehydrated wood ear does go wrong, the recorded case-fatality rate is 60% (Zhang 2023). A low probability times a severe consequence is worth changing a habit for.Food poisoning is just diarrhea? Most of the time, yes. But bloody stools, high fever, neurological symptoms and dehydration belong to a different tier (CDC), and bongkrekic acid poisoning has a case-fatality rate of 29.5% (Zhang 2023).Raw-marinated seafood is sterilized by the liquor and seasoning? Neither the alcohol concentration nor the marinating time comes anywhere near sterilizing it; that is exactly the route by which Vibrio parahaemolyticus became the top cause of outbreak cases in China (Liu 2018). If you want to eat it, accept the risk, but do not comfort yourself with it has been sterilized.An honest closing note: almost everything in this story is preventable, and the prevention is cheap — two cutting boards, a thermometer, a refrigerator, and the habit of not using your nose as a detector. What is scarce has never been the equipment; it is knowing which things deserve to be taken seriously.
cfs-2024-bongkrekic-food-safety-focus
References · 15
- Regenthal, P., Hansen, J. S., Andre, I., & Lindkvist-Petersson, K. (2017). Thermal stability and structural changes in bacterial toxins responsible for food poisoning. PLOS ONE, 12(2), e0172445. Preformed staphylococcal enterotoxins may persist through thermal food processing. 10.1371/journal.pone.0172445
- Centers for Disease Control and Prevention. (2024). Salmonella and eggs. Cook until both white and yolk are firm; at-risk groups should avoid raw/runny eggs. www.cdc.gov/foodsafety/communication/salmonella-and-eggs.html
- Centers for Disease Control and Prevention. (2024). Campylobacter (campylobacteriosis). Raw poultry is a common source; cooking to 74 °C and avoiding cross-contamination control it. www.cdc.gov/campylobacter
- Liu, J., Bai, L., Li, W., Han, H., Fu, P., Ma, X., et al. (2018). Trends of foodborne diseases in China: lessons from laboratory-based surveillance since 2011. Frontiers of Medicine, 12(1), 48-57. Vibrio parahaemolyticus caused 42.3% of outbreak cases. 10.1007/s11684-017-0608-6
- Han, D., Chen, J., Chen, W., & Wang, Y. (2023). Bongkrekic acid and Burkholderia gladioli pathovar cocovenenans: Formidable foe and ascending threat to food safety. Foods, 12(21), 3926. BKA is described as a flavorless, odorless, colorless, thermally stable, highly unsaturated tricarboxylic acid. (The paper states thermal stability without specifying a temperature or duration.) 10.3390/foods12213926
- U.S. Department of Agriculture, Food Safety and Inspection Service. (2024). Danger Zone (40 F - 140 F). Bacteria multiply rapidly between 4-60 C and can double in as little as 20 minutes; perishable food should never be left out over 2 hours. www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/danger-zone-40f-140f
- Walker, S. J., Archer, P., & Banks, J. G. (1990). Growth of Listeria monocytogenes at refrigeration temperatures. Journal of Applied Bacteriology, 68(2), 157-162. Minimum growth temperatures ranged from -0.1 to -0.4 C. 10.1111/j.1365-2672.1990.tb02561.x
- U.S. Food and Drug Administration. (2024). People at Risk of Foodborne Illness: Listeria and unpasteurized soft cheeses. Advises pregnant people to avoid soft cheeses made from unpasteurized milk. www.fda.gov/food/people-risk-foodborne-illness
- Chen, L., Wang, J., Chen, J., Zhang, R., Zhang, H., Qi, X., & He, Y. (2023). Epidemiological characteristics of Vibrio parahaemolyticus outbreaks, Zhejiang, China, 2010-2022. Frontiers in Microbiology, 14, 1171350. 383 outbreaks, 4,382 illnesses; July-September accounted for 77.54%. 10.3389/fmicb.2023.1171350
- Jiang, D., Han, H., Guo, Y., Zhang, R., Zhan, L., Zhou, Y., et al. (2024). Epidemiological characteristics of sporadic foodborne diseases caused by Vibrio parahaemolyticus - China, 2013-2022. China CDC Weekly, 6(51), 1354-1359. 23,818 cases identified. 10.46234/ccdcw2024.269
- U.S. Department of Agriculture, Food Safety and Inspection Service. (2020). Safe minimum internal temperature chart. Whole pork 63 °C (145 °F) + 3-min rest; ground meat 71 °C (160 °F); poultry 74 °C (165 °F). www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/safe-temperature-chart
- Zhang, H., Guo, Y., Chen, L., Liu, Z., Liang, J., Shi, M., et al. (2023). Epidemiology of foodborne bongkrekic acid poisoning outbreaks in China, 2010 to 2020. PLOS ONE, 18(1), e0279957. 19 outbreaks, 146 illnesses, 43 deaths; CFR 29.5%; 79.0% occurred at home; Auricularia auricula 3/5 deaths (60%). 10.1371/journal.pone.0279957
- Anwar, M., Kasper, A., Steck, A. R., & Schier, J. G. (2017). Bongkrekic acid - a review of a lesser-known mitochondrial toxin. Journal of Medical Toxicology, 13(2), 173-179. BKA inhibits mitochondrial adenine nucleotide translocase; odorless and tasteless; no specific antidote exists. 10.1007/s13181-016-0577-1
- Centers for Disease Control and Prevention. (2024). Food poisoning symptoms - five signs of severe food poisoning. See a doctor for bloody diarrhea, fever above 38.9 C, persistent vomiting, dehydration, or diarrhea lasting more than 3 days. www.cdc.gov/food-safety/signs-symptoms/index.html
- Centers for Disease Control and Prevention. (2024). Symptoms of botulism. Difficulty swallowing, muscle weakness, double vision, drooping eyelids, slurred speech, difficulty breathing. Improperly home-canned, preserved, or fermented foods are the most common source. www.cdc.gov/botulism/signs-symptoms/index.html