Shortness of breath diarrhea

Food poisoning is very stressful to the body and is often quite a debilitating illness. Foodborne illnesses come as a result of eating contaminated, toxic, or spoiled food. The condition is quite common as it affects millions of people – or 1 in 6 persons – in the United States every year. The symptoms of food poisoning can range from mild to severe, but most commonly include nausea, vomiting, and diarrhea. The duration of a foodborne illness can range from a few hours up to a few days.

Symptoms of food poisoning aren’t easy to miss, although they can vary a bit depending on what the infection stemmed from. Depending on the source, it can take from as little as an hour for symptoms to occur, all the way up to almost an entire month (28 days). If you have a common case of food poisoning, you likely suffer from at least three of the following symptoms:

  • Nausea
  • Vomiting
  • Abdominal cramps
  • Diarrhea
  • Fever
  • Headaches
  • Weakness
  • Light-headedness
  • Fatigue
  • Loss of appetite

Certain cases of food poisoning are more severe than others and could even be potentially life-threatening without treatment. If you are experiencing any of these more severe symptoms you should seek medical attention immediately:

  • Diarrhea and vomiting lasting for more than three days
  • A fever that is higher than 101.5 degrees (Fahrenheit)
  • Severe dehydration symptoms: noticeable decrease in urination, dry mouth, difficulty keeping fluids down
  • Difficulty seeing
  • Difficulty speaking
  • Blood in urine

How long does food poisoning last?

Most cases of food poisoning only last for 1 to 2 days, however sometimes you will only experience symptoms for a few hours. Symptoms will typically resolve on their own after a couple of days, however, if you are experiencing symptoms for longer than 3 days then you should go to see your doctor in Arlington.

Certain infections, such as Cyclospora infections, can cause one to exhibit diarrhea symptoms for a few weeks. In that case you would need to see your doctor to assist in recovery and to ensure you do not become severely dehydrated, etc. This type of infection is one of the more common reasons that certain symptoms persist for extended periods of time.

What causes food poisoning?

The cause of food poisoning is linked to exposure to either certain bacteria, parasites, or viruses. Bacteria is the most common cause of food poisoning, parasites are less common, but they can be very dangerous, especially to those who suffer from weak immune systems. Viruses are another common cause of food poisoning and are responsible for over 19 million cases each year.

How is food poisoning treated?

Food poisoning often can be treated from home and will usually go away on its own in a matter of 1 to 3 days. Visiting an urgent care in Arlington will likely be your best option as you will be able to get in the quickest that way.

The most important thing to do if you have food poisoning is to stay hydrated as you will lose a lot of needed hydration along with the symptoms of the condition. Buying water that has added electrolytes is your best option. You should avoid any drinks that have caffeine as they can increase dehydration and irritate your stomach.

If your condition doesn’t better in 3 days or longer or if you are experiencing any of the more severe symptoms that are listed, then you should come see us here at Urgentology. Walk-ins are of course always welcome, but our center also accepts appointments for your convenience. Call us or come by today.

Important: If you have a life-threatening emergency, please call 911 or go to your nearest Emergency Room. Information in this site is not intended to be used as a diagnosis for your symptoms. If you experience any of these symptoms, please seek medical attention or visit Urgentology Care.

Food Poisoning

Food poisoning is the term the general public tends to use when speaking of illnesses caused by eating food that made them ill. Food can be contaminated by a a large number of bacteria, viruses, and parasites. If you consume food products that contain these germs, you could become seriously ill and this infection can trigger sepsis.

Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection. Sepsis kills and disables millions and requires early suspicion and treatment for survival. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations.

The most common germs that cause food poisoning are:

  • Norovirus: Most people who have heard of norovirus likely think of it as an illness that passes from person to person, particularly among children. However, this virus can also be spread through contaminated food and water. It causes 58% of foodborne illnesses each year in the United States, causing between 19 million and 21 million cases of acute gastroenteritis and up to 800 deaths per year. Most outbreaks are associated with contaminated leafy greens (such as lettuce), fresh fruit, and shellfish.
  • Salmonella: Over 1 million people in the U.S. each year contract salmonella poisoning from food. It causes almost 400 deaths per year. This infection is often the result of consuming contaminated raw meat, poultry, and seafood. Other foods that can transmit the infection are raw eggs, and fresh fruit and vegetables that have not been thoroughly washed or have come in contact with uncooked raw meat or poultry.
  • Clostridium perfringens: This strain of infection also affects about 1 million people in the U.S. each year. It is found most often in foods like beef, poultry, and pre-cooked foods. It can also be found in dried foods. Outbreaks of this bacteria are most frequently found in areas where large amounts of food are prepared, such as cafeterias or catering facilities.
  • Campylobacter: Another foodborne illness that affects over 1 million people in the U.S. each year, campylobacter, is most often contracted by eating raw or undercooked poultry, consuming unpasteurized milk or contaminated water, or by touching these products and not washing your hands.
  • Staphylococcus aureus: This particular bacteria is quite common and many of us have the bacteria on our skin and in our nose, without any illness. However, if you carry Staphylococcus aureus and you don’t wash your hands thoroughly before handling food, the bacteria could multiply and cause serious illness to others. The products most likely to spread this germ include salads (especially if they have prepared meats, such as ham and chicken), dairy products, and eggs.

The following four germs are not as common as the others, but they cause the most serious illnesses:

  • Clostridium botulinum (botulism): Up to 200 people per year in the U.S. develop botulism, less than 50 of them from food. The bacteria are found in the soil where the food grows. If food is not processed and canned (or bottled) safely, the bacteria can grow, producing a toxin. Botulism is a particular concern with home canning.
  • Listeria: Listeria poisoning, called listeriosis, only affects about 1,600 people in the U.S. each year, but over 250 die from it. If a pregnant woman contracts the infection, she may not be seriously ill, but it can cause serious complications for the fetus. Listeria may be found in prepared meats, unrefrigerated foods (such as meat spreads), unpasteurized cheeses, and raw sprouts.
  • Escherichia coli (E. coli). E. coli is an infection that often hits the news when there is an outbreak. The bacteria itself is all around us and most are harmless. However, there are two types that can cause serious illness. You can learn more about E. coli at Sepsis and Intestinal E. Coli Infections.
  • Vibrio: Vibrio causes vibriosis, affecting about 80,000 people in the U.S. each year, causing about 100 deaths. It can be spread if you have an open wound that is exposed to contaminated sea water, but it is a foodborne illness as well, caused by consuming raw or undercooked seafood.

Prevention

Not all infections can be prevented, but you can reduce your risk by following these tips:

  • Cook all meat thoroughly, particularly ground beef or meet that has been mechanically tenderized.
  • Don’t eat raw or undercooked eggs
  • Don’t reuse cutting boards or utensils after using them for meat products unless they’ve been washed in hot, soapy water first.
  • Drink only pasteurized milk and eat pasteurized dairy products.
  • Wash all fruits and vegetables thoroughly.
  • Wash your hands thoroughly, especially after touching animals and before and after handling food.

To reduce the risk of contracting infections while in countries where the bacteria are more common:

  • Drink bottled water and use bottled water to brush your teeth
  • Do not eat undercooked foods.
  • Do not use ice cubes made with tap water
  • Eat fruits that you can peel yourself
  • Wash your hands frequently

Symptoms

The most common symptoms of foodborne illnesses are abdominal cramping, diarrhea, nausea and vomiting. If you experience any of these symptoms and they worsen instead of improve, or if you see fresh blood in your stools, contact your doctor immediately or go the the closest emergency department.

Watch for signs of sepsis. The earlier sepsis is recognized and treated, the better the outcome. Think TIME for the most basic of symptoms. If your loved one is showing a combination of these symptoms, contact your doctor, go to the emergency room, or call 911, and say, “I suspect sepsis.”

To learn more about the different conditions that could increase your risk of developing sepsis, please visit the Sepsis and… library.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”

Updated June 5, 2019

What is food poisoning?

Food poisoning means getting sick from eating food with poisonous stuff in it. But not usually the kind of poisons used by the killer in an Agatha Christie story. Usually the poison comes from some type of germ.

Many types of germs can cause food poisoning, including bacteria, viruses and parasites. Common culprits include:

  • Campylobacter
  • Salmonella
  • Norovirus
  • Rotavirus

You are more likely to pick up food poisoning if you are not careful about how you store and handle food, and about what and where you eat or drink.

What are the symptoms of food poisoning?

  • The main symptom is diarrhoea, often with being sick (vomiting) as well. Diarrhoea is defined as “loose or watery stools (faeces), usually at least three times in 24 hours”. Blood or mucus can appear in the stools with some infections.
  • Crampy pains in your tummy (abdomen) are common. Pains may ease for a while each time you pass some diarrhoea.
  • You may feel hot one minute and cold and shivery the next, and achy all over. These are symptoms of a high temperature (fever) which sometimes develops along with the tummy symptoms.

If vomiting occurs, it often lasts only a day or so but sometimes longer. Diarrhoea often continues after the vomiting stops and commonly lasts for several days or more. Slightly loose stools may persist for a week or so further before a normal pattern returns. Sometimes the symptoms last longer.

The vomiting and diarrhoea usually start hours or a very few days after eating the infected food. Afterwards, you often feel drained and washed out for a few days, while you regain your appetite and “oomph”.

Symptoms of lack of fluid in the body

Diarrhoea and vomiting may cause lack of fluid in the body (dehydration). Consult a doctor quickly if you suspect you are becoming dehydrated. Mild dehydration is common and is usually easily reversed by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of your body need a certain amount of fluid to function.

Symptoms of dehydration in adults include:

  • Tiredness.
  • Dizziness or light-headedness.
  • Headache.
  • Muscle cramps.
  • Sunken eyes.
  • Passing less urine.
  • A dry mouth and tongue.
  • Weakness.
  • Becoming irritable.

Symptoms of severe dehydration in adults include:

  • Profound loss of energy or enthusiasm (apathy).
  • Weakness.
  • Confusion.
  • A fast heart rate.
  • Producing very little urine.
  • Coma – may occur.

Severe dehydration is a medical emergency and immediate medical attention is needed.

Dehydration in adults is more likely to occur in:

  • Elderly or frail people.
  • Pregnant women.
  • People with severe diarrhoea and vomiting. In particular, if you are not able to replace the fluid lost with enough drinks.

When do I need to seek medical advice?

You should seek medical advice if:

  • You think that you are becoming dehydrated.
  • You are vomiting a lot and can’t keep fluids down at all.
  • You have blood in your stools (poo) or you vomit up blood.
  • You have severe tummy pain.
  • You have severe symptoms, or if you feel that your condition is becoming worse.
  • You have a high temperature (fever), which doesn’t settle with medicines such as paracetamol, or which hangs about for three days or more.
  • Your symptoms are not settling; for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
  • Your infection was caught abroad.
  • You are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory bowel disease, kidney disease.
  • You have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, HIV infection.
  • You are pregnant.
  • You suspect that you may have contracted food poisoning from eating restaurant or takeaway food.
  • There are any other symptoms that you are concerned about.

What are the causes of food poisoning?

Food poisoning is common and most of us will recognise the scenario. You ate something that looked (or smelled) a little dodgy, or you were abroad in a country where it isn’t safe to drink the water, and you had a salad. Washed in the water you know you shouldn’t drink. A few hours later you get tummy ache, and you are being sick (vomiting) and running backwards and forwards to the toilet. There are pet names for it in different parts of the world: Delhi belly, Kathmandu quickstep, Montezuma’s revenge, Karachi crouch. But you can pick it up pretty much anywhere, including your own home.

Bacteria
Campylobacter is the most common germ (bacterium) that causes food poisoning in the UK. Other germs (bacteria) that can cause food poisoning include:

  • Salmonella.
  • Escherichia coli (usually shortened to E. coli).
  • Listeria.
  • Shigella.
  • Clostridium perfringens.

Viruses
Some germs (viruses), such as norovirus or rotavirus, can contaminate food and cause food poisoning.

Parasites
These are another type of microbe. Parasites are living things (organisms) that live within, or on, another organism. Examples include cryptosporidium, Entamoeba histolytica and giardia parasites. Food poisoning caused by parasites is more common in the developing world.

In the UK, a common cause of food poisoning is Toxoplasma gondii. This is a parasite that lives in the bowels of a number of animals, including cats. Food poisoning can occur if food or water is contaminated with the stools (faeces) of infected cats, or if raw or undercooked meat from another animal carrying the parasite is eaten. The infection is known as toxoplasmosis. Symptoms of this type of food poisoning include swollen lymph glands and sometimes a skin rash.

Toxins and chemicals
Poisons (toxins) produced by bacteria can also contaminate food, as well as the bacteria themselves. For example, the bacterium Staphylococcus aureus can contaminate ice cream and its toxins can lead to food poisoning. The bacterium Bacillus cereus can contaminate rice. If contaminated rice is reheated and eaten, the toxins produced can lead to food poisoning.

Certain types of fish (including shark, marlin, swordfish and tuna) contain high levels of the chemical mercury. Eating these types of fish is not normally a problem for most people – it does not cause gastroenteritis or food poisoning. But pregnant women are advised to avoid eating shark, marlin and swordfish and to limit tuna. This is because a high level of mercury can damage the developing nervous system of an unborn baby.

Oily fish may be contaminated by chemicals called polychlorinated biphenyls. Again, this does not usually cause a problem or food poisoning for most people. However, you should limit the amount of oily fish you eat in pregnancy because of possible effects of these chemicals on a developing baby. The Department of Health recommends no more than two portions of oily fish a week.

Note: this is a general leaflet about food poisoning. There are separate leaflets that give more details about some of the different microbes that cause food poisoning.

How does food become contaminated?

Contamination of food can occur because of problems in food production, storage or cooking. For example:

  • Not storing food correctly or at the correct temperature. For example, not refrigerating food. This is particularly a problem for meat and dairy products.
  • Inadequate cooking of food (undercooking or not cooking to the correct temperature). Bacteria are often found in raw meat, including poultry. Adequate cooking usually kills the bacteria.
  • Contamination by someone preparing the food who has not followed food hygiene rules and has not washed their hands properly.
  • Contamination from other foods (cross-contamination). For example, not washing a board used to prepare raw meat before you cut a slice of bread using the same board. Storing raw meat in the fridge above food that is “ready-to-eat” and so allowing raw meat juices to drip on to the food below.
  • Bacteria can also be present in unpasteurised milk and cheese. The pasteurisation process kills the bacteria.

How does water become contaminated?

Water can become contaminated with bacteria or other microbes usually because human or animal stools (faeces) get into the water supply. This is particularly a problem in countries with poor sanitation. In such countries, food may also be washed and prepared using contaminated water. So, for example, in countries with poor sanitation, you should always avoid:

  • Drinking tap water.
  • Having ice cubes in drinks (as the ice may have been made from tap water).
  • Brushing your teeth with tap water.
  • Eating salads (as the lettuce, tomatoes, etc, may have been washed in contaminated water).
  • Eating uncooked vegetables (as they may have been washed in contaminated water).

How is food poisoning diagnosed and do I need investigations?

Most people will recognise food poisoning from their typical symptoms. If symptoms are mild, you do not usually need to seek medical advice or receive specific medical treatment.

However, in some circumstances, you may need to seek medical advice when you have food poisoning (see below about when to seek medical advice). The doctor may ask you questions about recent travel abroad or any ways that you may have eaten or drunk contaminated food or water. The doctor will also usually check you for signs of lack of body fluid (dehydration). They may check your temperature, pulse and blood pressure. They may also examine your tummy (abdomen) to look for any tenderness.

Your doctor may ask you to collect a stool (faeces) sample. This can then be examined in the laboratory to look for the cause of the infection. A stool sample is not always needed. Your doctor is likely to suggest one in certain situations, such as:

  • If you have recently been abroad.
  • If you are very unwell.
  • If you have blood or pus in your stools.
  • If your diarrhoea is not settling after a week.
  • If you have recently been in hospital or had antibiotic treatment.
  • If you have another medical condition, particularly one which affects your immune system.
  • If the doctor is not sure you have food poisoning or a gut infection (gastroenteritis).
  • If your job involves handling food.

The reason a stool sample is not always needed is that in many cases knowing what germ you have does not make any difference to the treatment you need. Most cases of food poisoning get better on their own even before the stool test result is back.

If you are very unwell, you may need admission to hospital. If this is the case, further investigations may be needed such as blood tests, scans or a lumbar puncture. This is to look for spread of the infection to other parts of your body.

If you think your infection may have come from food at a particular restaurant or shop then inform your local Environmental Health Office. (Find them via the Food Standards Agency website’s Report a food problem page.) This is so that the business can be checked out by environmental health officers. Further actions may be taken if there is a problem with their food hygiene practices. This will hopefully help to reduce the chance that other people will get food poisoning. If your doctor suspects or confirms that you have food poisoning, they are also required by law to report this.

What is the treatment for food poisoning?

Symptoms often settle within a few days or so as your immune system usually clears the infection. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop (see below).

The following are commonly advised until symptoms ease:

Fluids – have lots to drink

The aim is to prevent lack of body fluid (dehydration), or to treat dehydration if it has developed. (Note: if you suspect that you are dehydrated, you should contact a doctor.)

  • As a rough guide, drink at least 200 mls after each watery stool (each bout of diarrhoea).
  • This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above “200 mls after each watery stool” is in addition to this usual amount that you would drink.
  • If you are sick (vomit), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.
  • You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.

For most adults, fluids drunk to keep hydrated should mainly be water. Also, ideally, include some fruit juice and soups. It is best not to have drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.

Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies. (The sachets are also available on prescription.) You add the contents of the sachet to water. Rehydration drinks provide a good balance of water, salts, and sugar. The small amount of sugar and salt helps the water to be absorbed better from the gut (intestines) into the body. They do not stop or reduce diarrhoea. Do not use home-made salt/sugar drinks, as the quantity of salt and sugar has to be exact.

Eat as normally as possible

It used to be advised to ‘starve’ for a while if you had food poisoning. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able – but don’t stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first.

Medication

Antidiarrhoeal medicines are not usually necessary. Your body is doing its best to get rid of the germ for you, and you will recover more quickly if you let it do so. However, a medicine called loperamide may be advised in some situations. For example, to help you over a special event such as a wedding, or if you have difficulty reaching the toilet quickly. Loperamide works by slowing down your gut’s activity and it can reduce the number of trips that you need to make to the toilet. You can buy loperamide from pharmacies. The adult dose of loperamide is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea, up to a maximum of eight capsules in 24 hours. You should not take loperamide for longer than five days.

Note: although loperamide is usually safe, there have been reports of very serious gut problems developing in some people who have taken loperamide. These problems were mainly in people who had severe inflammation of the gut. So, do not use loperamide or any other antidiarrhoeal medicine if you pass blood or mucus with the diarrhoea or if you have a high temperature (fever). Also, people with certain conditions should not take loperamide. Pregnant women should not take loperamide. Therefore, to be safe, read the leaflet that comes with the medicine.

Paracetamol or ibuprofen is useful to ease a high temperature or headache.

In some cases, your doctor may ask for a sample of the diarrhoea. This is sent to the laboratory to look for infecting germs (microbes such as bacteria, parasites, etc). A course of antibiotic medicine is sometimes needed when the germ is identified. Examples where antibiotics might be needed include:

  • If symptoms are very severe
  • If the infection is not improving as expected. For example, if symptoms are still persisting after one week.
  • If you are older than 50 with confirmed infection with salmonella.
  • If you have other medical conditions, such as problems with your heart valves, and have confirmed salmonella infection.
  • If you have blood in your diarrhoea and have confirmed shigella infection.
  • If your immune system is not working as well as normal – for example, due to chemotherapy or if you have an illness such as AIDS.
  • Infections with some specific germs, usually those acquired abroad, are usually treated with antibiotics. For example, infection with giardia, or amoebic infection.

What are the complications of food poisoning?

Complications are uncommon in the UK. Those who are older are more likely to develop complications. Complications are also more likely if you have an ongoing (chronic) condition such as diabetes or if your immune system is not working normally. (For example, if you are taking long-term steroid medication or you are having chemotherapy treatment for cancer.) Possible complications include the following:

  • Salt (electrolyte) imbalance and lack of fluid (dehydration) in your body. This is the most common complication. It occurs if the salts and water that are lost in your stools (faeces), or when you are sick (vomit), are not replaced by you drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild, and will soon recover as you drink. Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, your kidneys may be damaged. Some people who become severely dehydrated need a “drip” of fluid directly into a vein. This requires admission to hospital. People who are elderly or pregnant are more at risk of dehydration.
  • Reactive complications. Rarely, other parts of your body can “react” to an infection that occurs in your bowels. This can cause symptoms such as joint inflammation (arthritis), skin inflammation and eye inflammation (either conjunctivitis or uveitis).
  • Spread of infection to other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if diarrhoea is caused by salmonella infection.
  • Persistent diarrhoea syndromes may rarely develop:
    • Irritable bowel syndrome is sometimes triggered by a bout of food poisoning.
    • Lactose intolerance can sometimes occur for a period of time after food poisoning. This is known as “secondary” or “acquired” lactose intolerance. Your bowel (intestinal) lining can be damaged by an episode of bowel infection. This leads to lack of a chemical (enzyme) called lactase that is needed to help your body digest a sugar called lactose that is in milk. Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the bowel lining heals. It is more common in children than in adults.
  • Haemolytic uraemic syndrome is another potential complication. It is rare and is usually associated with food poisoning caused by a certain type of E. coli infection. It is a serious condition where there is anaemia, a low platelet count in the blood and kidney failure. It is more common in children. If recognised and treated, most people recover well.
  • Guillain-Barré syndrome may rarely be triggered by campylobacter infection. This is a condition that affects the nerves throughout your body and limbs, causing weakness and sensory problems. See separate leaflet called Guillain-Barré syndrome for more details.
  • Reduced effectiveness of some medicines. During an episode of food poisoning, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or vomiting means that reduced amounts of the medicines are taken up (absorbed) into your body. Examples of such medicines are those for epilepsy, diabetes and contraception. Speak to your doctor or practice nurse if you are unsure of what to do if you are taking other medicines and have food poisoning.

How can I prevent food poisoning?

The Foods Standards Agency in the UK has identified the “4 Cs” to help prevent food poisoning:

Cleanliness

  • Keep work surfaces and utensils clean.
  • Wash and dry your hands regularly but especially after going to the toilet, before preparing food, after handling raw food and before touching “ready-to-eat” food.
  • Don’t prepare food for others if you have diarrhoea or are being sick (vomiting).
  • Cover any sores or cuts on hands with a waterproof plaster before you touch food.
  • Change dishcloths and tea towels regularly.

Cooking

  • Make sure that you cook food thoroughly, especially meat. This will kill germs (bacteria). Food should be cooked right through and be piping hot in the middle.
  • If you are reheating food, it needs to be cooked right through and be piping hot in the middle.
  • Don’t reheat food more than once.

Chilling

  • Food that needs to be chilled or refrigerated should be. If food is left out of the fridge, bacteria may multiply to levels that can cause food poisoning.
  • Your fridge needs to be kept between 0°C and 5°C. Also, don’t leave the door open unnecessarily.
  • Cool leftover food quickly and then refrigerate. Taking it out of the cooking pot and putting it into a shallow container can speed up the cooling process.

Cross-contamination

This occurs when bacteria pass from foods (commonly, raw foods) to other foods. It can occur if:

  • Foods touch directly.
  • One food drips on to another.
  • Your hands or utensils or equipment such as knives or chopping boards touch one food and then another.

It is important to:

  • Wash your hands after touching raw foods.
  • Separate raw and cooked or ready-to-eat foods.
  • Keep raw meat in a sealable container at the bottom of the fridge.
  • Avoid using the same surface or chopping board for preparing raw and ready-to-eat foods.
  • Make sure that knives and utensils are cleaned after preparing raw foods.

Preventing the spread of food poisoning to others

Some infections causing diarrhoea and vomiting are very easily passed on from person to person. If you have diarrhoea, the following are also recommended to prevent the spread of infection to others:

  • Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water but any soap is better than none. Dry properly after washing.
  • Don’t share towels and flannels.
  • Don’t prepare or serve food for others.
  • Regularly clean the toilets that you use. Wipe the flush handle, toilet seat, bathroom taps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
  • Stay off work, college, etc, until at least 48 hours after the last episode of diarrhoea or vomiting.
  • Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations may arise and sometimes longer time off is needed. If in doubt, seek advice from your employer or GP.
  • If the cause of food poisoning is known to be (or suspected to be) a germ called cryptosporidium, you should not swim in swimming pools for two weeks after the last episode of diarrhoea.

Help! I think I have a UTI

Have you got that burning feeling? Is ‘going number one’ suddenly an urgent experience? Have you noticed a change in the colour or odour of your pee?

You might have a urinary tract infection. Find out what UTIs are, how they’re treated and how to prevent them below.

What is a urinary tract infection?

Urinary tract infections (UTIs) are common infections that affect males and females of all ages, though are more common in women. They are caused by micro-organisms, usually bacteria, that get into your urinary tract.

UTIs can affect all parts of the urinary tract from the bladder to the kidneys. Kidney infections (pyelonephritis) are quite serious and can cause serious complications.

What are the symptoms of a UTI?

Those who have had a urinary tract infection will tell you that they’re not a pleasant experience. Even though they’re common and very treatable, UTIs can be painful and frustrating, especially if they reoccur often.

Symptoms of a UTI can include:

  • pain in your lower back or side
  • pain, stinging or burning when you urinate
  • feeling like you need to urinate more often than normal, but only passing a few drops
  • cloudy urine
  • urine that smells unusual and
  • blood in your urine.

If a UTI has spread to your kidneys you might also experience fever, back pain, abdominal pain, diarrhoea and vomiting.

How are urinary tract infections treated?

If you have any symptoms of a UTI, it’s important that you see your GP for correct diagnosis and treatment. Untreated kidney infections can lead to serious complications.

Your doctor will probably prescribe antibiotics to treat the bacterial infection. They may also recommend special drinks you can take to help flush your urinary tract and make urinating more comfortable. They might recommend you take over-the-counter medications to help deal with pain or fever.

UTIs are not contagious, which means you can’t spread them to other people. However the symptoms of a UTI are similar to those caused by sexually transmitted infections. While UTIs aren’t contagious STIs are, so you should talk to your doctor about the cause of your symptoms.

How to prevent UTIs?

While some people are more likely to get UTIs than others because of their anatomy, there are things everyone can do to prevent UTIs.

Drink plenty of fluids (water is always best) throughout the day. This will help flush your urinary tract, stopping bacteria from building up.

Always go to the toilet when you feel the need to urinate – don’t hold on. When it comes to timing, nature knows best!

After going to the toilet to poo or urinate, women and girls should wipe from front to back to make sure no bacteria are pushed from their anus towards their urethra.

Always urinate after having sex to flush out any bacteria that might have been pushed into the urethra. This goes for men and women.

Wear cotton underwear rather than silk, nylon or spandex, and avoid wearing tight fitting clothes that don’t allow your downtown to breathe. Bacteria thrive in warm, moist areas, so wear loose-fitting cotton clothing to avoid setting up their ideal environment.

Only use mild soaps on your genitals. Fragrance-free soaps are best, and should be washed off immediately. Women – you do not need to wash your vagina (it’s self-cleaning so you only need to wash the skin outside) and you should never add artificial scents to this area.

Looking after yourself by eating a healthy diet, doing plenty of physical activity and getting good quality sleep will help your immune system stay strong and keep bacteria in check.

More information

Urinary tract infections – Health Direct

Urinary tract infections – Mayo Clinic

Symptoms of E. coli: How to Know if You Have an Infection, and What Type

Complications Associated With Intestinal E. coli Infections

Approximately 5 to 10 percent of individuals with STEC develop a related complication called hemolytic uremic syndrome (HUS). This is a potentially life-threatening condition where the red blood cells that have been destroyed by the E. coli bacteria go on to damage the kidneys’ filtering system, which can lead to kidney failure.

Those who are most likely to be impacted include children under age 5, the elderly, and those with compromised or weakened immune systems. (6) People who take antibiotics to treat an E. coli infection are also at an increased risk for developing HUS, according to a report published in November 2012 in the journal Toxins. (7)

Usually, HUS emerges about seven days after E. coli symptoms first appear — and once diarrhea starts to subside. (6)

Symptoms may include:

  • Bloody diarrhea
  • Abdominal pain
  • Decreased urination or blood in urine
  • Vomiting
  • Fatigue and irritability
  • Fever (occasionally)
  • Pallor
  • Small, unexplained bruising
  • Confusion or seizures
  • Increased blood pressure
  • Swelling (face, hands, feet, body) (8)

It’s very important to immediately visit a healthcare professional if the affected individual doesn’t urinate for 12 hours or more, experiences bloody diarrhea, or has several days of nonbloody diarrhea followed by:

  • Decreased urine output
  • Unexplained bruising
  • Unusual bleeding (8)

Symptoms of E. coli Infections in the Urinary Tract

The E. coli bacteria is behind more than 85 percent of all urinary tract infections (UTIs), according to research published in March 2012 in the journal Emerging Infectious Diseases. (9)

UTIs occur when E. coli, which typically resides in the colon, enters the urinary system through the urethra. This can happen through improper hygiene (wiping from back to front after a bowel movement) or via sexual contact. A woman’s urethra is located next to the vagina and anus, making for an easy pathway for E. coli to enter the urinary tract. (10)

Urinary tract infections don’t always produce symptoms, but most people will experience at least one of the following signs:

  • Burning feeling during urination
  • Intense and persistent urges to urinate
  • Passing frequent but small amounts of urine
  • Unusual- or strong-smelling urine
  • Cloudy urine
  • Red, bright pink, or cola-colored urine (these are an indication that blood is present in the urine)
  • Fever or chills
  • Pain in the lower back, hips, or flanks
  • Pelvic pain in women, rectal pain in men (10)

Symptoms of E. coli Infections That Cause Neonatal Meningitis

It’s estimated that E. coli causes about 20 percent of all neonatal bacterial meningitis cases, but less than 2 percent of meningitis cases at all other ages. (11) Premature babies and those born at a low birth weight are at an increased risk of contracting this type of meningitis. An E. coli strain called K1 causes the vast majority of all E. coli–related neonatal meningitis cases, according to the Meningitis Research Foundation. (11) Newborns may become infected with E. coli K1 during birth, or from bacteria later acquired in the hospital or home. That said, bacterial meningitis is very rare in developed countries.

A newborn with meningitis may experience one or more of the following symptoms:

  • Breathing trouble
  • Unusually cold or warm skin
  • Jaundice
  • Lethargy
  • Seizures
  • Vomiting
  • Unusual fussiness and irritability that does not subside when the baby is held
  • Bulging soft spot at the top of the head (the fontanelle) (12)

Older children or adults with bacterial meningitis due to E. coli usually develop a stiff neck and have a headache as well. (12)

Symptoms of E. coli Infections That Cause Sepsis

Beyond neonatal meningitis, E. coli (as well as listeria and certain strains of streptococcus) can also put newborns and babies at risk for sepsis, or blood poisoning. Neonatal sepsis is an infection of the blood that occurs in babies less than 90 days old. The infection can be acquired from the mother before or during delivery (preterm delivery, early water breaking, and chorioamnionitis increase risk), or after delivery due to an extended hospital stay or extended catheter use. Signs and symptoms include:

  • Changes in body temperature and heart rate
  • Breathing issues
  • Diarrhea or decreased bowel movements
  • Low blood sugar
  • Reduced movements and sucking
  • Seizures
  • Swollen belly area
  • Vomiting

Neonatal sepsis is a serious issue and a leading cause of infant death. The more quickly an infant gets diagnosed and treated with antibiotics, the better the outcome. (13)

Symptoms of E. coli Infections That Cause Pneumonia

Streptococcus pneumoniae is the most common bacterial perpetrator of pneumonia, but E. coli can also sometimes cause the disease, according to the Centers for Disease Control and Prevention (CDC). (14) The most common symptoms of pneumonia include:

  • Chest pain when breathing or coughing
  • Cough with phlegm
  • Shortness of breath
  • Nausea, vomiting, or diarrhea
  • Fatigue
  • Fever
  • Shaking chills
  • Confusion or changes in mental awareness (in those ages 65 and older)
  • Lower than normal body temperature (in those ages 65 and older and in people with a weakened immune system) (15)

Additional reporting by Joseph Bennington-Castro.

What can cause abdominal bloating and shortness of breath?

Abdominal bloating and shortness of breath may occur together for several reasons. Some are benign, whereas others may be more serious.

The following sections discuss these potential causes in more detail.

Benign causes

Three relatively benign causes of abdominal bloating and shortness of breath include:

Overeating

A person may experience bloating after overeating. This bloating may then put pressure on the diaphragm, causing the person to feel short of breath.

Certain foods and additives

Some foods and additives can cause excess gas production. The excess gas can put pressure on the diaphragm.

Some foods and additives that may cause or contribute to excess gas include:

  • high fiber foods, such as beans, lentils, and whole grains
  • carbonated drinks
  • artificial sweeteners

Pregnancy

A woman may experience bloating and nausea during pregnancy. Slight breathing difficulties may also occur toward the end of the second trimester or during the third trimester, when the growing fetus may push against a woman’s diaphragm.

Underlying medical causes

Sometimes, abdominal bloating and shortness of breath can occur due to one of the following medical conditions. Some of these conditions are more serious than others:

  • obesity
  • food intolerances
  • irritable bowel syndrome
  • celiac disease
  • gallstones
  • hernia
  • fluid in the abdomen, or ascites
  • pancreatic insufficiency
  • panic disorder
  • anxiety disorder
  • hyperventilation
  • excessive air swallowing, or aerophagia
  • cystic fibrosis
  • COPD
  • peripheral neuropathy
  • Legionnaires’ disease
  • polio
  • ovarian cancer
  • non-Hodgkin lymphoma

People with an underlying medical condition might experience additional symptoms. The exact symptoms will depend on the condition.

Some general symptoms that may accompany breathing difficulties include:

  • coughing
  • wheezing
  • excessive mucus
  • lightheadedness
  • fatigue

Some general symptoms that may accompany abdominal bloating include:

  • indigestion
  • burping
  • flatulence
  • abdominal pain
  • constipation or diarrhea
  • mucus in stool

There are many conditions that could cause both bloating and shortness of breath. People who are not sure of the cause of these symptoms should consult their doctor as soon as possible.

July 29, 2008— — “Time is brain.”

The phrase is repeated like a mantra in the halls and classrooms of medical schools and hospitals throughout the country. The reminder to young trainees is that time is of the essence; the faster a diagnosis is made and treatment initiated, the less damage will have occurred.

Yet it is often the minutes and hours before a patient decides to seek medical attention that play the largest role in the ultimate outcome. Any doctor will tell you that, given the presence of certain concerning symptoms, “watchful waiting” is never the right approach.

Dr. Richard O’Brien, spokesperson for the American College of Emergency Physicians, says he often sees patients who have put off their trip to the emergency room for hours or days, ignoring worrisome symptoms. In many cases, these individuals had major symptoms which resolved. They ultimately seek help when the same symptoms return and don’t go away, he says.

But why wait? It turns out that there are a number of barriers to keep people from seeking medical attention when they need it most — such as concerns about missing prior obligations, high hospital bills, or inconveniencing others.

There’s no doubt that going to the emergency room is inconvenient, both for the patient and those accompanying them. Often, says O’Brien, people end up waiting “because they don’t want to bother anyone, especially their families.”

Besides, if given the choice, few people would spend a nice Sunday afternoon in the emergency room.

However, often it is a simple unawareness of the gravity of the situation that keeps people from seeking medical care. The key is to know those symptoms that are worrisome and require prompt evaluation.

Paying Attention to the ‘Red Flags’

While crushing chest pain is hard to ignore, many concerning symptoms are not as obvious. So, what are those symptoms that represent something potentially serious, something that shouldn’t wait until morning, or even until the end of the Red Sox game?

Some of the most important symptoms are those that portend the future — they can be thought of as “red flags” that are letting us know that something is brewing.

For example, strokes are often preceded by a TIAs, also known as a “mini-stroke.” In these cases, people experience neurologic symptoms — such as weakness, difficulty speaking, blurry vision, or confusion — that resolve spontaneously.

“TIA is a warning sign of impending stroke and should be taken seriously as an opportunity to stop a massive stroke in its tracks,” says Dr. Wendy Wright, an intensive care neurologist at Emory University Hospital. She has had numerous patients who had symptoms and then went to bed or took a nap to literally try to “sleep it off,” often with disastrous results, later waking up with irreversible neurologic damage.

“It is a tragedy to think that something could have been done in the meantime,” she says.

Sometimes, however, it is the combination of seemingly benign symptoms that is enough to raise red flags in doctors’ minds. You may wonder why, when you tell your doctor about your screaming headache, he or she asks you about vomiting, fevers, your eyes, and your home heating system. They are doing this for a very specific reason. When certain symptoms occur together, different diagnoses may pop to the top (or bottom) of the list of possibilities in your doctor’s mind.

This thought process can be seen at play for those diagnosed with carbon monoxide poisoning. Individuals exposed to the gas often present with a staggering variety of seemingly vague symptoms, including headache, vomiting and abdominal pain. As a result, affected individuals can easily be misdiagnosed with a viral illness or food poisoning.

Dr. Eric Lavonas, associate director of the Rocky Mountain Poison and Drug Center in Denver, says he becomes suspicious when he sees flu-like symptoms either in multiple family members or in patients without fever. He and other doctors are able to make the right diagnosis by recognizing the combination of symptoms, as well as asking the right questions.

To further complicate the issue, people often present “atypically,” meaning that the symptoms they experience may be different than the textbook example.

“There is the classic misconception of the ‘Hollywood heart attack,'” says Dr. Christopher Cannon, cardiologist and associate professor of medicine at Harvard Medical School. The stereotypical heart attack, he says, stems from what people see in the movies — a middle aged man suddenly clutches at his chest, complains of agonizing pain, then slumps to the floor.

However, most people with heart attacks actually describe a diffuse pressure or squeezing. Says Cannon, “A real heart attack is very subtle.”

Indeed, atypical presentations are often the ones that often stump doctors. When even those of us who have spent years learning to sniff out the atypical and esoteric get fooled, how can we expect the general population not to be fooled sometimes, as well?

Dr. Jesse Pines, an emergency medicine physician, advises that patients look to their primary physician for guidance on symptoms they should pay attention to, given their specific medical history and risk profile. “Because each patient’s situation is different, they should look to their regular providers for guidance on which symptoms should prompt seeking urgent medical care,” he advises.

Of course, good preventive and primary care is the best way to avoid the emergency room altogether. O’Brien emphasizes that regular primary care visits are part of the solution. Furthermore, he says, “Pay close attention to your body and make a serious effort to keep any medical problems you have under control.”

The ‘Red Flag’ Symptoms You Mustn’t Ignore

This list is not exhaustive, nor should it take the place of a doctor’s evaluation; it is purely meant to highlight some important symptoms that shouldn’t be ignored. As usual, it is best to consult with your own doctor, and seek medical attention if you are concerned.

1. Chest Pain

Discomfort that feels like squeezing, pressure, or heaviness;

Pain and sweating, nausea, or a feeling of dread;

Difficulty breathing ;

Any change in the pattern or frequency of your “normal” pain;

Pain or pressure that gets worse with exertion and improves with rest;

Pain associated with passing out or feelings of lightheadedness;

Pain or shortness of breath in anyone with a swollen or painful leg;

Feeling like your heart is fluttering or beating quickly.

2. Shortness of Breath:

Difficulty breathing that worsens when you lie flat or when you exert yourself;

Feeling like you are breathing faster than usual or are having difficulty talking;

Difficulty breathing that starts suddenly;

Worsening of formerly stable shortness of breath, such as is seen in an acute asthma attack;

Shortness of breath with fever;

Coughing up blood;

Difficulty breathing in anyone with a swollen or painful leg.

3. Symptoms of stroke or TIA

Any of these symptoms are concerning even if they are transient or improve;

Weakness, numbness, or inability to move any part of your body;

Any changes in vision, including double vision, blurry vision, or loss of vision;

Difficulty speaking ;

Confusion;

Feelings of dizziness, loss of balance, unsteadiness, or difficulty walking;

Recent head injury (such as a fall) or stroke;

Seizure.

4. Abdominal and Gastrointestinal Symptoms

Bloody stools or bloody diarrhea;

Diarrhea associated with severe abdominal pain;

New onset of constipation, or stools that look darker than normal;

Vomiting blood or vomit that looks like coffee grounds;

History of heavy alcohol use;

Vomiting or pain that is keeping you from taking your regular medications;

Abdominal pain associated with fever, vomiting, diarrhea, or lack of appetite;

Abdominal pain that becomes worse after meals;

Abdominal pain in the presence of chronic ibuprofen (or any other NSAID drug) or aspirin use;

Abdominal pain that starts suddenly;

Abdominal pain that doesn’t resolve;

Any of the above symptoms associated with a history of heavy alcohol use.

5. Loss of consciousness or significant lightheadedness

Passing out associated with chest pain, palpitations, abdominal pain, shortness of breath, or headache;

Passing out associated with the presence of any symptoms concerning for stroke or TIA;

Passing out without preceding warning symptoms;

Passing out during exercise.

6. Severe headache:

Headache that starts suddenly (you can pinpoint the exact moment your headache began), like a “thunderclap”;

Headache that you would describe as the “worst headache of your life”;

Headache associated with confusion, fever, stiff neck, vomiting, seizure, weakness, numbness, visual changes, or pain with chewing;

Recent trauma or fall.

7. Visual Changes

Double vision, blurry vision, or loss of vision (even if transient);

History of glaucoma;

History of diabetes, high blood pressure, or atrial fibrillation;

Changes in vision associated with severe eye pain, headache, scalp or jaw pain.

8. Allergic Reaction (Following an insect sting or ingestion of any substance such as a food or medication):

Feeling like it is difficult to breathe;

Hoarseness;

Swelling of lips, face, tongue, or throat;

Redness, rash or hives over the body.

9. Depression

Feeling that you want to hurt yourself or someone else;

History of abuse or feeling that you are unsafe at home;

Persistent sadness;

Loss of interest in normal activities;

Increased use of alcohol or substances.

10. Back pain:

Incontinence or retention of stool or urine;

Weakness or numbness of your legs or groin area;

Persistent pain that comes on with no history of falls or other trauma;

History of osteoporosis;

History of cancer;

Back pain associated with fever;

Back pain associated with burning or painful urination.

PMC

Discussion

Pulmonary artery sarcomas include two types, intimal sarcomas presenting as intraluminal growing excrescences and mural sarcomas involving the pulmonary artery wall, with intraluminal involvement rather than intraparenchymal infiltration.5 PAIS arise predominately in the right pulmonary vessels rather than the left.4 The definitive diagnosis of PAIS is considered to be difficult and based on pathological examination findings, and specimens are usually obtained from surgery or autopsy. Intimal sarcomas have an unknown cell of origin and usually show undifferentiated cells with variable immunophenotyping.6 The true incidence of this malignancy is unknown, and the natural course of this orphan disease remains unclear. Metastases of PAIS occurs commonly; direct infiltration or lung metastases have been reported in 40% of affected patients while extrathoracic spread has been observed in approximately 16%–20% of cases,1,7 involving the lungs, lymph nodes, adrenals, thyroid, brain, liver, pancreas, kidneys, muscles, and skin. Metastatic disease is associated with poor prognosis.

Patients with PAIS generally have a slowly progressive course over weeks to months,8,9 manifesting with a variety of cardiopulmonary complaints, atypical symptoms such as dyspnea, chest pain, back pain, cough, hemoptysis, shortness of breath, malaise, or fatigue have been reported. Clinical findings include right ventricular dysfunction, pulmonary hypertension, and pulmonary insufficiency. Multiple gastrointestinal disturbances were typical in patients with advanced cancer, and diarrhea was more common in women than men.10,11 In the present case, the initial symptom was diarrhea associated with abdominal pain, presenting as digestive tract congestion. Nevertheless, the digestive discomfort was intermittent for more than 10 years. Her digestive complaints were rare in primary nongastrointestinal stromal tumor soft-tissue sarcomas (STS). Schwenk et al12 reported a case of primary hemangiosarcoma of the adrenal who presented with diarrhea as initial manifestation. Foale et al13 reported a dog that presented with chronic diarrhea and was diagnosed with left ventricular myosarcoma – symptoms disappeared after surgery. To our knowledge, no study has reported diarrhea as initial manifestation of PAIS before. Paraneoplastic syndromes (PNS) secondary to mesodermal tumors are relatively uncommon. We excluded causes such as gastrointestinal tumor and infectious pathogens. Furthermore, as the patient’s gastrointestinal symptoms improved after PEA, we supposed that the patient’s chronic diarrhea could be considered as PNS. The advanced tumor caused pulmonary hypertension and right ventricular dysfunction, resulting in digestive tract congestion and presenting as exacerbation of diarrhea. Further studies would be useful to explore the underlying mechanisms of PNS in PAIS.

PAIS often masquerades as other pulmonary vascular diseases because of their similar clinical manifestations and radiologic appearance. At this point, clinicians must pay attention to symptoms that are not commonly associated with pulmonary vascular diseases such as weight loss, anemia, fever, malaise, or fatigue, which are symptoms commonly associated with malignancy. Unheralded or recurrent PE should also raise the possibility of a malignancy as the underlying cause. Contrast-enhanced CT or CTPA is usually applied as the primary image modality in the differential diagnosis of PAIS. The CT characteristics indicative of sarcoma are unilateral, lobulated, heterogeneously enhancing intravascular masses. Gan et al14 reported that the wall eclipsing sign on contrast-enhanced CT was pathognomonic for PAIS. Positron emission tomography-CT or magnetic resonance imaging is also useful for distinguishing tumors from thrombi. Clinicians ought to consider the possibility of alternative diagnoses as well as PE in patients with pulmonary infarction. The absence of predisposing factors for PE and the lack of response to anticoagulant or thrombolytic therapy are useful for differential diagnoses.

There were no standard therapeutic guidelines and there were few treatment options for the management of intimal sarcoma. PAIS is so rare that it has not been studied in large clinical randomized trials and the results vary in different subtypes of sarcomas. Surgical intervention is known to be the optimal treatment for patients with PAIS, and reported curative surgical procedures for treating the tumor include tumor endarterectomy, graft reconstruction of the pulmonary artery, and pneumonectomy.15 An analysis of 20 cases by Wong et al suggested that patients who underwent PEA had significant alleviation of symptoms, even though surgery did not result in a statistically significant survival benefit.16 Nonsurgical methods include chemotherapy, radiotherapy, and targeted therapy. Chemotherapeutic agents such as anthracyclines, ifosfamide, gemcitabine with docetaxel, and dacarbazine are recommended in advanced STS,17 but at the expense of toxicity and without a clear survival advantage. Radiotherapy, for instance, external beam radiation therapy, has been used to treat residual or unresectable intimal tumors.18 The development of targeted drugs such as sorafenib, bevacizumab, and sunitinib has provided opportunities to evaluate new agents in several specific STS subtypes. Sorafenib is a multi-targeted tyrosine kinase inhibitor used in patients with STS and the response rate to this drug was 14% in a Phase II trial.19 Cytotoxic chemotherapy in combination with targeted agents is considered in advanced STS. Sorafenib with dacarbazine was considered to be an active and safety regimen in patients with pretreated STS and a Phase II trial is ongoing in patients affected by selected sarcoma subtypes.20 Unfortunately, the role of this adjuvant therapy or combination therapy remains disappointingly controversial, and even with multimodality treatment, the prognosis for PAIS is dismal.8,21 Large clinical randomized trials and trials focusing on specific subtypes of sarcomas are expected in the future.

In conclusion, PAIS is a rare malignancy, and clinical manifestation is atypical and easily misdiagnosed. Clinicians must be aware of the presentation and imaging characteristics of this disease.

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