The diarrheal type is associated with a wide range of foods, has an 8.0- to 16-hour incubation time, and is associated with diarrhea and gastrointestinal pain. Also known as the 'long-incubation' form of B. cereus food poisoning, it might be difficult to differentiate from poisoning caused by Clostridium perfringens.[15] Enterotoxin can be inactivated after heating at 56 °C (133 °F) for 5 minutes however it is unclear whether its presence in food causes the symptom since it degrades in stomach enzymes; its subsequent production by surviving B. cereus spores within the small intestine may be the cause of illness.[17]
The 'emetic' form is commonly caused by rice cooked for a time and temperature insufficient to kill any spores present, then improperly refrigerated. It can produce a toxin, cereulide, which is not inactivated by later reheating. This form leads to nausea and vomiting one to five hours after consumption. It can be difficult to distinguish from other short-term bacterial foodborne intoxications such as by Staphylococcus aureus.[15] Emetic toxin can withstand 121 °C (250 °F) for 90 minutes.[17