Food poisoning is an acute gastro-enteritis

caused by ingestion of food or drink

contaminated with either living bacteria or
their toxins or inorganic chemical substances
and poisons derived from plants and animals

Substances containing specific poisons like

eating fungi like Amanita phylloides instead
of edible mushroom
Food contaminated by poisons due to
agricultural or industrial activities
Foods infected with organisms mainly by
three bacterial groups-Salmonella,
Clostridium and Staphylococcus.

Bacteria or toxins

Staphylococcus
Bacillus cereus
Clostridium perfringens, botulinum
Salmonella typhimurium, cholera-suis, enteritidis
Shigella
Vibrio vulnificus, parahaemolyticus

Chemicals

Pesticides
Rodenticides
Fertilizers
Heavy metals

Agent

Source

IP

Mechanism Clinical features

Salmonella
typhimurium
cholera-suis
enteritidis

Meat, poultry,
12 milk &
24 h
products, eggs

Organisms
multiply in
intestine,
give rise to
enteritis,
colitis

Staph
aureus
enterotoxins

Skin, nose,
12
throat of food
36 h
handlers, boils,
pyogenic infns,
mastitis in
cows
contaminate
salads,
custards, milk

Ingestion of Sudden onset vomiting

intra-dietetic +++, abdominal cramps
toxins
+, diarrhoea +,
blood/mucus in severe
cases
NO FEVER

Sudden onset, chills,

fever +++, nausea
++,vomiting ++, profuse
watery diarrhoea +++ ,
abdo cramps ++ for 2-3 d
Mortality 1%

Comparison chart of common agents

Agent

Source

IP

Mechanism

Clinical features

Clostridium
perfringens

Meat, poultry,
eggs
(food cooked
24 h or more
before
consumption,
cooled slowly
and reheated

6 -24
h
(1014 h)

Spores survive
cooking, then
germinate at
cool temp.
Multiply when
reheated upto
50oC, produce
toxins

Diarrhoea +++,
abdominal cramps +++
Fever, nausea,
vomiting uncommon
Symptoms for short
duration

C
botulinum
Exotoxin
A,B, E

Soil, dust,
12
intestine.
36 h
Spores enter
home canned
foods, pickled
fish, home
made cheese
(low acid foods)

Ingestion of
intra-dietetic
toxins

Dysphagia, diplopia,
ptosis, dysarthria,
blurred vision,
quadriplegia. Fever
absent. Death 4-8 d
due to resp/cardiac
failure

Comparison chart of common agents

Agent

Source

IP

Mechanism

Clinical features

Bacillus
cereus

Soil, raw,
dried or
processed
foods
Rice

1-6 h
Emetic form
12-24 h
Diarrhoeal
form

Spores survive
cooking, then
germinate at
favourable temp.
Preformed toxins

Vomiting, nausea in
emetic form
Abdominal cramps,
diarrhoea, no fever
in diarrhoeal form

Ingested chemical
acts inside the body
depending on its
chemical structure

Depending on
chemical such as
organophosphates
Nausea/ vomiting
++, neuromuscular
symptoms +++

Chemica Pesticides Short, few

-ls
in contact min to hrs
with food

Comparison chart of common agents

Agent

Source

IP

Mechanism

Clinical features

Cholera

Contaminatio
n of water,
food

Few
hrs
5
days

Ingested vibrio acts on

wall on the intestinal
lumen and increases
water permeability by
AC-CAMP system

Onset with purging,

projectile vomiting,
rice watery stools,
marked
dehydration,
cramps ++, temp

Shigella Ingestion of
12-96 Ingested organisms
contaminated h
invade distal SI, colon.
food/water/pMucosal ulcerations,
to-p
colonic crypt
microabscesses

Nausea/ vomiting
+++, abdo
cramps+++, fever
+++, blood/mucus
in stools +++

Large number of people affected

History consumption of a common meal
Similar symptoms
Similar period of onset

Infective
Incubation period 12 24 hrs

Predominantly diarrhoea

Preformed toxin
Incubation period 1 6 hrs
Predominantly vomiting

Implicate the exact food item

Ascertain circumstances leading to its
contamination
Find the causative organism
Recommend measures to prevent recurrence

Epidemiological Investigation
Laboratory Studies
Circumstantial enquiry

Complete history of the outbreak

List of persons who consumed the meal
List of items served
Obtain history from each individual
Clinical examination of each individual
Tabulation of data
Calculation of attack rates
Deductions

FOOD & SICKNESS HISTORIES

Ser Name Illnes
s
No &
Parti Y/N
cular
s

Nause
a/
vomiti
ng

Diarr
hoea

Abdo
cram
ps

Fever Food
Mutton Dal
Item 1 curry
Matar
paneer

Rice

Alpha Y

Bravo N

Charli Y
e

SUMMARY OF LINE LIST

Those who ate
the item

Those who did not eat

the item

Food
item

Ill

Not
ill

Total

IE

Ill

Not
Ill

Tota INE
l

RR
IE/INE

AR
IE-INE

Mutton
curry

31

40

78%

42

47

11%

7.09

67%

Matar
paneer

30

31

61

49%

20

26

23%

2.13

26%

Moong dal

27

24

51

53%

27

36

25%

2.12

28%

Chapati

32

43

75

43%

12

33%

1.30

10%

Rice

34

46

80

43%

29%

1.48

14%

CALCULATION OF FOOD SPECIFIC ATTACK RATES

Food

Persons who ate the specific

item of food

Persons who did not eat

the specific item of food

Difference
between
attack rates

No. who
ate

No. ill

Attack No.
No. ill
rate % who
did not
eat

Attack
rate %

Mutton curry

109

80

73

21

14

66

-7

Dal

88

70

79

32

24

75

-4

Pulao (Rice)

95

76

80

25

18

72

-8

Raita (Curd)

98

84

85

22

-76

Potato-Pea curry

78

60

77

42

20

48

-29

Chatni(Pickle)

65

13

20

55

27

48

-28

Papad

60

10

60

24

40

-30

Sweet (Kheer)

110

77

75

10

60

-15

Some persons who ate the food were resistant to

the infectious agent and therefore remained
unaffected.
One item of food may be contaminated by traces
of another during preparation, storage, handling or
serving.
The history of the consumption of individual items
of food may be incorrect, due to lapses of memory
or misunderstanding

Bacteriological and chemical examination

Samples
Remnants of food articles
Faeces, vomitus

Viscera
Blood for culture and serology

Transportation
Sterile containers

Packed in Ice
Quickest route

Source of infection or contamination

Place of preparation
Source of supply
Handling
Time gaps
Food handlers
Water used
Utensils used

Objective - Why did this item get contaminated, to prevent

future recurrences
Detailed history of each ingredient of the food item taken

List the ingredients.

Where was each procured?
Hygiene at point of procurement?
Storage in cook house?
Sanitary conditions at the time of cooking?
Temperature achieved in initial cooking?
Whether cooked food was eaten hot and freshly cooked or
was it stored?
If stored at what temp and hygienic conditions?
Was it reheated before consumption? To what temp?

Meat/poultry should be taken from a butchery which is clean

Meat on hooves provided to units. Slaughtering at unit level
If slaughtering in morning the meat should be lunch dish and
not dinner dish
Meat dish should be last one to be cooked
All meals freshly cooked and served hot
No storage of cooked food unless essential. If stored, to be in
icebox >4 h
Cooked food item reheated to atleast 60oC prior to
consumption

Meat inspection ensured by trained staff

High standard of hygiene among food handlers including raw
food
Food handlers medically inspected regularly
Ready-to-eat foods not to be handled with bare hands
Time between preparation and consumption kept short
Importance of rapid cooling,storage and reheating
emphasised
Sanitation of workplace, utensils, storage area
Regular education of food handlers
Surveillance