Food Poisoning

Freddie Bwanga
M.B;Ch.B, M.Med (Microb), PhD Tues 24th Nov 2010

Definition Food poisoning

An illness caused by the consumption of food or water contaminated with bacteria and/or their toxins, or with parasites, viruses, or chemicals.

Characteristics of a food-borne disease outbreak:

Similar illness Often gastrointestinal Minimum of 2 people Evidence of food as the source

Symptoms - varying degree and combination

Abdominal pain Vomiting Diarrhea Headache Most illnesses are mild and improve without treatment. Some patients have severe disease and require hospitalization, aggressive hydration, and antibiotic treatment. More serious cases can result in life-threatening neurologic, hepatic, and renal syndromes leading to permanent disability or death.

Burden of Food Poisoning

Worldwide problem More common in developing countries CDC estimates in the United States:

76 million illnesses
325,000 hospitalizations 5,000 deaths each year Travelers to developing countries often encounter food poisoning in the form of traveler's diarrhea Terrorist can use food toxins as weapon

Causes food Poisoning1

1. Pathogens causing non-inflammatory diarrhea (NID)

Bacteria:

Vibrio cholerae, Enterotoxic Escherichia coli Clostridium perfringens Bacillus cereus Staphylococcus aureus.

Viruses:

Rotavirus, Giardia lamblia Norovirus (genus Norovirus, previously Cryptosporidium called Norwalk virus), and Adenovirus.

Parasites:

NID is due to the action of enterotoxins on the secretory mechanisms of the mucosa of the small intestine, without invasion.
Large volume watery stools +- profound dehydration No blood or pus in stool No severe abdominal pain The enterotoxins may be either preformed before ingestion or produced in the gut after ingestion. Organisms involved

In some types of food poisoning (eg, staphylococci, B cereus), vomiting is caused by a toxin acting on the central nervous system. The clinical syndrome of botulism results from the inhibition of acetylcholine release in nerve endings by the botulinum.

Causes food Poisoning..2

2. Pathogens causing Inflammatory diarrhea (ID)

Bacetria:

Campylobacter jejuni, Vibrio parahaemolyticus, Enterohemorrhagic and Enteroinvasive E coli Yersinia enterocolitica, Clostridium difficile, Salmonella Shigella

Parasites

Entamoeba histolytica, and

ID Charcterstics

Mucosal invasion & destruction Colon or the distal small bowel commonly involved Patients usually febrile and may appear toxic. Diarrhea stool: small vol, usually bloody, mucoid & leukocytes +ve Dehydration is less likely because of smaller stool volumes. Organisms may penetrate the mucosa and proliferate in the local lymphatic tissue, followed by systemic dissemination. ,

Causes food Poisoning3

3. Non-Infectious causes
Mushrooms Toadstools Heavy metals [eg, arsenic, mercury, lead]) For these non infectious causes, the pathophysiological mechanisms that result in acute gastrointestinal symptoms are not well known.

Suspicion of causative agent

Indicator /Symptom Vomiting A profuse rice-water stool Painful abdominal muscle cramps Bloating Severe Abdominal pain Symptoms similar to those of appendicitis Proctitis syndrome ie Frequent painful bowel movement Stool contains blood, pus, and mucus. Tenesmus and rectal discomfort Undercooked meat/poultry Raw seafood Homemade canned foods Unpasteurized soft cheeses Deli meats notoriously unpasteurized milk or juice Raw eggs Reactive arthritis Suspected cause

Staphylococcus aureus, B cereus, Norovirus]

Cholera Giardiasis Inflammatory processes Yersinia enterocolitis Shigellosis (dysentry)

Salmonella, Campylobacter, Shiga toxin E coli, C perfringens.

Norwalk-like virus, Vibrio organism , Hepatitis A.

C botulinum Listeria, Salmonella, Campylobacter, Shiga toxin, E coli, Yersinia.

Listeriosis Campylobacter, Salmonella, Shiga toxin E coli, and Yersinia.

Salmonella
Salmonella, Shigella, Campylobacter, and Yersinia infections.

When To Seek Medical Care

Nausea, vomiting, or diarrhea lasts for more than two days. Younger than three years. The abdominal symptoms are associated with a low-grade fever.

Symptoms begin after recent foreign travel.

Other family members or friends who ate the same thing are also sick. The ill person cannot keep any liquids down. Immunosuppressive conditions (e.g. HIV/AIDS, cancer and undergoing chemotherapy, kidney disease). Nervous system symptoms e.g. slurred speech, muscle weakness, double vision, or difficulty swallowing.

Signs of emergence
Patient collapses, become dizzy, lightheaded, or have problems with vision, speech or swallowing T >39C occurs + abdominal symptoms Sharp or cramping pains do not go away after 10-15 minutes Swollen abdomen The skin and/or eyes turn yellow Vomiting blood or having bloody bowel movements

Oligouria/anuria, or have dark urine

Difficulty or rapid breathing One or more joints swell or a rash breaks out on the skin Patient or caretaker considers the situation to be an emergency

Prevention of Food Poisoning 1

Safe food preparation Keep everything clean! Wash hands after the toilet, and before touching foods/utencils/cutlery Wash hands before and after handling raw meat and poultry

Sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart of water
Do not cross-contaminate. Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.

Prevention of Food Poisoning 2

Safe cooking Through cooking of meats/poultry before eating Keep hot foods hot and cold foods cold. Use cooked leftovers within four days. Microwave: Cook meat and poultry immediately after microwave thawing.

Prevention of Food Poisoning 3

Safe shopping Buy cold foods last during your shopping trip. Get them home fast. Never choose torn or leaking packages. Do not buy foods past their "sell-by" or expiration dates. Keep raw meat and poultry separate from other foods. Safe storage of foods Keep it safe; refrigerate. Unload perishable foods first and immediately refrigerate them. Place raw meat, poultry, or fish in the coldest section of your refrigerator. Check the temperature of your appliances. To slow bacterial growth, the refrigerator should be at 2-8oc, the freezer at minus 20C. Cook or freeze fresh poultry, fish, ground meats, and variety meats within two days.