food borne diseases and its prevention

8/14/2019 Food borne diseases and its prevention

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Definitions

Infection

Intoxication

Metabolic food

disorder

Allergy

Idiopathic illness

Foodborne disease is any

illness resulting from the

consumption of food

contaminated with one ormore disease-producing

agents. These include

bacteria, parasites, viruses,

fungi and their products as

well as toxic substances notof microbial origin.


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The Food and Drug

Administration (FDA) Ranking ofFood Hazards

ranking*

1. microbial contamination

2. naturally occurring toxicants3. environmental contaminants (e.g., metals

4. nutritional problems (i.e., malnutrition,undernutrition)

5. pesticide residues

6. food additives

*1 being most dangerous, 6 least dangerous


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Major identified foodborne pathogens,United States circa 2002

Bacterial: Bacillus cereus Brucella Campylobacter* Clostridium botulinum

Clostridium perfringens E. coliO157:H7* E. coli, non-O157 STEC* E. coli, other diarrheagenic* Listeria monocytogenes* Salmonella Typhi Salmonella non-typhoidal

Shigella Staphylococcus Streptococcus Vibrio cholerae, toxigenic*

Bacterial, continued: Vibrio vulnificus* Vibrio, other* Yersinia enterocolitica*

Parasitic: Cryptosporidium* Cyclospora* Giardia* Toxoplasma* Trichinella

Viral: Norwalk-like viruses* Rotavirus* Astrovirus* HepatitisA

* Recognized as foodborne in last 30 years (Zoonotic reservoir)

Prions*


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1. Bacterial foodborne infection Disease-causing organism is carried by food or water into the

host While infection occurs inside the body, there is lag-time:

onset time = time from infection to appearance ofsymptoms

Fever usually appears Possibly nausea, headaches, vomiting and chills

2. Bacterial foodborne intoxication (poisoning)

Organisms multiply to great numbers within the food productand then produce toxin in the process.

If enough quantities of the toxin are ingested, itll override thebodys immune system and cause illness.

Faster acting than food infections NO fever usually (toxin acts immediately on the body)

Vomiting may result

Classification of Foodborne Illness


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1. Exotoxins

Released by the bacteria when they are alive and growing

Endotoxins Released by the bacteria after they die

1. Enterotoxins Toxins that develop in the gastro-intestinal tract

Classification of Food Poisoning Toxins

Toxins may be:1. Heat stable hot temp. does not alter the toxin chemical

e.g. Staphylococcus aureus toxin

2. Heat labile hot temp. alters the toxin protein which getdeactivated

e.g. Clostridium botulinum toxin


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Food poisoning: Notifications and laboratoryreports, 1995-2005, Northern Ireland

0

500

1000

1500

2000

2500

1995 1996 1997 1998 1999 2000 2001 2002 200 2004 2005

Year

Numberofnotifications/lab

reports

Campylobacter sp Cryptosporidium sp Salmonella sp Food Poisoning Notifications


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Laboratory reports ofClostridium difficiletoxin (all speci en types), 1995 2005,

Northern Ireland

0

200

00

00

00

10001200

1 00

1 00

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


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Laboratory reports ofClostridiumperfringens (all speci en types), 1995

2005,Northern Ireland

0

5

10

15

20

25

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


10/181


11/181

Laboratory reports ofCryptosporidium sp(all speci en types),

1995 2005, Northern Ireland

050

100

150

200

250

00

50

00

50

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


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Laboratory reports ofEscherichia coliO15(all speci en types),


0

10

20

0

0

50

0

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


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Laboratory reports ofGiardia lamblia(all speci en types),


0

10

20

30

0

50

0

1995 199 199 199 1999 2000 2001 2002 2003 200 2005

ear

N

berofLab

e

ports


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Laboratory reports ofListeria sp(all speci en types),


0

1

2

4

5

6

7

1995 1996 1997 1998 1999 2000 2001 2002 200 2004 2005

ear

Nu

berofLab

eports


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Laboratory reports of Rotavirus(all speci en types),


0

100

200

00

00500

00

00

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

Nu

berofLabReports


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Laboratory reports ofSalmonella sp,1995-2005, Northern Ireland

0

100

200

00

00

500

00

00

00

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLabR

eports

Salmonella (total)

S. enteritidis

S. typhim rium


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Laboratory reports ofSalmonella sp(all speci en types),


0

100

200

00

00

50000

00

00

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


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Laboratory reports ofSalmonella enteritidis(all speci en types),


0

100

200

00

00

500

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


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Laboratory reports ofSalmonellatyphimurium (all speci en types),


0

50

100

150

200

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

berofLab

eports


21/181

Laboratory reports ofSalmonellatyphimurium DT 10 (all speci en types),


0

20

0

0

0

100

120

1 0

1 0

1995

199

199

199

1999

2000

2001

2002

200

200

2005

ear

N

berofLab

eports


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Laboratory reports ofShigella sp(all speci en types),


0

50

100

150

200

250

00

1992

199

199

1995

199

199

199

1999

2000

2001

2002

200

200

2005

ear

N

berofLab

eports


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Laboratory reports of Norovirus(all speci en types),


0

50

100

150

200

25000

50

00

50

1995 199 199 199 1999 2000 2001 2002 200 200 2005

ear

N

u

berofLab

eports


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Outbreaks vs. Cases

Foodborne disease outbreak: an incident inwhich two or more persons experienced a

similar illness after ingestion of a commonfood, and epidemiologic analysis implicateda food as the source of illness.

Foodborne disease case: one individualexperiences illness after ingestion of anepidemiologically incriminated food.


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Estimatesofthe yearly incidenceof

foodborneillness

The estimates vary greatly but thought to be

around 76 million cases per year

Cost estimates range from $523 billion per

year

High cost due to many factors:

medical care, investigation of illness, loss of

productivity, loss of business, legal activities


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Informationreported toand compiled by

the CentersforDisease Control (CDC)

Outbreaks of known etiology = where laboratory evidence

indicated a specific agent

Outbreaks of unknown etiology = where epidemiologicalevidence implicated foodbornetransmission, but the etiological agent

was not identified.4 subgroups based on incubation period:

< 1 hr = probable chemical poisoning

1 7 hr = probable Staphylococcus aureuspoisoning

8 14 hr = probable Clostridium perfringens foodpoisoning

> 14 hr = probably other infectious/toxic agents

Outbreaks of known vehicle =a particular food item was associatedwith the illness


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Numberofreported foodborne-diseaseoutbreaks, cases, and

deaths, by etiology United States, 19931997

Bacterial 655 (23.8) 43,821 (50.9) 28 (96.6)

Chemical 148 (5.4) 576 (0.7) 0 (0)

Parasitic 19 (0.7) 2,325 (2.7) 0 (0)

Viral 56 (2.0) 4,066 (4.7) 0 (0)

Confirmed etiology878 (31.9) 50,788 (59.0) 28 (96.6)

Unknown etiology1,873(68.1) 35,270 (41.0) 1 (3.4)

Total 199319972,751(100.0) 86,058(100.0) 29 (100.0)

No. (%) No. (%) No. (%)

Outbreaks Cases Deaths

ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm


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Infection with a variety of different pathogens

Illness ay occur in large focal outbreaksMost illness is sporadic: either individual cases or

part of unrecognized dispersed outbreaks

Reservoir: locus of sustained trans ission and

persistence So e have a hu an reservoir: Shigella, hepatitis A, Norwalk

virus

So e have an ani al reservoir: Salmonella, Campylobacter,E. coliO15 :H , Listeria, Vibrio, Yersinia, Toxoplasma

Often trans itted by several different pathways Specific foods, water, direct contact with ani als, direct

contact with hu ans

Foodborne diseases


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Estimated illnessesforknown

foodborne pathogens, United States

Disease or agent Estimated total cases

Bacteria 5,204,934

Parasites 2,541,316

Viruses 30,883,391

Grand Total 38,629,641

ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V.

Tauxe. Food-related illness and death in the United States.Emerging Infectious Diseases 5(5):607625

(1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm


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Each year an esti ated illion cases 1 in four A ericans gets a foodborne illness each

year

1 in 1000 A ericans is hospitalized each year $ .5 billion in edical and other costs

Prevention depends on efforts fro far totable to reduce conta ination of food

Public health burden of foodborne

disease


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199 Esti ate: each year an esti ated illioncases*

1 in four A ericans gets a foodborne illness eachyear

1 in 1000 A ericans is hospitalized each year

Prevention depends on efforts fro far to table toreduce conta ination of food

Healthy People Goals for 2010: 50% reduction fro199 baseline in incidence of infections with:

S

almonella Campylobacter E. coliO15 Listeria monocytogenes Outbreaks caused by Salmonella Enteritidis

Public health burden of foodborne disease

* Mead, EID 5:607, 1999


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Infection

Definition:

a disease state caused by the presence of

viable, usually multiplying organisms at thesite of inflammation

Bacteria - Salmonella, Campylobacter

Virus - hepatitis A, Norwalk virus Protozoa - Cryptosporidium, Cyclospora

other parasites - Trichinella spiralis


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Sources of Foodborne

Pathogens

You mean there are things on my hands that can

make people sick?


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O

verview

Microorganisms

Susceptible Populations Infectious Doses

Intoxication vs. Infection

Fungal Pathogens

Parasitic Pathogens

Bacterial Pathogens

Viral Pathogens


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Pathogenic Microorganisms Fungi

Parasites

Bacteria

Viruses


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Salmonella - salmonellosis Symptoms - 7-72 hrs

Livestock, poultry,

eggs, pets, wildanimals, people

Meat, poultry,

eggs/products,

unpasteurized dairy

Over 2000Salmonella

Grow well at 95o

F Healthy adults ingest

thousands to get ill;young children,

elderly - few cells Killed by heat if hotenough 150o F


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Eggs - Salmonella Enteritidis Uncracked shell eggs --- 3-7%

Transmission from hen to egg before egg is

laid

Processed foods pasteurized eggs required

examples:


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Campylobacter jejuni -

campylobacteriosis Sym headache, fever, abdominal pain,

recurring over several weeks

Anaerobic bacteria, no spores Source: livestock of various species

Foods: meat, poultry, unpasteurized dairy,

cross-contaminated foods

Very frequent cause of illness


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Escherichia coli O157:H7 First recognized in 1982

Infection and/or intoxication

Causes severe illness/kidney failure/death

Sym - ab pain, fever, cramps, nausea,bloody diarrhea - particularly harmful to

children, elders Secondary infections caused by

poor hand washing


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Source - intestinal tract of livestock, wild

game,

Food: ground beef, other undercooked

meats, apple cider, water


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Listeria monocytogenes -

Listeriosis Meningitis

Nausea, vomiting, headache in healthy

adults.

Miscarriage, stillbirth in pregnant women.

Retardation, meningitis, deaths in newborns


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1 day to 3 weeks

Source

Unpasteurized dairy; raw, soil-grown

vegetables may be contaminated; raw

meats and poultry, processed meats


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Viral Causes of FB

I


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Hepatitis A virus Sym - Fever, nausea, ab pain, fatigue,

jaundice, may be liver involvement

15-50 days onset

Source: human

Foods - Prepared salads, oysters/clams - raw

or slightly cooked

Does not reproduce in food


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Norwalk virus Sym - ab pain, vomiting, diarrhea, headache,

low grade fever

1-2 days for onset

Source - human

Does NOT reproduce in food

Virus particles stay viable a long time


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Intoxication Definition:

a disease state, caused by exposure to a

toxic chemical, that is not mediatedimmunologically and is not primarily the

result of a genetic deficiency.

Staphylococcal food poisoning, botulism Saxitoxin, ciguatera


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Foodborne Intoxications


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Staphphyloccus aureus - food

intoxication Bacteria secrete toxins into surrounding

food as they grow.

Bacteria killed by heat; but toxin is veryheat stabile

Sym.- nausea, vomiting, diarrhea, cramps,dehydration, prostration.

1-7 hours after eating toxin in food - FAST


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Source - people !

40 - 50 % of all healthy adults are carriers.

Found in nasal passage, cuts, wounds, boils,acne,skin.

Foods: ham, chicken and

potato salads, cream fillings good places forbacteria to grow and produce toxin

Under what conditions?


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Clostridium botulinum - botulism Rare but very serious, often fatal or long-term

recovery.

Symptoms: double vision, constipation; difficulteye movement, swallowing, speech, loss ofautonomic nervous system function

Sporeforming, anaerobic - organism becomesvegetative and produces toxin

Vegetative and spore forms found in soil, water,intestinal tracts of animals, fish


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Processed Foods

Improperly canned low acid meats,

vegetables

Smoked, vacuum-packed fish

Other improperly prepared and held,

modified - atmosphere packaged


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Clostridium perfringens Toxin-mediated infection - organisms eaten

in food, stay in intestine and produce toxin

Mild illness

Sym 8-22 hours

Source- soil, dust, human and animal feces

Foods - cooked meats, chili, stews, poultry,

gravies, baked beans, other thick dishes


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Foodborne Diseases

Infections

PoisonousAni

alTissues

PoisonousPlant

Tissues

Che

icalPoisoning

Intoxications

MicrobialIntoxications

Other Neurotoxins Enterotoxins

Toxicoinfection Invasive Infection

IntestinalMucosa

Syste

ic Other Tissues or

Organs(Muscle,

Liver, Joints,Fetus, Other)

Mycotoxins(FungalToxins)

Algal Toxins BacterialToxins

Diarrhogenic Emetic Enterotoxins Neurotoxins Other


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Foodborne Diseases

InfectionsIntoxications

InvasiveInfection

IntestinalMucosa

Systemic OtherTissues or

Organs(Muscle,Liver,

Joints,Fetus,Other)

Other Neurotoxins Enterotoxins

Toxicoinfection


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Foodborne Diseases

Diarrhogenic Emetic Enterotoxins Neurotoxins Other

Infections

PoisonousAnimalTissues

PoisonousPlant

Tissues

ChemicalPoisoning

Intoxications

MicrobialIntoxications

Mycotoxins(FungalToxins)

AlgalToxins

BacterialToxins


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Examplesoffoodborne

infections/intoxications

DiseaseR

eservoirBotulism food intoxication Soil contaminated foods

Campylobacteriosis Cattle, poultry, shellfish

Clostridium perfringens Soil contaminated foodsfood poisoning

Salmonellosis Animals and birds

Staphylococcal food poisoningHuman carriers

Vibrio parahaemolyticus Seafoodsinfection

Yersinia enterocolitica Animal intestines

infection


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Objectivesoffoodborne disease

surveillance

prevention and control:identification of contaminated products

knowledge of disease causation:observe the track record of various illness-causing agents

administrative guidance:assessment of trends to justify regulatorydecisions/actions


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Susceptible Populations

Elderly and infants

Pregnant women Impaired immune system (AIDS) Cancer patients Organ transplant recipients Predisposing illness (ex. alcoholism,

diabetes, cirrhosis of the liver)


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Infectious DosesMinimuminfectious dose (MID) notdetermined for most pathogens

Consumption of just a few (10-100)organisms in some individuals maycause disease (depends upon immunestatus)

High numbers (>106) of organisms maybe required to cause disease inhealthy adults


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Infection vs. Intoxication


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Examples of Foodborne Infection

Virus: Hepatitis A, Norwalk, Rotavirus

Bacteria: Salmonella spp., Vibrio spp.Campylobacterspp., Yersinia spp., Shigella spp.,Listeria monocytogenes

Parasite: Trichinella spiralis, Anisakis simplex,

Giardia duodenalis (protozoan)


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Foodborne Intoxication

occurs when food are ingested that containtoxins produced by bacteria or molds

toxins may be heat stable symptoms can occur within minutes to 15

hours after ingestion

symptoms may include headache, vomiting,

diarrhea, dehydration, intestinal cramping,weakness, blurred vision -->

paralysis/death (ex. C. botulinum); nofever


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Examples of Foodborne

Intoxication

Staphylococcus aureus

Bacillus cereus

Clostridium botulinum

Aspergillus flavus/parasiticus


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Foodborne Parasites

Trichinella spiralis

Giardia lamblia

Cryptosporidium parvum

Cyclospora


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Trichinella spiralis


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Giardia lamblia


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Giardia lamblia

Flagellated protozoan

Found in domesticated and wild animals,

humans, rodents, contaminated water supplies Foodborne infection-1 week

May require only 1 cyst to cause infection

Diarrhea


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Giardia lamblia

Associated foods: salads, water

Poor personal hygiene is responsible for

contamination of foods handled by infectedemployees


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Associated foods: water, vegetables treated with

animal manure

Poor personal hygiene is responsible for

contamination of foods handled by infected

employees


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Cyclospora


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Cyclospora

Unicellular parasite

Associated with contaminated water supplies,

human waste Foodborne infection-1 week

Symptoms: Watery diarrhea, explosive bowel

movements, stomach cramping, low grade fever


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Cyclospora

Associated foods: water, fruits and vegetables

treated with animal manure

Poor personal hygiene is responsible forcontamination of foods handled by infected

employees


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Bacterial Pathogens

Salmonella spp.

Listeriamonocytogenes

Campylobacter jejuni

E. coli O157:H7


Clostridiumspp.Aeromonasspp.Vibriospp.Yersiniaspp.Shigellaspp.


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BacteriaDifferentiated accordingDifferentiated accordingto ability to retainto ability to retainspecific stainsspecific stains

Gram Stain:Gram Stain:

GramGramPositivePositive

GramGramNegativeNegative


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Salmonella spp.


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Salmonellaspp.

Gramnegative, non-sporeforming, aerobic,motilerod

Found inanimals, man, soil, water, insects,raw meat, poultry, seafood, kitchens

Foodborneinfection; 1-2 days

As few as 20 cells-10,000 cells may causedisease(depends uponhost, age, etc).

Symptoms: Diarrhea, fever, vomiting,

severedehydration


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Salmonellaspp.

May causearthritis (3-4 weeks afterinfection)

Associated foods: undercooked poultryand meat, beef jerky, unpasteurized orcontaminated milk, salad dressings, creamfilled desserts, eggs, orangejuice


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Listeria monocytogenes


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Grampositive, non-sporeforming,facultativeanaerobe, motilerod

Found inintestinaltractsof man, birds, soil,silage, water, livestock, cold & dampareas

Survivesdrying, refrigeration, freezing,

and heattreatmentsFoodborneinfection; 3-70 days


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Symptoms: Diarrhea, meningitis,encephalitis, septicemia, miscarriages,

stillbirthsInfectivedosemay be


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Campylobacter jejuni


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Campylobacterjejuni

Gramnegative, non-sporeforming,motilerod

Microaerophilic-low oxygen

Found inman, animals (domesticandwild), birds, flies, water

Foodborneinfection; 2-5 days

As few as 400-500 cells causeinfection


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Escherichia coli O157:H7


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E. coli O157:H7

Gram negative, non-spore forming,aerobic, rod

Found in intestinal tracts of cattle,deer, birds, man

Foodborne infection; 3-4 days

Acid tolerant, heat tolerantSymptoms: bloody diarrhea, fever,severe cramping, HemolyticUremic

Syndrome (HUS)


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Staphylococcusaureus

Gram positive, aerobiccocci

Staph arefound in air, dust, sewage,

watermilk, food, equipment, animalsandhumans:skin, hair, nose, throat, opensores, boils, saliva

Transmitted tofoodsviahandling,coughing, sneezing, wiping


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Staphylococcusaureus

Foodborneintoxication;hours

Symptoms: Vomiting, abdominalcramping

Organism producestoxin in food

Toxin isheatstable

Associated foods:cured meatproducts,improperlycooled food products, salads

(ex. egg, tuna, chicken, potato, macaroni),crmefilled pastries, canned mushrooms


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Clostridium perfringens

Gram positive, sporeforming, anaerobic rod

Foundinsoil, intestinaltractsofmanandanimals

Foodborneinfection;8-22 hours;toxinisformedinthegut

Symptoms: Diarrhea, severedehydration,cramps


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Clostridium perfringens

Largenumberofcells(108) neededtocause

diseaseAssociatedfoods:temperatureabusedfoods, roastbeef, stews, meatgravy, poultry


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Clostridiumbotulinum

Grampositive, spore forming,anaerobic rod

Foundinsoil, water, animal, poultry,vegetables, shellfish, horses, fish

Foodborne intoxication; hours

Symptoms: Paralysis, blurredvision,death

Toxinissusceptible toheat

175F, 10 min


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Clostridiumbotulinum

Associatedfoods: honey, improperlycannedfoods, underprocessedor

temperature abusedfoods, stews,meat/poultry loaves;sausages, seafoodproducts, garlic-in-oil, liverpate,

smokedandsaltedfish, bakedpotatoes,pickledeggs


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Aeromonashydrophila

A h d hil


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Aeromonashydrophila

Gramnegative, non-sporeforming, aerobicrod

Foundinbrackishfreshwater, seafood, fish,salt water

Foodborneinfection

Symptoms: Waterydiarrhea, dehydration,septicemia

Associatedfoods: fish, shellfish, beef, pork,

lamb, poultry


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Vibriospp.


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Vibriovulnificus

Gramnegative, non-spore forming,aerobicrod

Found infresh and salt water,plankton, shellfish, brackish lakes

Foodborne infectionorentersvia

wound (shucking oysters, stepping onshell, etc).


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Vibriovulnificus

Symptoms: Diarrhea, septicemia,septicshock, death

Associated foods:raw, undercooked,orcontaminated oysters, clams, crabs


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Yersiniaenterocolitica


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Gram negative, non-spore forming, aerobicrod

Found in domestic and wild animals, pigs,ponds, lakes, birds, beavers

Foodborne infection

Symptoms:Diarrhea, cramps, nausea,vomiting, fever, severe abdominal pain(mimic appendicitis), septicemia

Yersinia enterocolitica


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Associated foods: pork, beef, lamb, oysters,

fish, raw milk, chocolate milk, tofu,

chitterlings

Yersinia enterocolitica


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Shigellaspp.


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Viruses

Hepatitis A

RotavirusNorwalk


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Hepatitis A


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Hepatitis A

AKA: type A viral hepatitisExcreted in feces of infected employeesFoodborne infection (10 to 50 days)Infection may occur with approximately 10-

100 virus particlesSymptoms: Fever, malaise, nausea,

abdominal discomfort, jaundiceAssociated foods: delimeats, salads,beverages, sandwiches, fruits, dairy

products


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Hepatitis A

Poor personal hygiene is responsible forcontamination of foods handled byinfected

employees


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Rotavirus

AKA:Viral gastroenteritisExcreted in feces (108-10) of infected

employees; found in fecally contaminatedwater suppliesFoodborne infection (1-3 days)Symptoms:Vomiting, diarrhea, dehydration

Poor personal hygiene is responsible forcontamination of foods handled byinfectedemployees


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NorwalkVirus

AKA= Norwalk-like virus, viralgastroenteritisFound in contaminated water supplies;contaminated shellfish beds, cruise shipsFoodborne infection: 1-2 daysSymptoms: Nausea, vomiting diarrhea,

abdominalpain, low grade feverPoor personal hygiene is responsible forcontamination of foods handled byinfected

employees


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BotulismBotulinim toxin


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History

Neurologic disease from botulinum toxin

Most lethal substance known

History as bioweapon


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History



History as bioweapon Japanese in WWII (Unit 731)


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History




Former US and USSR programs


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History





Iraqi deployed weapons


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History





Iraqi deployed weapons Japanese cult in early 1990s


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Epidemiology

Found worldwide

U.S. incidence

~100 cases annually (1/4 foodborne)


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Epidemiology

Mechanisms of intoxication

No person-to-person transmission


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Epidemiology



Toxin ingestion (foodborne)


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Epidemiology




Toxin generated from wound infection (wound)


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Epidemiology





Toxin from intestinal colonization (infant, intestinal)


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Epidemiology





Toxin from intestinal colonization (infant, intestinal)

Toxin inhalation (aerosol release)

Mortality


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Microbiology



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Microbiology


Large, anaerobic Gram positive bacillus

Spore-forming

i bi l


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Microbiology



Spore-forming

Rarely infects humans

i bi l


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Microbiology



Spore-forming


Produces potent neurotoxin

7 types (A-G)

Mi bi l


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Microbiology



Spore-forming


Produces potent neurotoxin 7 types (A-G)

Types A, E, B most common in U.S.

Mi bi l


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Microbiology



Spore-forming


Produces potent neurotoxin 7 types (A-G)

Types A, E, B most common in U.S.

Same general mechanism


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Arnon S, et al. JAMA. 2001;285:1059-70.

Clinical Features


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Clinical Features

Incubation 12-72 hours

Probably faster if inhalational exposure

Clinical Features


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Clinical Features

Classic syndrome

Clinical Features


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Clinical Features

Classic syndrome

Acute symmetric cranial nerve palsies

Clinical Features


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Clinical Features

Classic syndrome


Blurry vision, ptosis, dysphasia

Clinical Features


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Clinical Features

Classic syndrome



Descending flaccid paralysis

Clinical Features


149/181

Clinical Features

Classic syndrome



Descending flaccid paralysis Complete skeletal muscle paralysis

Clinical Features


150/181

Clinical Features

Classic syndrome




Respiratory (ventilatory) failure

Clinical Features


151/181

Clinical Features

Classic syndrome





Autonomic urinary retention, orthostasis

Clinical Features


152/181

Clinical Features

Classic syndrome





Autonomic urinary retention, orthostasis

Afebrile, normal mentation

Clinical Feat res


153/181

Clinical Features

DifferentialDiagnosis

Clinical Features


154/181

Clinical Features


Myasthenia Gravis anticholinesterase response

Clinical Features


155/181

Clinical Features



Guillaine-Barre Syndrome - ascending


156/181

Clinical Features


157/181

Clinical Features




Stroke

asymmetric, abnormal brain imaging

Tick paralysis ascending, presence of tick

Clinical Features


158/181

Clinical Features




Stroke

asymmetric, abnormal brain imaging

Tick paralysis ascending, presence of tick

Poliomyelitis asymmetric, preceding viral illness

Clinical Features


159/181

Clinical Features

Otherfeatures

Foodborne nausea, diarrhea, dry mouth

Clinical Features


160/181

Clinical Features

Otherfeatures

Foodborne nausea, diarrhea, dry mouth

Infant- constipation

Diagnosis


161/181

Diagnosis

Highindexofsuspicionnecessary

No readily available rapid confirmatory tests

Diagnosis


162/181

Diagnosis

Highindexofsuspicionnecessary

No readily available rapid confirmatory tests

Clinical diagnosis

Diagnosis


163/181

Diagnosis

Laboratory confirmation

Specimensblood, stool

At reference labs

Mouse bioassay

ELISA

Treatment


164/181

Treatment

Supportivecare

Treatment


165/181

Treatment

Supportivecare

Mechanical ventilation, nutritional support

Prevention of secondary infections

Treatment


166/181

Treatment

Supportivecare

Mechanical ventilation, nutritional support

Prevention of secondary infections

Avoid aminoglycosides, clindamycin

Treatment


167/181

Treatment

Passiveimmunization (antitoxin)

Treatment


168/181

Treatment


Halts paralysis, doesnt reverse

Treatment


169/181

Treatment



Must be given ASAP

Treatment


170/181

Treatment



Must be given ASAP

Equine antitoxin (Types A, B and E toxins) Serum sickness (9%), anaphylaxis (2%)

Treatment


171/181

Treatment



Must be given ASAP

Equine antitoxin (Types A, B and E toxins) Serum sickness (9%), anaphylaxis (2%)

Heptavalent antitoxin (Types A-G) Investigational, less hypersensitivity

Post-Exposure Prophylaxis


172/181

Post Exposure Prophylaxis

Antitoxin not recommended

High incidence hypersensitivity

Limited supplies

Post-Exposure Prophylaxis


173/181

Post Exposure Prophylaxis

Antitoxin not recommended

High incidence hypersensitivity

Limited supplies

Clinical monitoring

Extreme vigilance for symptoms

At least 72 hours

Antitoxin immediately for any symptoms

Vaccination


174/181

Vaccination

Botulinum toxoid

No role for post-exposure prophylaxis

Immunity develops over months


175/181

Infection Control


176/181

Infection Control


Patient handling

Standard precautions Clinical specimens

Standard precautions

Metabolic food disorder


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Metabolicfood disorder

Definition:

a disease state caused by exposure to a

chemical that is toxic to certain individualsonly because they exhibit some genetic

deficiency

lactose intolerance

favism

Allergy


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Allergy Definition:

a disease state caused by exposure to a particular

chemical that (often proteinaceous) to which certain

individuals have a heightened sensitivity

(hypersensitivity) that has an immunological basis

proteins (heat resistant and resistant to digestion)

cows milk:F-lactoglobulin, casein, etc.

egg-ovalbumin

small molecules

penicillin

Idiopathicillness


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Definition:any illness of uncertain pathogenesis that may

possibly but not certainly be due to foods;

also, any food-caused illness that does not fitinto one of the other categories

Chinese restaurant syndrome

celiac disease

hyperkinesis

Foodborne diseases:Philosophy of prevention


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No vaccines formost of these pathogens

Educating consumers, foodhandlers and producers isimportant, but not sufficient

Groups at highest risk: oung children, elderly,immunocompromised

Contamination can occur from farm to table

Understand mechanisms of contamination well enough

to prevent it upstream from the consumer

Targets: Specific pathogen food combinations

The World HealthOrganizations

GoldenRulesfor SafeFood Preparation


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1. Choosefoods processed forsafety

2. Cookfood thoroughly

3. Eatcooked foodsimmediately.

4. Storecooked foodscarefully.

5.R

eheatcooked foodsthoroughly.6. Avoid contactbetweenrawand cooked foods.

7. Washhandsrepeatedly.

8. Keep allkitchensurfacesmeticulously clean.

9. Protectfoodsfrominsects, rodents, and otheranimals.

food borne diseases and its prevention

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