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Foodborne Diseases: Narciso Tapia, MD, Mhped, RMT
Foodborne Diseases: Narciso Tapia, MD, Mhped, RMT
FOODBORNE DISEASES
Foodborne disease
Caused by consuming contaminated foods or
beverages. Poisonous chemicals, or other harmful substances can cause foodborne diseases if they are present in food. Our focus is on those caused by organisms.
Foodborne disease
More than 250 different foodborne diseases
have been described. Most of these diseases are infections, caused by a variety of bacteria, viruses, and parasites that can be foodborne. Other diseases are poisonings, caused by harmful toxins or chemicals
Campylobacter
causes fever, diarrhea, and abdominal cramps. The most commonly identified bacterial cause of
diarrheal illness in the world. Live in the intestines of healthy birds Most raw poultry meat has Campylobacter on it. Eating undercooked chicken, or other food that has been contaminated with juices dripping from raw chicken is the most frequent source of this infection. Guillain-Barre syndrome can be caused by Campylobacter infection
Salmonella
is widespread in the intestines of birds, reptiles and mammals. can spread to humans via a variety of different foods of animal origin. Salmonellosis, typically includes fever, diarrhea and abdominal cramps. In persons with poor underlying health or weakened immune systems, it can invade the bloodstream and cause life-threatening
infections.
E.Coli O157: H7
has a reservoir in cattle and other similar
animals. Human illness typically follows consumption of food or water that has been contaminated with microscopic amounts of cow feces. The illness it causes is often a severe and bloody diarrhea and painful abdominal cramps, without much fever.
E.Coli O157: H7
In 3% to 5% of cases, a complication called
hemolytic uremic syndrome (HUS) can occur several weeks after the initial symptoms. This severe complication includes temporary anemia, profuse bleeding, and kidney failure.
Calicivirus
is an extremely common cause of foodborne
illness, though it is rarely diagnosed, because the laboratory test is not widely available. It causes an acute gastrointestinal illness, usually with more vomiting than diarrhea, that resolves within two days. Unlike many foodborne pathogens that have animal reservoirs, it is believed that Norwalklike viruses spread primarily from one infected person to another.
Calicivirus
Infected kitchen workers can contaminate a
salad or sandwich as they prepare it, if they have the virus on their hands. Infected fishermen have contaminated oysters as they harvested them.
foodborne illness
Foodborne diseases
Foodborne by direct infection Foodborne through toxin
presence of a toxin in the food that was produced by a microbe in the food. For example, the bacterium Staphylococcus aureus
a toxin that causes intense vomiting.
when the bacterium Clostridium botulinum grows and produces a powerful paralytic toxin in foods. These toxins can produce illness even if the microbes that produced them are no longer there.
What happens in the body after the microbes that produce illness are swallowed?
After they are swallowed, there is a delay, called
the incubation period, before the symptoms of illness begin. may range from hours to days, depending on the organism, and on how many of them were swallowed. During the incubation period, the microbes pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and begin to multiply there.
What happens in the body after the microbes that produce illness are swallowed?
Some types of microbes stay in the intestine, some produce a toxin that is absorbed into
the bloodstream, and some can directly invade the deeper body tissues.
The symptoms produced depend greatly on
contaminated food and two or more of them come down with the same illness.
happened to buy and eat the same contaminated item from a grocery store or restaurant.
temperature for many hours, allowing the bacteria to multiply to high numbers, and then be insufficiently cooked to kill the bacteria.
The symptoms and time of onset, and location of possible cases is determined, and a "case definition" is developed that describes these typical cases.
who fell ill A map of where the ill people live, work, or eat. Calculating the distribution of cases by age and sex shows who is affected. If the causative microbe is not known, samples of stool or blood are collected from ill people and sent to the public health laboratory to make the diagnosis.
the likely sources for the specific microbe involved, these hypotheses are then tested in a formal epidemiologic investigation.
interviews about a list of possible exposures with the ill persons, and with a comparable group people who are not ill. By comparing how often an exposure is reported by ill people and by well people, investigators can measure the association of the exposure with illness. Using probability statistics, the probability of no association is directly calculated.
food itself (if available) may provide additional information about the nature of contamination.
to culture all the leftover foods in the kitchen, and conclude that the one that is positive is the one that caused the outbreak.
Remember
Laboratory testing without epidemiologic
Even without isolating microbes from food, a wellconducted epidemiologic investigation can guide immediate efforts to control the outbreak.
intestinal contents.
looking egg can be contaminated with Salmonella even before the shell in formed. Oysters and other filter feeding shellfish can concentrate
Vibrio bacteria that are naturally present in sea water, or other microbes that are present in human sewage
agricultural product.
For example, Shigella bacteria, hepatitis A virus and Norwalk virus can be introduced by the unwashed hands of food handlers who are themselves infected.
A food that is fully cooked can become recontaminated if it touches other raw foods or drippings from raw foods that contain
pathogens.
contaminated can also make a difference in whether or not an outbreak occurs. Many bacterial microbes need to multiply to a larger number before enough are present in food to cause disease.
supply of nutrients, one bacterium that reproduces by dividing itself every half hour can produce 17 million progeny in 12 hours.
As a result, lightly contaminated food left out
Refrigeration or freezing
In general, refrigeration or freezing prevents
virtually all bacteria from growing but generally preserves them in a state of suspended animation. This general rule has a few surprising exceptions.
Two foodborne bacteria, Listeria monocytogenes
Heat
Microbes are killed by heat. If food is heated to an internal temperature
for the Clostridium bacteria, which produce a heatresistant form called a spore.
Heat
The toxins produced by bacteria vary in their
sensitivity to heat.
The staphylococcal toxin which causes vomiting is
not inactivated even if it is boiled. Fortunately, the potent toxin that causes botulism is completely inactivated by boiling.
raw shellfish.
Because filter-feeding shellfish strain microbes from the sea over many months, they are particularly likely to be contaminated if there are any pathogens in the seawater.
individual animals, are particularly hazardous because a pathogen present in any one of the animals may contaminate the whole batch.
such as bulk raw milk,
hundreds of animals.
from hundreds of chickens. A glass of raw milk may contain milk from hundreds of cows. A broiler chicken carcass can be exposed to the drippings and juices of many thousands of other birds that went through the same cold water tank after slaughter.
particular concern.
Washing can decrease but not eliminate
contamination. The quality of the water used for washing and chilling the produce after it is harvested is critical. Using water that is not clean can contaminate many boxes of produce.
also contaminate them. Unpasteurized fruit juice can also be contaminated if there are pathogens in or on the fruit that is used to make it.
Listeria monocytogenes Salmonella typhi Nontyphoidal salmonella Shigella sp. Staphylococcus aureus Streptococcus group A Vibrio cholerae, O1 or O139 Vibrio cholerae other serotypes Vibrio parahemolyticus Vibrio vulnificus Yersinia enterocolitica
globalization of food
supply and centralized processing of foods population growth and increased urbanization and crowding population movement due to civil wars, famines and other manmade or natural disasters
and reforestation projects that alter habits of disease-carrying insects Increased use of antimicrobial agents and pesticides, hastening the development of resistance Human habits and behavior
E. Coli O157:H7
Currently, there are four recognized classes of
enterovirulent E. coli (collectively referred to as the EEC group) that cause gastroenteritis in humans. Among these is the enterohemorrhagic (EHEC) strain designated E. coli O157:H7.
E. Coli O157:H7
E. coli serotype O157:H7 is a rare variety of
E. coli that produces large quantities of one or more related, potent toxins that cause severe damage to the lining of the intestine. These toxins [verotoxin (VT), shiga-like toxin] are closely related or identical to the toxin produced by Shigella dysenteriae.
Nature of disease
characterized by severe cramping (abdominal
pain) and diarrhea which is initially watery but becomes grossly bloody. Occasionally vomiting occurs. Fever is either low-grade or absent. The illness is usually self-limited and lasts for an average of 8 days. Some individuals exhibit watery diarrhea only.
Nature of disease
Infective dose -- Unknown, but from a compilation of outbreak data,
the dose may be similar to that of Shigella spp. (as
few as 10 organisms).
anemia.
symptoms, constitutes This illness can have a mortality rate in the elderly as high as 50%.
All people are believed to be susceptible to hemorrhagic colitis, but young children and the elderly appear to progress to more serious symptoms more frequently.
Associated food
Undercooked or raw hamburger (ground
in Canada.
Diagnosis
Hemorrhagic colitis is diagnosed by isolation
of E. coli of serotype O157:H7 or other verotoxin-producing E. coli from diarrheal stools. Alternatively, the stools can be tested directly for the presence of verotoxin. Confirmation can be obtained by isolation of E. coli of the same serotype from the incriminated food.
Food analysis
Unlike typical E. coli,
isolates of O157:H7 do not ferment sorbitol and are negative with the MUG assay; therefore, these criteria are commonly used for
selective isolation.
Sorbitol-MacConkey agar has been used extensively to isolate this organism from clinical specimens. Hemorrhagic colitis agar, a selective and
differential medium, is used in a direct plating method to isolate O157:H7 from foods.
Food analysis
A third procedure uses Sorbitol-MacConkey
medium containing potassium tellurite and Cefixime. It includes an enrichment step Rapid methods using a variety of technologies, including recombinant DNA methods, are being developed.
Yersinia enterocolitica
a small rod-shaped, Gram-negative bacterium, is often isolated from clinical specimens such as
wounds, feces, sputum and mesenteric lymph nodes. However, it is not part of the normal human flora. Yersiniosis is frequently characterized by such symptoms as
gastroenteritis with diarrhea and/or vomiting; however, fever and abdominal pain are the hallmark
symptoms.
Yersinia enterocolitica
Yersinia infections mimic appendicitis and
mesenteric lymphadenitis. Illness onset is usually between 24 and 48 hours after ingestion
Associated food
Strains of Y. enterocolitica can be found in
meats (pork, beef, lamb, etc.), oysters, fish, and raw milk.
Associated food
However, the prevalence of this organism in
the soil and water and in animals such as beavers, pigs, and squirrels, offers ample opportunities for it to enter our food supply. Poor sanitation and improper sterilization techniques by food handlers, including improper storage, cannot be overlooked.
Diagnosis
Stool culture is the best way to confirm a
diagnosis of Yersinia enterocolitica. The culture result is usually positive within 2 weeks of onset of disease. Instruct the laboratory to plate enteric specimens onto enteric media, with incubation at 25C for 48 hours.
Diagnosis
If Y enterocolitica is suspected,
cold enhancement techniques or cefsulodin-irgasan-novobiocin (CIN) agar should be
used.
Colonies deep red center with clear colorless zone, 1-2 mm in diameter
Diagnosis
Presumptive biochemical ID
LIA: alkaline/acid (no gas, H2S -negative) Urease -positive
Diagnosis
Other biochemical tests:
Lipase test. When grown on agar media containing egg yolk such as Anaerobic egg yolk agar, colonies may exhibit lipase activity. A positive reaction is indicated by oily, iridescent, pearl-like colony surrounded by precipitation ring and outer clearing zone.
Diagnosis
Identification
use of API 20 E system
Determination of pathogenicity is more
complex.
YERSINIA ENTEROCOLITICA
Pathogenicity testing
Pyrazinamidase test(PYZ)*
Congo Red Magnesium Oxalate (CR-MOX)*
Listeria monocytogenes
a Gram-positive bacterium, motile by means of flagella. Some studies suggest that 1-10% of humans may be intestinal carriers of L. monocytogenes. It has been found in at least
37 mammalian species, both domestic and feral, 17 species of birds and possibly some species of fish and shellfish.
Listeria monocytogenes
It can be isolated from soil, silage, and other environmental sources. is quite hardy and resists the deleterious
effects of freezing, drying, and heat remarkably well for a bacterium that does not form spores.
Listeria monocytogenes
some reports suggest that normal, healthy
Listeria monocytogenes
has been associated with such foods as
raw milk, supposedly pasteurized fluid milk, cheeses
(particularly soft-ripened varieties), ice cream, raw vegetables, fermented raw-meat sausages, raw and cooked poultry, raw meats (all types), and raw and smoked fish.
Listeria monocytogenes
The manifestations of listeriosis include
septicemia, meningitis (or meningoencephalitis), encephalitis, and intrauterine or cervical infections in pregnant
women,
which may result in spontaneous abortion (2nd/3rd trimester) or stillbirth.
Listeria monocytogenes
The infective dose of L. monocytogenes is
unknown but is believed to vary with the strain and susceptibility of the victim. From cases contracted through raw or supposedly pasteurized milk, it is safe to assume that in susceptible persons, fewer than 1,000 total organisms may cause disease.
Listeria monocytogenes
Food analysis complex and time consuming Identification based on: Gram stain, gray colonies with halo on PALCAM Hemolysis on BAP, narrow zone of beta hemolysis, Motilitytumbling motility, end to end with characteristic inverted test tube brush on semi solid agar Catalase positive Absence of hydrogen sulfide Hemolysis by CAMP test using test organisms Blue colonies by Henrys illumination API Listeria Serotyping: 1/2a, 1/2b and 4b commonly reported in outbreaks
PALCAM agar
Campylobacter jejuni
a Gram-negative slender, curved, and motile rod. It is a microaerophilic organism,
it has a requirement for reduced levels of oxygen.
It is relatively fragile, and sensitive to environmental stresses (e.g., 21% oxygen, drying, heating, disinfectants, acidic conditions). Because of its microaerophilic characteristics the organism requires
3 to 5% oxygen and 2 to 10% carbon dioxide for optimal growth
conditions.
Campylobacter jejuni
leading cause of bacterial diarrheal illness in
sticky and can contain blood (usually occult) and fecal leukocytes (white cells).
Campylobacter jejuni
Other symptoms often present are fever,
abdominal pain, nausea, headache and muscle pain. The illness usually occurs 2-5 days after ingestion of the contaminated food or water.
Campylobacter jejuni
The infective dose of C. jejuni is considered to
be small.
about 400-500 bacteria
in others, greater numbers are required.
completely understood, but it does produce a heat-labile toxin that may cause diarrhea. may also be an invasive organism.
Associated foods
frequently contaminates raw chicken.
20 to 100% of retail chickens are contaminated. This is not overly surprising since many healthy
Raw milk is also a source of infections. The bacteria are often carried by healthy cattle
and by flies on farms. Non-chlorinated water may also be a source of infections. However, properly cooking chicken, pasteurizing milk, and chlorinating drinking water will kill the bacteria.
Campylobacter jejuni
Campylobacter jejuni
Other procedures for cheese products available in Bacteriological Analytical Manual (FDA)
Isolation procedures
is usually present in high numbers in the diarrheal stools of individuals,
Cultured on Skirrows medium with vancomycin, trimethoprim, cephalothin, polymixin and amphoteracin B Failure to grow at 25C, oxidase positive and sensitivity to nalidixic acid
The optimal temperature for growth is 42C for