Pg - 1 Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings.

Definition - Food poisoning is if acute illness with mainly gastrointestinal or neurologic manifestations that results from eating food that is contaminated either by bacteria or bacterial toxins or by chemicals. Symptoms usually commence 1-24 hours after ingestion and include vomiting, diarrhoea, abdominal pain and nausea. Can be divided in to (a) microbial (b) Chemicals of nonmicrobial origin. (a) Microbial Food Poisoning IP 1-6hrs Tosxins/mecha nismo location 1.Staphylo -Noninflam c-occus matory aureus (enterotoxine) -Proximal small bowel Bacteria Symptoms & recovery time A/ 1 Diarrhoea, 2 vomiting 3 dehydration 4 shock B/ Recovers rapidly (few hours) A/ Same clinics B/ Recovers rapidly Diagnosis -Culture organism in vomit or remaining food -No faecal leukocytes -Culture organism in foeces & food -No faecal leukocytes -Culture in faeces & food -No faecal leukocytes Source -Contaminated food usually by human. -Milk, sweet corn, mayonnaise, egg, salad, ham, cream

2.Bacillus cereus (emetic form)

" "

-Spores in food (often rice) survives boiling -Fried rice

8-16hrs 1.Cl. perfringes

Noninflammat ory (enterotoxins) -Proximal small bowel " "

A/1.Watery diarrhoea 2.Cramping pain B/Recovery 2-3days A/Clinics as watery diarrhoea & cramp B/Recovery rapid

-Spores in food survives boiling -Beet, poultry legumes

2.B.cereus (diarrhoea form)

" "

-Spores in food survives boiling -Meats, vegetables, dried beans, cereals

pg - 2

IP >16hrs 1648hrs


Toxins/mecha Symptoms & nisms. recovery time location -Inflammatory (Invasion or cytoxin) -Colon or distal small bowel A/1.Fever, malaise 2Abdominal cramps, pain 3.Diarrhoea+ RBC,WBC & mucus 4.Vomitingsalmonella B/Recovery some days (2-5days salmonella & c.jejuni 3-5 days) A/1Watery dearrhoea "Abdominal cramps 3Vomiting B/Recovers in days (1-3d) A/1Nausea 2Vomiting 3Dearrhoea 4Paralysis B/Recovers in 10-14d (Paralysis laryngeal pharyngeal later generalized Resp. insu



1.Salmonel la 2.Shigella 3.Enteroto xigenic E.Coli 4.Campylo bacter jejuni

-Culture -Bowels of animals organism in -Salads, cheese, stools meats, eggs, dairy, -Feacal proclucts, patato, PMN raw vegetables, leulcocytes lettuce ,beef


Vibrio -Inflammatory paraheamo (Invasion or lyticus cytotoxic) -Colon or distal small bowel Cl. botulinum


Preformed toxin neurotoxic

-Stools & rectal swabs for culture & fresh stools for motile organisms -No feacal leucocytes -Demonstrati on of the organism or its toxins in vomitus, gastric fluid, stool. -Isolation of organism from food

shell fish & other sea food

-Canned food -Bottled food

1 Preformed toxins -Staph. aureus - B cereus - Cl. botulinum 3 Tissue invasion - Salmolella - ETEC - Shgella - C.jejuni

1 Toxin production in vivo - C.perfringes - B.cereus - ETEC - V.cholera 4 Toxin production &/or Tissue invasion - V.parahaemolyticus - Y.enterocolitica

pg - 3 (b) Chemicals of non microbial origin (1) Food - mushrooms, shellfish Salivation sweating, vomiting, abdominal pain/cramps, diarrhea, vertigo, confusion, coma.

1 2 3 4 5 6 7 8

(p) May die within few hours but complete recovery in 24 hrs usual with appropriate therapy (2) Others - Organophosphates, heavy metals Pb, Hg etc. Summary of symptoms M:O Diarr Vomiting Nausea Fever Abdominal Paralysis hoea cramps   S.aureus} B.cereus} C.perfringens} B.cereus} Salmonella Snigella C.jejuni ETEC  (watery)   

9 V.cholera 10 ETEC 11 C.botulinum

 (watery) 

  

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Treatment (a) Microbial - I Rehydrahon - oral in mild or moderate Parenteral if severe II Antibiotics - If shigella, cholera (b) Chemical - I Gastric lavage - Inducing vomiting is contraindicated. General principles: 1 Supportive treatment 2 Rehydration with glucose, electrolyte solution orally if mild - moderate dehydration (even if vomiting small sips should be taken to replace volume) 3 If vomiting is severe antiemetic (chlorpromazine >25-100mg/d IM) may be beneficial. 4 Meperidine 50mg Im - severe abdominal cramps. 5 When (p) can tolerate fluids without vomiting semisolid food (cereals, gelatin, bananas, toast) may be added. 6 Antibiotics - shigellosis, cholera 7 In botulinism - maintain adequate respiration with assisted ventilation in addition to I/V administration of antitoxins. Guanidine hydrochloride 15-40 mg/kg. Improves botulism induced paralysis by reversing intramuscular blockade (Botulinum leads to marked neuromuscular blockade).

Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings Report prepared by 1. Sajid Mahmood, Accident & Emergency Department, NHS Liverpool United Kingdom, 2. Adnan Akram, Infectious Diseases Department. University Hospital Riga Latvia. 3. Aftab Ahmed, Infection Control Department, Kaunas Medical University Clinic. Lithuania. contact: