Task 1

The 16 sufferers.
The clinical picture: cramping abdominal pain, repeated diarrhea (with mucus),
the body temperature is up to 38-40oC, weakness, dizziness, headache pain.
In hospital patients were assisted, but recovery was very slow, and even after
discharge from hospital weakness has been noted for long time.
The consumable foods.
All the sick were members of a family celebration. Everybody ate veal cutlets,
bought on the unauthorized market. The cutlets during cooking have been just
fried, but didn’t have been heated in an oven. The dish was served hot.
The analyze results.
The gastric lavage, excrements and blood culture from the patients, raw meat, from

which veal cutlets were cooked, and 15 washings from equipment and utensils
were analyzed. The food residues were not examined, because were absent. A
culture of opportunistic microorganisms was found in the patients' materials, as
well as in 5 washings from the inventory. Pathogenic microflora was not found.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. List the characteristics of this subgroup of food borne diseases.
Task 2

Family: father, mother, grandmother and daughter.

The consumable foods.
They had for dinner on the 21st of July: boiled potatoes with butter, homemade stock
fish, cake and tea. The father had only tea and cake.
The cake was bought in the store. It was made in the factory on the 20th of July and
was kept in the refrigerator. The father made the stock fish the last summer. The fish
was caught in the river, was splitted on the sand, was washed in the river, was lightly
salted and was being stored in an enamel saucepan for 4 hours and then it was dried
exposed to the sunrays. Potatoes were brought from their own kitchen-garden. Manure
from a nearby farm was used for its cultivation.
The clinical picture.
The girl was sluggish and had difficulty swallowed the food next morning. She felt
dizzy and said that her "mouth was dried up". A doctor found on the examination
anisocoria (the eye pupils has unequal size). The girl said when she looked at objects,
they appeared double.
The grandmother felt increasing weakness, “mist in the eyes”. She had vomit,
headache, and visual disturbances. Her consciousness was clear; the temperature was
normal; it was cardiac failure and respiratory failure.
The father and the mother felt good.
The test results. Food residues was absent.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne diseases
include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. What methods of diagnostics and treatment of this disease do you know?
Task 3

The 26 sufferers.
The clinical picture: general weakness, pain in the epigastric region, along the colon and
small bowel, bloating, frequent fetid diarrhea (up to 20 times a day, copious, watery), the
normal body temperature.
The consumable foods.
All victims ate the patties with liver that were bought in the cafe at the stadium.
The results of the cafe examination.
The process equipment for patties production is modern, the industrial hygiene enforced
rigorously, and the staff underwent a medical examination and was tested for the bacteria
carrying (negative results). Raw materials for the production of patties are prepared with
meat-packing plant. Centralized delivery is made in a special transport. The patties were
made for the first time.
Unrealized on the first day patties (90 items) were kept in the cafe at the air temperature
18 °C. Interviews with victims indicated that all of them ate the patties, realized on the
second day. The patties were sold in a heated state, but their organoleptic properties did
not correspond to ones of a fresh food.
The gastric lavages, feces of the patients, the washings from the process equipment were
examined. The spore-forming anaerobic bacteria strains of type A were found in the
material of patients. The analyze results of liver samples and the washings from cutting
boards were negative.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne diseases
include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. Give the characteristics of the causative agent.
Task 4

There is a mass poisoning in the kindergarten.

The clinical picture: pale skin, cold limbs, headaches, dizziness, nausea, repeated
vomiting. Two impaired children with a low level of physical development were in
a collaptoid state.
The consumable foods.
The children had for breakfast buckwheat porridge with milk, cocoa and cheese
sandwich.
Milk mixture was used (the night boiled part and morning boiled part). Milk
mixture was not boiled additionally. One of the workers has the burn marks on the
back of her hand.
The circumstances.
The personnel of the dairy farm (the supplier of milk) were examined. The
personnel do not have any complaints; according to the last medical examination
they are healthy. The cows were examined by a veterinarian. The vet conclusion of
- the cows are healthy.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. Could the additional boiling of milk mixture prevent the disease?
Task 5

A victim is a woman of 56 years old.

The consumable foods.
March, 17
Breakfast (9 a.m.): cheesecake with raisins, tea.
Lunch (2 p.m.): soup, boiled potatoes with canned homemade mushrooms, compote
of dried fruits, white bread.
Dinner (7 p.m.): tea with lemon, bun with jam, apple.
The clinic picture.
The firs symptoms were on the 18th of March at 10 a.m.
The first day: a state of moderate severity, epigastric pain, nausea, pallor, cyanosis of
the lips and nose, an unformed stool. The blood pressure was 100/60 mm Hg, the
pulse was 120 per minute, the body temperature is 37 °C, the liver was not increased
in size. There was leukocytosis in the blood, the presence of protein in the urine.
The second day: dizziness, severe weakness, tremor of the fingers, light yellowness of
the sclera of the eyes and skin, enlarged liver, vomiting. Concentration of direct
bilirubin in the blood was 3.6 mg% (N = 0.15% mg), indirect bilirubin - 2.8 mg% (N
= 0.5 mg%). The activity of liver enzymes (aspartate transferase and transaminase)
sharply increased. The disease was fatal, despite an intensive therapy.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne diseases
include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. List the possible syndromes and their causes due to consumption of this etiological
agent.
Task 6

The 24 workers suffered.

The clinical picture: headache, weakness, dizziness, abdominal pain, nausea, and
diarrhea without mucus and blood. Temperature is normal.
The consumable foods.
All patients had breakfast at home and lunch in the canteen.
Dinner in the canteen consisted of the following dishes: salad of pickled cabbage,
potato soup on bone broth, fried beef with buckwheat porridge, bread, stewed fruit,
and meat jelly. The workers ate the meat jelly with mustard. The meat jelly seemed
slightly slimy and had bitterish taste.
The meat jelly was prepared from meat in the canteen. The ready meat jelly was
kept in the refrigerator, where raw meat and offal had been kept before.
The circumstances.
All workers of the canteen are healthy, promptly passed a medical examination and
passed the tests for the bacteria carrying. Technological equipment and kitchenware
are clean.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
6. Give the definition of the term “food toxicoinfection”.
Task 7

2 children (of 3 and 5 years old) were hospitalized into infectious department.
The clinical picture: lethargy, severe weakness, severe pallor, cyanosis of the mucous
membranes, double vision. Heart rate is 110 per minute, blood pressure was not determined.
The general condition was extremely grave. Despite on the treatment, the patients died.
The consumable foods.
Children had dinner at home with their family: meat dumplings, homemade canned
tomatoes, bread, and milk. When cooking the meat dumplings, salt was added to the water.
About 24 hours all the family members noted repeated vomiting, severe weakness, one-time
diarrhea, pale skin. These symptoms stopped in an hour and half.
In the morning children ate milk soup with salt; parents had cup of tea and ate a sandwich.
Each child had the full bowl of milk soup. After 20 minutes the children had severe
weakness, pallor and cyanosis of the mucous membranes. The parents did not have
symptoms of the poisoning.
The circumstances.
The parents of children work at the factory for the production of meat delicatessen. The
parents brought salt in a plastic bag from work to home a few days ago.
The test results.
The frozen dumplings, the remains of the milk, open can of tomato, and “salt”, and also the
blood of the children, their gastric lavage, and (after the death of the children) cell material
(part of the intestine, liver, and blood) were examined. The results of bacteriological studies
of the selected objects were negative.

The questions:
1. Make an etiological diagnosis of the foodborne disease.
2. What group (and subgroups) according to the classification of foodborne diseases include
this disease?
3. Name the food, the consumption of which leaded to food poisoning in this case
4. List the main activities to prevent food-borne disease in this case.
5. Give the characteristics of the agent that became a cause of foodborne disease in this case.
6. Describe the action mechanism of the cause of foodborne disease in this case.
Task 8

8 from 18 children of the kindergarten group suffered.

The clinical picture: confused consciousness, delirium, severe tachycardia,
impairment of speech and swallowing, impaired near vision, diplopia,
photophobia, the red and dry skin, frequent pulse, dilated pupils that did not react
to light, dryness of mouth.
The circumstances.
The children went for a walk to the forest with the kindergarten group. The
children played in the forest. There were shrubs of elderberries, viburnum,
belladonna in the forest. Some children found a shrub with large red berries, "like a
cherry." The children ate a few berries. The children said that the berries were
sweet. These children were among the victims. One of the boys did not swallow
berry and spited it. He stayed healthy.
The consumable foods.
For breakfast children had porridge with butter, cocoa and cheese sandwich.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
Task 9

The case of a family disease was recorded in town H.

Clinical picture: fever; pain in the masseter muscles, in the neck muscles, in the
intercostal muscles and in the muscles of the upper and lower extremities;
myasthenia; edema predominantly of the periorbital part and face on the whole.
The test results.
In the blood: high eosinophilia, leukocytosis. In the serum: hypoproteinemia
(decreased albumin), reduced levels of potassium and calcium, increased creatinine
phosphokinase enzymes and alanine transpherasa.
The consumable foods.
The family uses traditional food. A week ago, all members of the family ate meat
of a wild boar, that had been shot while the hunting.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
Task 10

A young man of 22 years old was ill.

Clinical picture: signs of acute cholecystitis and cholangitis. Body temperature is
38oC, excessive sweating, weakness, fatigue, and headache. The liver is enlarged,
icterus.
The test results. In the blood: eosinophilya, hyperleukocytosis. The patient does
not have any inherited diseases.
The circumstances. The first signs of sickness appeared 5 days ago in Siberia,
where the man had been being on holidays. During the holidays he caught carp and
bream in the river. Almost every day he had a fish soup prepared from the catch. A
part of the catch fish was salted a little bit and was dried. Occasionally this kind of
the fish was also used in the diet.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
Task 11

Three member of a family (V. of 52, C. of 27 and A. of 17 years old) suffered.

The clinical picture: they had chills, weakness, headache, dizziness, shortness of
breath, "fog" before the eyes (one person), dryness and bitterness in the mouth,
severe facial flushing, and low blood pressure. The body temperature was 36,3-
36,5oC. Two of the three victims lost consciousness.
The consumable foods. All patients ate 4-5 pieces of preserves "Fatty herring".
The victims noted that herring had a bitterish taste.
The test results. The patients' blood, gastric lavage, urine, herring leftovers were
examined for the presence of botulinum toxin and microorganisms. The results of
all studies were negative.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What is the mechanism of formation of causative substance?
5. What data are needed to diagnose of this poisoning?
Task 12

A disease of unknown etiology was found among the 17 residents of a village of

the Penza region. One of them died.
The clinical picture: sudden headache, nausea, vomiting, in severe cases -
epigastric pain, sudden muscle weakness. Temperature did not rise. Diarrhea was
not. Vomiting in mild cases was single, and in more severe cases - often after a
meal or a drink and was continuing for several days. Then, in the condition of
hospital the patients showed some improvement but remained weakness, nausea,
loss of appetite, headache, thirst, dry mouth, and progressive weight loss.
The patients had pale and dry skin, puffy face, varying degrees of exhaustion until
cachexia. In the blood: slight decrease in hemoglobin, increased erythrocyte
sedimentation rate to 47 mm/hour, hypercalcemia. In the urine: hyaline cylinders,
protein, leukocytosis, daily volume of urine was 2.5-3.5 liters, hypercalciuria. 4
patients had osteoporosis of the lower jaw.
The consumable foods.
All victims used vegetable oil which they bought simultaneously at the point of
unorganized trade.

The questions:
1. Name the food, the consumption of which leaded to the disease in this case.
2. List very specific symptoms of this disease.
3. Metabolism of what chemical substance was disturbed?
4. What essential micronutrient (that present in this food) relate with this
chemical metabolism?
5. Name the disease.
6. What group (and subgroups) of alimentary depended diseases include this
disease?
7. What pathogenesis of this disease is?
8. Why this food did become harmful for human health in this case?
Task 13

Several children had the signs of acute gastritis.

The clinical picture: nausea, vomiting, cutting pain in the epigastric region,
diarrhea without mucus and blood. Body temperature is 36oС. They entered the
hospital for in-patient treatment at 11 p.m.
The consumable foods: cream-filled pastries that were made in a city cafe.
The circumstances. It was found that a part of pastries was not sold on the day of
making and was stored in a room at a temperature 27-30 оС for 20 hours.
Cafe staff was trained to sanitary rules, personnel was examined by doctor and
promptly passed the tests on the bacteriocarrier.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.
Task 14

There were the cases of poisoning of unknown etiology in one of the cities of the
northern region.
Clinical picture: headache, facial flushing, and compression of the throat, a
metallic or bitter taste in the mouth, shortness of breath, vomiting. Some of the
victims suffered from diarrhea. Several patients had itchy skin rash with blisters or
popular elements.
The consumable foods. All the victims ate at the restaurant: vegetable salad, bun
with tuna, tuna fillet.
The circumstances. The restaurant uses frozen tuna. Before it was cooked it had
been thawed and frozen several times. The temperature in the storage chambers
was not standard.
The test results. A chemical compound was discovered in tuna meat, the chemical
concentration was above the standard in many times.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. Make an etiological diagnosis of the foodborne disease.
3. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
4. List risk groups of this disease.
5. List other possible sources of this poisoning and particularities of the toxin
distribution in the food.
Task 15

A woman of 60 years old suffered.

The consumable foods: fried mushrooms, boiled potatoes, vegetable salad, tea, cake
with cream.
The circumstances. Mushrooms were collected during a walk in the forest on the
14th of August. Other foods were bought in the store a day ago. 3 people ate
mushrooms: the woman, her daughter, and family’s friend. They did not have any
signs of the disease.
The clinical picture.
August, 15: sudden cramping abdominal pain, nausea, repeated vomiting (up to 20
times), chills, watery diarrhea (up to 15 times a day), a state of moderate severity, pale
skin, cyanosis of the lips and nose, blood pressure - 120/70 mm Hg , heart rate - 96
per minute, the body temperature - 37 oC.
August, 16: the state did not improved, vomiting, nausea, copious diarrhea, dizziness,
severe weakness, tremor of the fingers.
August, 17: weakness, there was a mild yellowness of the sclera and skin, enlarged
liver, vomiting with blood, diarrhea.
August, 18: increased yellowness of the skin and sclera, enlarged liver. In the blood:
the concentration of direct and direct bilirubin was above the norm, sharply increased
liver enzymes concentration. The mother felt into a coma, renal and hepatic failure
had developed. She died.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne diseases
include this disease?
3. Name the etiological factor of this disease. List it properties.
4. What syndromes of this disease do you know? Which of them present(s) in this
case?
5. List the main activities to prevent food-borne disease in this case.
Task 16

Patient is a man of 33 years old.

The clinic picture. The first day: nausea, single vomiting, dry mouth, a feeling of
a lump in the throat, weakness, blurred vision.
The 2nd day: a sharp deterioration, increased weakness, dizziness, visual and
swallowing disturbance, changed voice.
The circumstances. The victim ate homemade canned eggplants, baked meat with
potatoes. Meat and potatoes were bought on the market. Friends who ate with him
- also fell ill, the symptoms are similar.
The results of the test. The leftovers of food were examined. Any microorganisms
were not detected.

The questions.
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. List the properties of causative agent. Explain how these properties are realized
during food cooking that was a source of poisoning.
5. List the main activities to prevent food-borne disease in this case.
Task 17

The victims: employees of an institution.

Clinical picture: headache, drowsiness, irritability, body temperature was normal,
abdominal pain and pain in the guts were absent, stool was normal. Malaise was
continuing for 24-48 hours and stopped without any significant complications. One
man was hospitalized. After 5 days after the beginning of mentioned ailments the
most of the victims had skin desquamation in the facial area.
The circumstances. All the victims ate chicken liver that was bought in a frozen
state in the same store. All persons stated that the liver was stored in the cold, and
then was thawed directly before cooking in the frying pan. Then liver was roasted
with vegetable oil and potatoes or pasta. Heat treatment was continuing for 20-25
minutes. Cooked dishes were eaten in hot form. Each person had eaten about 200 g
of liver on average.
Sanitary doctor examined shop and plant for poultry handling. It was found that the
violations of the conditions of storage and sale of the party of the chicken liver
were not. The results of bacteriological examination of the liver samples were
negative.
On the poultry farm feed for birds is enriched with retinol acetate. The content of
toxic substances in the feed does not exceed the established hygienic standards.

The questions:
1.Name the food, the consumption of which leaded to the health disorder in this

case.
2.Why this food did become harmful for human health in this case?

3.List very specific symptoms of this health disorder.

4.Name this health disorder.

5.What group (and subgroups) of alimentary depended diseases include this

disease?
6.What else diseases of this group do you know?
Task 18

Victims - 6 holidaymakers from the holiday home.

Clinical picture: general malaise, weakness, dizziness, headache, nausea, vomiting,
expressed abdominal pain, watery and frothy stool up to 3-5 times a day, temperature of
39 oС. All victims were hospitalized in an infectious hospital.
The circumstances.
The menu of the holiday home:
Breakfast - semolina porridge, eggs, cocoa, bread, butter, cheese.
Lunch - vegetable soup, rice with stewed beef, fruits.
Snack - tea, waffles, dry biscuits.
Dinner - casseroles with jam and tea with lemon.
The 280 people eat in the dining room of the holiday home, only these six persons
were ill.
All the victims are friends. They celebrated the birthday of one of them on that
day. They did not go to the dining room for dinner. They ate smoked duck, fruits,
chocolates and champagne in the room.
The fruit, chocolates and champagne were bought in the store, and the duck was
homemade.

The questions:
1. Name the food, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne
diseases include this disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.