Sources of organism

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Water supplies contaminated with faecal matter Unhygienic practices by the handlers Infected animals excrete may gain access into milk

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Disease in relation to man. Both LT and ST toxins of E. coli can cause food poisoning syndromes in man. Although children are more susceptible, the sensitive adults may also be afflicted with E. coli poisoning through ingestion of contaminated milk and milk products.

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Symptoms. The symptoms produced as a result of ingestion of LT toxin resemble those of cholera. There is massive watery diarrhoea due to accumulation of fluid in the intestine. In case of ST type, the symptoms include, diarrhoea, with or without vomition, which is nonbloody and without inflammatory exudate in the stool. Fever may be caused in children but not in adults.

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Incubation period. It is 8-24 h. Prevention and control. The control of E. coli poisoning is similar to that for any other enteric disease. However, the following precautions should be taken in this connection. i) The faecal contamination of water supply should be avoided. ii) Handlers should strictly follow hygienic practices. iii) Cross contamination from infected animals should also be avoided.

4. Cholera
Cholera is one of the acute diarrhoeal disease caused by Vibrio cholerae. It frequently occurs in the form of massive epidemics, and unhygienic practices appear to be chiefly responsible for the eruption of outbreaks. Although cholera is mainly a water-borne illness, the involvement of milk and milk products may also transmit the disease.

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The organism adheres to the epithelial cells lining the crypts of mucosa in the small intestine where it produces enterotoxin that causes loss of fluid and electrolytes from the body followed by dehydration. Causative agent. Vibrio cholerae.

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Sources of the causative organism i) Milk may be infected by soiled hands of a patient or a convalescent carrier. ii) Use of infected water for dairy purposes. iii) adulteration of milk with contaminated water may also be one of the causes.

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Disease in relation to human beings. V. cholerae organisms penetrate the mucosa of the intestines and accumulate in layers next to the sub-mucosa. Symptoms. In mild cases of cholera, diarrhoea appears to be the only symptoms. However in severe cases, the symptoms are diarrhoea, vomiting, rice water stools, abdominal pain, thirst, dehydration symptoms, etc. The disease runs a short course terminating in death, sometimes within 12 h after the appearance of symptoms.

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Incubation period. It is usually for 3 days (few hours to 5 days). Diagnosis. V. cholerae can be isolated from faeces of both infected individuals and carriers. The intraperitoneal inoculation of guinea pigs with pure cultures results in the death of the animals within 24 hours. Susceptibility and immunity. Natural resistance varies in different individuals. Clinical attacks confer a temporary immunity which may last for several years. Active artificial immunity may last for 6-12 months and may be induced b the use of vaccines.

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Prevention and control i) Proper pasteurization of milk and milk products. ii) Sanitary disposal of human excreta. iii) Protection of water by boiling. iv) Sanitary preparation and handling of products. v) Control or destruction of house flies.

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vi) vii) viii) ix) x) xi) xii)

Education of public in personal cleanliness. Isolation of patients. Disinfection of stools and vomits and articles soiled by these. Food left by patients should be burnt. Room of patient should be thoroughly cleaned and disinfected. Carriers should be isolated. Use of cholera vaccine in exposed population groups.

5. Fungal intoxications
The common types of fungal intoxications that result through milk and milk products are those caused by Aspergillus and other molds like penicillium Fusarium etc.

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a)Aflatoxicosis

Aflatoxicosis is a common type of fungal intoxication caused by the common molds Asoergukkys flavus and A. parasiticus by virtue of their ability of produce aflatoxin. Te aflatoxin can be present in milk as preformed toxin or it can be secreted in milk by the milch animal which has been fed with aflatoxin containing feeds.

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Therefore, even with an exceptionally satisfactory sanitation and hygiene observed during production and processing of milk, the mycotoxins can be transferred to the consumers. Upon ingestion, the Aspergillus-toxins are metabolised by the milch animals and are secreted into the milk in the form of M1 and M2 which are also toxic to the milk consumers.

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Types of aflatoxins. A. flavus can produce the following distinct types of aflatoxins in milk and milk products, apart from M1 and M2 toxins. i) B1, B2, B2a aflatoxin B1 is the most abundant and most toxic of the aflatoxins. ii) G1, G2 and G2a.

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These toxins are extremely heat stable, potent and exhibit very strong toxicity apart form being highly carcinogenic. Raw milk, ice-cream powder, evaporated milk, dried milks and cheese are the common foods implicated with aflatoxins. The recommended upper permissible limit of aflatoxins in foods is 90 ppm.

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Sources of the causative organisms. The main sources of Aspergillus spp. Which are capable of producing aflatoxins are as follows: i) Environment: aerial contamination is one of the most important sources of mold spores. ii) Soil and contaminated foods may also introduce mold spores in milk and milk products. iii) Poor storage conditions.

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Disease in relation to man and animals. As a result of ingestion of aflatoxins through contaminated milk and milk products, acute aflatoxicosis may result in the consumers. Symptoms. The main symptoms of the aflatoxicosis are liver hyperplasia, tissue haemorrhage, anorexia, hepatitis and finally death in animals. The vital organs like spleen, pancreas and kidney may also be involved in aflatoxicosis.

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Prevention and control. The system for controlling aflatoxins in milk and milk products as well as feeds are essentially the same as for controlling any microbial toxin. In this regard, the following measures are required to be taken. i) Prevent contamination of milk and milk products as well as feed by taking approprite precautions.

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ii)

iii)

Prevent fungal growth by storing the products under proper conditions and by the use of fungistatic agents. Detoxification of aflatoxins by physical, chemical or biological agents. However, this measure is relatively impractical in dairy products.

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b)

Other Mycotoxicoses Apart from aflatoxins, molds can also produce a variety of other toxins which can cause other human illnesses or mycotoxicoses, as a result of consumption of intoxiated milk and ilk products. A few such mycotoxins along with the producing organisms have been given in table below (Table 4.6).

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Like aflatoxins, some of these toxins are also resistant to processing conditions and a variety of milk and milk products can be implicated in such mycotoxicoses. The diagnosis of the disease in man, however, has been achieved only on a few occasions. This is mainly based on the detection of the mycotoxin in the food.

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Since clinical manifestations of different types of toxicoses are more or less similar, the diagnosis can’t be made on the basis of these symptoms. In addition to their acute effects on different parts of the body, certain mycotoxins have been shown to have terratogenic and carcinogenic effects.

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Prevention and control. The control of different mycotoxicoses requires the prevention or reduction of mycotoxin contamination in milk and milk products as has already been discussed under aflatoxicoses.

C. Milk-borne toxiinfections
The organisms like Clostridium perfringens and B. cereus cause toxi-infections through milk and milk products, as discussed in the following pages: 1. Clostridium perfringens (welchii) poisoning The perfringens type of food-poisoning can also occur due to the ingestion of contaminated milk or milk products. C. Perfringens causes gas gengrene

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Since this organism is anaerobic in nature like Cl. Botulinum, the anaerobic conditions as observed in canned products could be favourable for this type of toxi-infection. There are at least five antigenically distinct types of this organism according to the type of toxins it produces, namely A, B, C, D, and E. Two of their ability to produce enterotoxins which are lethal and emetic.

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Sources of the causative organism i) Cl. perfringens is commonly found in soil and faeces of man and animals from where it can find its way into milk and its products through dust, fodder and unsanitary handling. ii) Water supplies contaminated with sewage or faecal matter may also introduce this organism into milk.

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As it is a sporeforming organism, the highly resistant spores survive almost indefinitely in dust and are widely prevalent in cowsheds and dairies. Disease in relation to human beings. The disease caused in human beings is gastroenteritis which occurs due to the production of exotoxin/enterotoxins by this organism which are excreted during sporulation and the release of the spores.

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The enterotoxin is resistant to intestinal juices and, therefore, affects the intestinal walls. Children are more susceptible. The MLD (minimum lethal dose) of the toxin is 2,000 mice/mg nitrogen. Symptoms. Diarrhoea, vomiting, nausea, abdominal pain etc. are the common symptoms of this type of poisoning.

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Incubation period. It varies from 8-22 h and duration is generally one day or less. However, it is not very fatal. Prevention and control i) Proper heat treatment of milk. ii) Milk should not be stored under conditions suitable for the spores to vegetate and multiply. iii) After pasteurization, a rapid cooling and storage of milk at temperatures below 15°C is required. iv) Environment hygiene should be observed.

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2. Bacillus cereus poisoning B. cereus poisoning is yet another type of ‘toxi-infection’ which can occur as a result of ingestion of milk and milk products contaminated with B. cereus or its spores. Bacillus cereus, the causative agent of this poisoning, is an aerobic, sporeforming organism which occurs in almost all raw milk supplies as well as in pasteurized milk, cream cakes, pastry, confectionary fillings and processed cheese.

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Sources of the causative organisms i) Since B. cereus is one of the causatives for mastitis, the herd raw milk sometimes gets B. cereus from mastitis animals. ii) The raw milk may also get spores from animal’s teat and skin, and the milking equipments, especially cans. iii) Soil may also introduce B. cereus directly or indirectly in milk and ilk products.

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Toxins. The following three types of toxins are elaborated by toxigenic strains of B. cereus in milk and milk products. i) Haemolysin ii) Lecithinase (phospholipase C) iii) Enterotoxin

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Enterotoxin is responsible for food poisoning outbreaks, while lecithinase and haemolysin play an important role in the pathogenesis of the organism. Disease in relation to man. B. cereus causes two types of poisoning, viz. (i) diarrhoeal type, and (ii) vomiting type. Symptoms. The main symptoms are nausea, diarrhoea, abdominal pain etc.

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Incubation period. The incubation period is about 12 h and the duration is one day or less (6-12 h). Prevention and control. The following practices should be strictly observed to minimize B. cereus poisoning through milk and milk products:

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i) ii)

iii) iv)

Prompt cooling of milk/milk products during storage. Environment hygiene should be maintained and the aerial contamination should be avoided. Precautions should be taken during transition of milk. General hygiene conditions should be maintained during production of milk and marketing of dairy products.

D. Other milk-borne disorders of uncertain pathogenesis
1.

Proteus infection Illness caused by Proteus vulagris through milk and milk products is of rare occurrence. However, in some cases, Proteus mirabilis may cause summer diarrhoea in human beings, through its exact role in milk-borne Proteus infection is debatable.

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Since this organism is easily destroyed by heat treatment, proper pasteurization will render milk safe for consumption. Similarly, by following proper sanitizing practices, it may also be possible to control Proteus infections through milk and milk products.

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2.

Aeromonas infection Aeromonas is mainly associated with animals that live in water. However, certain species have been isolated from humans. A few species like Aeromonas hydrophilia appears to be enterotoxigenic, through the exact role of this organism in food poisoning through milk and milk products is not known at present.

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Contaminated water may be the source of this organism in milk. The incidence of this organism in milk and milk products can be controlled by following appropriate hygienic practices during production and processing of milk and also by giving suitable treatment to the contaminated water supplies.

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3.

Citrobacter infection This organism is very rarely associated with gastroenteritis through ingestion of contaminated foods including milk and milk products. A few strains of Citrobacter produce enterotoxins. However, the exact aetiology of Citrobacter include illness is not known as yet.

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4.

Klebsiella infection The involvement of Klebsiella in milk-borne gastrointestinal illnesses appears to be quite rare. Among its different species, K. pneumoniae can produce heat stable and heat labile toxins which are comparable to those of E. coli. However, there are conflicting reports concerning the food-poisoning potentials of these organisms. Hence, there is a need to study this organism extensively before associating it with such food-borne illnesses.

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5.

Pseudomonas infection The various species of Pseudomonas encountered in milk and milk products are Ps. Putrefaciens, Ps. Fluorescens, Ps. fragi, Ps. viscosa and Ps. aeruginosa. Of these, Ps. Aeruginosa appears to play an important role in food poisoning through milk and milk products.

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Ps. aeruginoa has been incriminated in several food poisoning outbreaks in human beings as well as in mastitis cases in animals. This organism has been isolated from raw milk and other milk products by Grover and Srinivasan (1989) and its pathogenicity was ascertained in different animal model systems.

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Sources of the causative organism i) Water supply is the initial source of this organism. ii) Improperly cleaned utensils, equipments, pipelines, milk cans, churns, holding cans, valves, milking machines, etc. constitute the other sources. iii) Udder teats and cowshed environment may also be the potential sources.

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Disease in relation to human beings and animals Human beings. In human beings, Ps. aeruginosa can produce urinary tract infections, eye infections, ear infections, septicaemia, abscess, meningitis and enteritis. The gastrointestinal distrubances dur to enterotoxin produced by Ps. aeruginosa have also been recorded.

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Animals. Ps. aeruginosa can cause mastitis, necrotizing enteritis, abortion, vaginitis and endometritus in cattle, swine and horse. Prevention and control The following are precautions required to be taken for the control of pseudomonas infection through milk:
ii)

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i) ii)

iii)

iv)

Proper heat treatment of milk. Hygienic conditions during production and processing. Microbicidal treatment of dairy water supply. Proper cleaning and sanitization of dairy utensils and equipments.

E. New emerging pathogens
1.

Listeriosis Listeriosis is yet another foodborne illness which has attracted worldwide attention during recent years. Listera monocytogenes, the causative agent of the disease, can easily gain access into milk and milk products.

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The presence of this organism in milk and milk products has caused a great concern to the dairy industry and the general public in view of high rate of human mortality. There has been an increase in the number of outbreaks of listeriosis due to ingestion of contaminated milk and milk products.

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Although, there has been tremendous impact and the necessary efforts for the combat of this disease in developed countries, on serious effort has been initiated by the developing countries to investigate the causative organism of the disease from public health point of view. Hence, there is a need to carry out extensive investigations in this country as well in respect of this organism to understand its pathogenic potentials

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Incidence in milk and milk products. Since L. monocytogenes is known to cause mastitis in milch animals, it can be secreted in milk. There have been a number of reports indicating the involvement of raw and pasteurized milk with the outbreaks of listeriosis.

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According to one such report (March, 1986), the incidence of L. monocytogenes in milk was similar to that of Salmonella comprising about 5% of the sample tested. Besides milk, other milk products like cheese have also been implicated in such outbreaks.

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Causative agent. Listeria monocytogenes, the causative agent, is a Gram-positive, non-sporulating rod capable of growing at a wide range of temperature (1° to 45°C). The pathogenicity of the culture is associated with the production of extracellular haemolysin (aplha, beta) by this organism.

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Source of the causative organism. The following sources of contamination may introduce the causative organism in milk and milk products. i) Infected animals are a major source of this organisms in milk through infected udders. ii) Handlers carrying the disease organism may also introduce the organism in milk and milk products.

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iii)

iv)

v)

Unhygienic practices observed during production and processing of milk may also contribute the organism. Faecal contamination of milk and water is yet another source. Contaminated refrigerators and dish clothes may also introduce the organism in milk.

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Heat resistance of the organism. Although there have been conflicting reports concerning the heat resistance of L. monocytogenes in milk and milk products, it definitely appears to survive some of the processing conditions of milk and milk products.

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The possible reason for survival of this organism during processing like pasteurization may be attributed to the ingestion of these organisms by leucocytes in milk which may give this organism some protection against heat treatment.

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However, according to a survey conducted by Food and Drug Administration (FDA, USA), pasteurization appears to be a safe process that reduce the number of L. monocytogenes in milk to a level that does not pose any risk to the consumer.

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Disease in relation to man and animals. The ingestion of L. monocytogenes through milk and milk products may cause listeriosis in man which may sometimes become lethal, leading to the heath of consumers. However, the exact pathogenesis of the disease is not known. In animals, the organism cause mastitis, infections bovine keratitis and meningioencephalitis.

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Symptoms. The symptoms of listeriosis are acute meningitis with or without septicaemia. The onset of meningitis is usually sudden with fever, nausea, headache, vomiting, followed by delirium, coma, collapse and shock resulting in death it not treated promptly and properly.

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Prevention and control. i) Strict hygiene practices should be followed during production and processing of milk. ii) The human carriers should not be allowed to handle milk and milk products. iii) Culling of the infected animals. iv) Proper heat treatment of milk. v) Proper storage conditions.

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2.

Campylobacter jejuni poisoning (Campylobacteriosis) Campylobacter jejuni is a relatively new bacterium which has been found to be involved in milk-borne campylobacteriosis. A number of outbreaks of this type of illness have been reported in different parts of the world and the vehicle of almost all the outbreaks was traced to be raw milk. A wide variety of warm-blooded animals have been found to be infected with Campylobacter jejuni.

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Sources of the causative organism i) The organism has been isolated from intestinal tracts and faecal matter of man, goat, sheep, etc. Faecal matter is thus the chief source of this organism. ii) Polluted water contaminated with C. jejuni can also be an important source for the entry of this organism in milk and milk products. iii) Infected personnel and animals.

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Diseases in relation to man and animals. C. Jejuni is now well recognized as a common cause of acute gastroenteritis in man. This organism is also implicated in mastitis in milch animals Symptoms. Severe abdominal pain and diarrhoea.

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Prevention and control. i) Milk should be properly pasteurized and heat treated as the organism does not survive efficient pasteurization. ii) Public water supplies should be adequately treated such as chlorination. iii) Good hygiene should be practised by dairy personnel. iv) Persons suffering from disease should not be allowed to handle milk and milk products.

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3. Yersinia enterocolitica poisoning (Yersiniosis) Yersinia enterocolitica is yet another potential pathogen which can cause yersiniosis in man and the raw milk has been suspected to be an important vehicle for the transmission of the disease. Several incidences of this illness/diseae through raw and pasteurized milk have been reported.

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Sources of the causative organism i) Water or streams often contain this organism, hence it constitutes the common source. ii) Faecal contamination may also introduce causative organisms. iii) Infected animals. iv) Contaminated raw materials.

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Disease in relation to man. Yersiniosis is produced in human beings. The illness causes acute syndrome with appendicitis. Animals are also frequently infected with the organism. Symptoms. Y. enterocolitica produces several disease syndromes in human beings on ingestion of contaminated milk.

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The gastro-intestinal illness caused by the organism in human beings its characterized by abdominal pain and fever. The other symptoms include vomiting and diarrhoea. The pathogenesis of the organism appears to be due to enterotoxin production as well as by invasiveness of the organism.

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Prevention and control. The disease can be controlled by taking the following precautions: i) Avoiding faecal contamination. ii) Following hygienic practices. iii) Avoiding handling of the products by infected personnel.

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4.

Vibrio parahaemolyticus Poisoning Vibrio parahaemolyticus is the causative agent of gastro-enteritis in human beings. This organism although is not as important as cholera, the prevalence of this illness appears to be increasing through the world. Among the enteric pathogens, V. parahaemolyticus is a recent addition.

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Now this organism has been recognized as a common agent of food-borne illnesses, particularly in Japan as well as USA. There have been quite a few number of outbreaks are fish, crabs and canned sea foods. However, milk and milk products are very rarely implicated in such outbreaks. The exact mechanism by which this organism causes gastroenteritis is not yet known.

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Sources of causative organism Contaminated water supply is the main source of this organism in milk and milk products. Disease in relation to man. The ingestion of contaminated food products typical gastroenteritis.

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Symptoms. Diarrhoea is the main symptom of this gastroenteritis. The other symptoms include abdominal cramps, nausea, vomiting, headache, chills and fever. In some cases, watery diarrhoea resembling cholera may also develop. In severe cases, death may also occur.

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Incubation period. This varies from 12-24 h. The symptoms persist from few hours to 10 days with the usual duration of 2-3 days. Prevention and control i) Contamination of marine or water environment should be avoided. ii) Application of good sanitary practices and personnel hygiene should help in preventing the cross-contamination.

F. Other milk-borne diseases
a) 2)

Bacterial diseases Tuberculosis (TB) Tuberculosis has been recognized as one of the most important infectious diseases in the world because of its high global impact and its chronic debilitating character, particularly in the poor section of society.

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Milk-borne tuberculosis is directly or indirectly related to the consumption of raw milk from infected dairy herds. Although extensive work has been carried out in several parts of the world on the incidence and transmission of TB through milk and milk products, there is paucity of information in India on this aspect, except for few sporadic reports.

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Causative agent. The most common causative agent is Mycobacterium tuberculosis. There are two types of tuberculosis: (a) pulmonary type, and (b) non-pulmonary type, pulmonary type of tuberculosis is caused by human type of this organism which mainly affects the respiratory tract. Bovine type bacillus causes non- pulmonary type of TB.

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Tuberculosis of cattle is produced by bovine bacillus called Mycobacterium bovis. Avian type of the organism may cause both types of tuberculosis. Anonymous or atypical type bacillus changes its character. The principal species of Mycobacterium which are pathogenic in man and animals are shown in Table 4.7.

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Table 4.7 Principal pathogenic species of Mycobacterium Species Host M. tuberculosis Man M. bovis Cattle and man M. avium Birds and swine; rarely man

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M.microti Field mouse M.Laprae Man M.Paratuberculosis Cattle, sheep M.ulcerans Man M.marinum Fish and man

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Incidence of mycobacteria in milk and their sources. There are a number of reports available from different countries concerning the incidence of mycobacteria in raw and and pasteurized milks.

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