WATER AND FOOD BORNE DISEASE

Presented by: Blancaver, Jenice Alyson

Dino, Gift Summer
Hisole, Sandhi
Layson, Christal Jane
Rom, Oyen
Water and Food Borne Diseases

• Food borne illnesses are defined as diseases,

usually either infectious or toxic in nature,
caused by agents that enter the body through
the ingestion of food
Water and Food Borne Diseases
Typhoid Fever

Hepatitis A

Cholera

Amoebic dysentery

E. coli diarrheal illness

Bacillary dysentery

Campylobacteriosis

Giardiasis
Typhoid Fever
 Typhoid Fever
• Also known as ENTERIC FEVER
• Etiologic agent:
• Salmonella typhi

• Source of infection:
• Feces and urine of infected
persons, transient carriers
Epidemiology

• Description:
▫ A systemic infection characterized by:
 Continued fever
 Anorexia
 Slow pulse
 Enlargement of spleen
 Rose spots on trunk
 diarrhea
TYPHOID FEVER

• Mode of transmission:
▫ Direct or indirect contact with patient or carrier
▫ Contamination by hands of carrier
▫ Flies

• Incubation period:
▫ Average of 2 weeks

Interval before symptoms:

the period between the time somebody is infected with a disease
and the appearance of its first symptoms
 TYPHOID FEVER

• Period of communicability:
▫ As long as typhoid bacilli appear in excreta,
usually form 1st week and throughout
convalescense

Recuperating patient:
a patient who is recovering from an illness or the effects of medical treatment

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi.
If so, the illness could return, or you could pass the disease to other people.
In fact, if you work at a job where you handle food or care for small children,
you may be barred legally from going back to work until a doctor has determined
that you no longer carry any typhoid bacteria.
Cases of Typhoid Fever in the
Philippines
25000

20000

15000

10000

5000

0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Data taken from an official report done by the

DOH the Republic of the Philippines:
http://www2.doh.gov.ph/data_stat/html/fhsis
/nd_byear.pdf
Cases of Typhoid Fever in Philippines
& Japan
25000

20000

15000
Philippines
10000 Japan

5000

0
1982 1985 1988 1991 1994 1997 2000

•Statistics obtained from: www.WHO.int/en/

Typhoid Fever in the Philippines

• Between 1 January and 13 November 2013, 28

224 cases of suspected or clinically diagnosed
typhoid fever were recorded in the Philippines.

• Two of these cases resulted in death, yielding a

case-fatality rate of 0.27%
 2 PHASES OF TYPHOID FEVER
• 1st phase:
▫ the patient's temperature rises gradually to 40ºC,
and the general condition becomes very poor with
sweating, no appetite, coughing and
headache. Constipation and skin symptoms
may be the clearest symptoms. Children often
vomit and have diarrhea. The first phase lasts a
week and towards the end the patient shows
increasing listlessness and clouding of
consciousness.
"Clouding of consciousness" is a term for a mild alteration of consciousness
with alterations in attention and wakefulness.[8

Listless - weary and uninterested: lacking energy, interest, or the willingness

to make an effort
2 PHASES OF TYPHOID FEVER

• 2nd phase:
▫ in the second to third weeks of the disease,
symptoms of intestinal infection are manifested
and the fever remains very high and the
pulse becomes weak and rapid. In the third
week, the constipation is replaced by severe
pea-soup-like diarrhea. The feces may also
contain blood. It's not until the fourth or fifth
week that the fever drops and the general
condition slowly improves.
 DIAGNOSIS

• Bacilli can be isolated from the blood early in

the disease and from urine or feces after the 1st
week
• Agglutination reaction becomes positive during
the 2nd week.

a clumping of bacteria or red cells when held together by antibodies (agglutinins).

 TREATMENT
• 1948 – 1970s
▫ DOC: Chloramphenicol
▫ Widespread resistance occurred

• Alternative drugs
▫ Ampicillin
▫ Trimethoprim-sulfamethoxazole
▫ Resistance occurred in 1980s

Chloramphenicol was used from 1948 until the 1970s,

when widespread resistance occured.
Ampicillin and trimethoprim-sulfamethoxazole then became tx of choice.
1980s resistance with these 3 meds.
TREATMENT
• Fluoroquinolones

▫ Highly effective against susceptible organisms

▫ There is resistance in many parts of Asia

 3rd generation Cephalosporins are used

• Choices for antibiotic therapy also include

ceftriaxone and azithromycin
 • Fluoroquinolones (cipro, levo, moxi, oflo) are highly effective vs
susceptible organisms (but there is resistance in may parts of asia)
 third gen ceph (cefixime, ceftazidime, ceftriaxone) are used
instead

 1st gen - Cephalexin, Cephradine, Cefadroxil,Cefazolin

▫ 2nd - Cefaclor, Cefuroxime, Cefprozil, Loracarbef, Cefonicid, Cefotetan, Ceforanide
▫ 4th - Cefepime, Ceftazidime, Cefpirome
• 5th - ceftobiprole

• Typhoid fever is treated with antibiotics. Resistance to multiple

antibiotics is increasing among Salmonellathat cause typhoid fever.
Reduced susceptibility to fluoroquinolones (e.g., ciprofloxacin) and
the emergence of multidrug-resistance has complicated treatment of
infections, especially those acquired in South Asia. Antibiotic
susceptibility testing may help guide appropriate therapy. Choices
for antibiotic therapy include fluoroquinolones (for susceptible
infections), ceftriaxone, and azithromycin. Persons who do not get
treatment may continue to have fever for weeks or months, and as
many as 20% may die from complications of the infection.
 PREVENTION
• Vaccination
• Other preventive measures for travellers to high-risk
areas include the following:
– Only use water that has been boiled or chemically
disinfected for:
• Drinking, or preparing beverages, such as tea or coffee
• Brushing teeth
• Washing face and hands (can also use alcohol-based gel
to wash hands)
• Washing fruits and vegetables
• Washing eating utensils and food preparation equipment
• Washing the surfaces of tins, cans, and bottles that
contain food or beverages
• Typhoid fever prophylaxis – selective
immunization vs TF for people travelling to
endemic areas

• - 1 cap PO every other day x 4 doses

• - booster: repeat regimen every 5 yr

• A vaccination for typhoid fever is available.

However, it can lose effectiveness after several
years, so a booster vaccination may be necessary.
PREVENTION

– Do not eat food or drink beverages from unknown

sources
– Do not put ice in drinks
– Avoid eating food from street vendors
– Any raw food could be contaminated and should be
avoided, including:
• Fruits and vegetables, particularly those that cannot be peeled
• Salad greens
• Unpasteurized milk and milk products
• Raw meat
• Shellfish
• Any fish caught in tropical reefs rather than the open ocean
HEPATITIS A
 HEPATITIS A

• Etiologic Agent:
▫ Hepatitis A virus

• Other names:
▫ Infectious hepatitis
▫ Epidemic hepatitis
▫ Catarrhal jaundice

Catarrh - runny nose: inflammation of a mucous membrane,

especially in the nose or throat, causing an increase in the production of mucus,
as happens in the common cold
HEPATITIS A

• Predisposing factors:
▫ Poor sanitation
▫ Contaminated water supplies
▫ Unsanitary method of preparing serving of food
▫ malnutrition
 HEPATITIS A

• Incubation period:
▫ 15-50 days
• Description:
▫ Influenza like such as
 -malaise and easy fatigability
 anorexia and abdominal discomfort
 nausea and vomiting
 Fever
 Jaundice accompanied by pruritus and urticaria
Malaise - 1. feeling of illness:
a general feeling of illness or sickness of no diagnostic significance
2. general feeling of discontent:
a general feeling of worry, discontent, or dissatisfaction, often resulting in lethargy
HEPATITIS A

• Period of Communicability
▫ Maximum infectivity during the latter half of the
incubation period, continuing for a few days after
onset of jaundice
▫ No carrier state or chronic infection
HEPATITIS A

• Diagnosis:
▫ Demonstration of virus in stool or by four fold or
greater rise of IgM antibodies against Hepa A
▫ Anti-HAV (IgM) – recent acute infection
▫ Anti-HAV (IgG) – past HAV infection

Test results for anti-HAV IgM are positive at the time of onset of symptoms
IgG – appears soon after IgM and persists for many years.
Presence of IgG in the absence of IgM indicates pasts infection or vaccination.
IgG provide protective immunity
• Diagnosis

▫ Test results for anti-HAV IgM are positive at the

time of onset of symptoms
▫ IgG – appears soon after IgM and persists for
many years.
 Presence of IgG in the absence of IgM indicates
pasts infection or vaccination.
 IgG provide protective immunity
 HEPATITIS A

• Prevention:
▫ Immunization
▫ Good sanitation and personal hygiene
▫ Proper sanitary disposal of feces
▫ Careful handwashing

Immunization is indicated for individuals travelling to areas of high endemicity

who have less than 2 weeks before departure
Vaccination and IM immunoglobulin should be administered to provide long-term
immunity, particularly in persons who intend to travel to these areas repeatedly
TREATMENT

• Involves supportive care

▫ Antiemetics for N&V
▫ IV fluids for dehydration

• Liver trasplantation
▫ If patient has fulminant hepatic failure

• Postexposure prophylaxis
▫ Recommended for nonimmunized close contacts of
those recently diagnosed with acute HAV infection
• Supportive care:
• Initial therapy often consist of bedrest.

• The appropriate public health authority should

be notified after diagnosis of infection, and the
process of contact tracing should be initiated. In
the US, 10% of the cases of acute HAV infxn are
seen in commercial food handlers.
CHOLERA
CHOLERA

• Etiologic agent:
▫ Vibrio cholerae
 A curved, alkali and salt tolerant, Gram (-) rod
bacterium
• El Tor biotype of v cholerae 01 is the
predominant cholera pathogen

• Use of antacids, histamine receptor blockers and

ppi increases risk of cholera infection
- Is an infectious disease that causes severe watery
diarrhea, which can lead to dehydration and
death if untreated.
- This disease is most common in places with poor
sanitation, crowding, war, and famine.
• Vibrio cholerae, is a bacterium that causes cholera,
is usually found in food or water contaminated by
feces from a person with the infection.

• When a person consumes the contaminated food or

water, the bacteria release a toxin in the intestine
that produces severe diarrhea.

• It is NOT likely you will catch cholera just from a

casual contact with an infected person.
SYMPTOMS
• It takes between 12 hours and 5 days for a
person to show symptoms after ingesting
contaminated food or water.
• Among people who develop symptoms, the
majority have mild or moderate symptoms,
while minority develop acute watery diarrhea
with severe dehydration.
• Most people infected with V. cholerae do not
develop any symptoms, although the bacteria are
present in their feces for 1-10 days after infection
and are shed back into the environment,
potentially infecting other people.
• This can lead to death if left untreated.
SIGNS AND SYMPTOMS
• Rapid heart rate
• Loss of skin elasticity (ability to return
to original position quickly if pinched)
• Dry mucous membranes, including the
inside of the mouth, throat, nose, and
eyelids
• Low blood pressure
• Thirst
• Muscle cramp
• Sudden onset of acute and profuse
colorless diarrhea
• Vomiting
• Severe dehydration
• Cyanosis
- Shock and death may occur because of
fluid loss from the circulatory system
Causes
• Inadequate access to clean water and sanitation
facilities.

• Places where minimum of clean water and

sanitation have not been met.
CHOLERA

• Treatment
▫ REHYDRATION is the first top priority
in the treatment of cholera

 Rehydration with a solution of electrolytes

and glucose given IV in severe cases or by
mouth in milder cases
• Ingredients Amount Purified water
Salt
Sugar 1 L (4¼ cups)
2.5 mL (½ teaspoon)
30 mL (6 teaspoons)

• -begin antibiotic tx after px has been rehydrated

and vomiting has stopped
• - tetra, doxy,furazolidone,cipro
• No other drugs should be used in the treatment
of cholera. Antimirobial agents are typically
administered for 3-5 days.

• However, single dose therapy with tetracycline,

doxycycline, furazolidone, or ciprofloxacin has
shown effective in reducing the duration and
volume of diarrhea.
TREATMENT AND PREVENTION
• Vaccine
• Drinking clean water
• Make sure to prepare clean food or drinks
• Brush your teeth
• Wash your face and hands
• Disinfect the dishes and utensils before and after using
• Wash fruits and vegetables before eating
• Observe proper hygiene
• Dispose human wastes properly
CHOLERA

• Period of communicability:
▫ 7-14 days after onset

• Diagnosis:
▫ Culture of vomit or feces

• Prevention:
▫ Immunization
▫ Purification of water
▫ Careful handwashing
From 2008 to 2013, 42,071 suspected and
confirmed cholera cases were reported in 87%
of provinces and metropolitan areas in the
country, confirming the endemicity of cholera
in the Philippines.
AMEBIASIS
AMEBIASIS

• Etiologic agent:
▫ Entamoeba histolytica, a protozoan

• Mode of Transmission:
▫ Contaminated water containing cysts from feces of
infected persons
▫ Spread by hand to mouth transfer of feces
▫ Contaminated raw vegetables
▫ Flies
▫ Sexually transmitted
• Viable in the environment for weeks to months,
cysts can be found in fecally contaminated soil,
fertilizer or water, or on the contaminated hands
of food handlers
AMEBIASIS

• Reservoir:
▫ Man, usually a chronically ill or asymptomatic
cyst passer

• Description:
▫ Intestinal disease varies from acute, fulminating
dysentery with fever, chills and bloody mucoid
diarrhea to mild abdominal discomfort with
diarrhea containing blood or mucus
AMEBIASIS

• Incubation period:
▫ Variable, from a few days to several months

• Period of communicability:
▫ During the period of cyst passing, this may
continue for years
AMEBIASIS

• Diagnosis:
▫ Direct microscopic demonstration of trophozoites
or cysts in fresh fecal specimen
▫ Smears obtained by proctoscopy
▫ Aspirates of abscesses or tissue secretions
• A growing stage in the life cycle of some sporozoan parasites,
when they are absorbing nutrients from the host.
• As cysts, protozoa can survive harsh conditions, such as
exposure to extreme temperatures or harmful chemicals, or
long periods without access to nutrients, water, or oxygen for
a period of time. Being a cyst enables parasitic species to
survive outside of a host, and allows their transmission from
one host to another.

• Proctoscopy is an internal examination of the anus and the

lower part of the rectum. The examination is performed using
a proctoscope (a plastic or metal tube with a lamp in it), by or
under the supervision of a specialised surgeon.
AMEBIASIS

• Prevention:
▫ sanitary disposal of human feces
▫ Protection of public water supplies against fecal contamination
▫ Fly control and protection of food, fruits and vegetables against
fly contamination

• Treatment:
▫ Metronidazole (for invasive amebiasis)
▫ Tinidazole (for intestinal and extraintestinal amebiasis)
▫ Paronomycin
Escherichia coli
Diarrheal Illness
E. coli Diarrheal Illness

• Etiologic agent:
▫ Escherichia coli

• Incubation period:
▫ 12-72 hours
E. coli Diarrheal Illness

Manifestations:
ETEC (Enterotoxigenic E. coli)
 Watery diarrhea without blood or mucus
 “Traveler’s diarrhea”
 Self limiting
 Prophylaxis : bismuth subsalicylate and with use of
antimicrobial chemoprophylaxis
EPEC (Enteropathogenic E. coli)
 No enterotoxins
 Mechanism not known
 Common cause of infantile diarrhea
 Self-limiting
E. coli Diarrheal Illness
• Manifestations:
▫ EIEC (Enteroinvasive E. coli)
 Less volume but with bloody mucoid stools
 Fever
 Headache
 Myalgia
▫ EHEC (Enterohemorrhagic E. coli)
 Serotype O157:H7
 Bloody diarrhea
 Severe abdominal cramps
 Nausea and vomiting
 Self-limiting
E. coli Diarrheal Illness

• Manifestations:
▫ EAEC (Enteroadherent E. coli)
 Associated with both acute and chronic diarrhea

• Mode of transmission:
▫ Fecal-oral route

• Reservoir
▫ Commonly asymptomatic carrier
MOT:
Epidemics occur from person to person from contamination of food,
unpasteurized milk and juices and water sources contaminated with feces
E. coli Diarrheal Illness

• Diagnosis:
▫ Stool culture and serotyping

• Prevention:
▫ Personal hygiene
▫ Handwashing
▫ Proper sanitary fecal disposal
• It is sometimes important to analyse multiple isolates
within a given species to determine whether they
represent a
• single strain or multiple strains. If a species of bacteria is
isolated and cultivated in the laboratory it is known as a
• strain. A single isolate with distinctive characteristic[s]
may also represent a strain.
• Members of the same species that have small differences
between them can be distinguished by additional
• methods. These species is then subdivided into
subspecies, subgroups, biotypes, serotypes, variants etc.
• The process of differentiating strains based on their
phenotypic and genotypic differences is known as
'typing'.
• These typing methods are useful in hospital
infection control, epidemiological studies, and
understanding the
• pathogenesis of infection.
• In hospital settings they may be used to:
• • determine whether a set of isolates obtained from
one patient represents a single infecting strain or
multiple
• contaminants.
• • determine whether a series of isolates obtained
over time represents relapse of an infection due to
single
• strain or separate episodes of disease due to
different strains.
 E. coli Diarrheal Illness

• Treatment:
▫ Replacing the fluid from vomiting and diarrhea
▫ Antimicrobials known to be useful in cases of
treveler’s diarrhea:
 Doxycycline
 TMP/SMZ
 Fluoroquinolones

The widespread use of antibiotics to prevent diarrhea, however, promotes the

appearance of resistant strains by fostering the spread of R plasmids
 Bacillary
Dysentery
(Shigellosis)
Bacillary dysentery
• is a type of dysentery, and is a severe form of shigellosis.
• Bacillary dysentery is associated with species of bacteria
from the Enterobacteriaceae family. The term is usually
restricted to Shigella infections.
• Shigellosis is caused by one of several types of
Shigella bacteria. A study in China indicated that
Shigella flexneri was the most common
serotype/serogroup.
• Bacillary dysentery should not be confused with
diarrhea caused by other bacterial infections. One
characteristic of bacillary dysentery is blood in stool
which is the result of invasion of the mucosa by the
pathogen.
Bacillary Dysentery (Shigellosis)

• Etiologic agent:
▫ Four main groups:
 Shigella flexneri
 S. boydii
 S. sonnei
 S. dysenteriae

Serotype/serogroup
a group of bacteria containing a common antigen, sometimes including
more than one serotype, species, or genus. This is an unofficial
designation, used in the classification of certain genera of bacteria, such
as Leptospira, Salmonella, Streptococcus and Shigella
• serogroup [sēr′o-gro̅o̅p]
• 1 a group of bacteria containing a common
antigen, sometimes including more than one
serotype, species, or genus. This is an unofficial
designation, used in the classification of certain
genera of bacteria, such as Leptospira,
Salmonella, Shigella, and Streptococcus.
• 2 a group of viral species that are closely related
antigenically.
Bacillary Dysentery (Shigellosis)

• Source of Infection:
▫ Feces of infected persons, many in apparent mild
and unrecognized infections.
• Description:
▫ An acute bacterial infection of the intestine
characterized by
 Diarrhea
 Fever
 Tenesmus
 in severe cases bloody and mucoid stools.
Tenesmus is the feeling that you constantly need to pass stools,
even though your bowels are already empty.
Bacillary Dysentery (Shigellosis)

• Mode of Transmission:
▫ Eating contaminated foods
▫ drinking contaminated water or milk
▫ by hand to mouth transfer of contaminated
materials
▫ by flies
▫ by objects soiled with feces of a patient or carrier.
Bacillary Dysentery (Shigellosis)

• Incubation Period:
▫ 1 day, usually less than 4 days.

• Period of Communicability:
▫ During acute infection and until microorganism
is absent from feces.
Bacillary Dysentery (Shigellosis)

• Prevention:
▫ Sanitary disposal of human feces
▫ sanitary supervision of processing, preparation and
serving of food particularly those eaten raw
▫ fly control and screening to protect foods & water
against fly contamination.
Bacillary Dysentery (Shigellosis)

• Treatment:
▫ shigellosis can be mild and typically resolves within
4–7 days without treatment
▫ Antibacterial medications such as
 ampicillin and cotrimoxazole (trimethoprim /
sulfamethoxazole) shorten the duration of symptoms and time
shigellas are excreted
 Third generation cephalosporin
• Although antimicrobial treatment, when given early
in the course of illness, can slightly shorten the
duration of symptoms and of carriage, shigellosis
can be mild and typically resolves within 4–7 days
without treatment. When treatment is required for
shigellosis associated with travel outside the United
States, a fluoroquinolone or ceftriaxone may be used
empirically until antimicrobial susceptibility data
are available. However, clinicians should be aware
that rates of multidrug resistance
among Shigella spp. are high globally, including
resistance to fluoroquinolones, azithromycin, and
third- and fourth-generation cephalosporins,
particularly in South and East Asia.
Campylobacteriosis
Campylobacterriosis
• Is a common cause of diarrhea
• It is caused by the bacteria in the genus
Campylobacter
• Campylobacter are the bacteria that infect the
intestinal tract and sometimes the blood
Symptoms
Campylobacter may cause:
• Mild to severe diarrhea
• Bloody diarrhea
• Nausea
• Stomach pain
• Fever
• And occasionally vomiting
Causes:
Campylobacteriosis is spread by the fecal-oral route. Fecal
materials from infected humans or animals can get into out
mouth by:
• Consuming contaminated food or drink
• Contact with the feces of infected humans that is not followed
by proper handwashing
• Contact with the feces of domestic or wild animals, including
pets and farm animals

Other sources of infection:

• Uncooked chicken and meats
• Unpasturized milk
• Driinking water
• Other fecally contaminated food
Test and Diagnosis
• Diagnosis is made by culturing the
microorganism from a stool sample
Treatment and drugs:
• Antibiotics are used to treat a campylobacter
infection
• People with campylobacteriosis are advised to
drink fluids to prevent dehydration from
diarrhea
Prevention
• Be aware of the risks associated with the food
products you buy and know how to prepare food
safely. Treat all raw poultry and meat as if it is
contaminated and handle it accordingly.
Giardiasis
Giardiasis
• Is an infection of the intestinal tract
• It cause by one-celled parasites; they belong to
the genus Giardia, and the particular parasite
causing is called Giardia lamblia
• It is often water borne, or spread in institutions
where hygiene is poor
Symptoms:
Giardia may cause:
• Diarrhea
• Abdominal cramps
• Frequent loose and pale greasy tools
• Bloating
• Nausea
• Weight Loss
• Fatigue
Causes
You can ingest giardia by:
• Drinking inadequately treated water
contaminated by humans or animals leaving
their droppings in or near water sources such as
streams, rivers, lakes or shallow wells
• Ingested contaminated water while swimming in
lakes, ponds, streams, rivers, swimming pools
• Eating contaminated food
• Contact with feces of an infected person
Test and Diagnosis
• Microscopic examination of one or more stool
samples is the means to diagnose of giardiasis
Treatment and drugs
• METRONIDAZOLE
• TINIDAZOLE
• NITAZOXANIDE