Food Poisoning

Agung Nova Mahendra

Department of Pharmacology & Therapy,

Faculty of Medicine, Udayana University
 Food Poisoning
Food poisoning (FP) is an illness caused
by ingestion of food or water
contaminated with bacteria and/or their
toxins, viruses, parasites, or chemicals

Two types of • Food infection

FP: • Food intoxication
 Food infection: disease caused by
microorganisms contained in the food

Food intoxication: disease caused by

bacterial exotoxin, chemicals (pesticides,
drugs), & other naturally-occurring toxins
 Risk Factors
• Host:
– Immunocompromised states: chronic illness, unfit
condition, under steroid tx.
– Age: children & elderly
– Pregnancy
– Irregular food intake
• Environment: raw food, poor food processing &
packaging hygiene, unsuitable storage
temperature
• Agent: bacteria, virus, parasites
 Clinical Signs & Sx
• General:
– N/V
– diarrhea
– abdominal colic
– fever may also occurs

• Dehydration & electrolyte imbalance

 Clinical Spectrum of FP

Mild illness Death

Life-threatening
(neurologic,
hepatic, & renal
syndromes) &
Disabling illness
 Bacteria that Cause Food Poisoning
Bacteria Incubation Period (hrs) Food Source
S aureus 2-6 Improperly frozen meat,
milk
B cereus 1-5 Fried rice
C perfringens 8-22 Beef, poultry meat,
beans, & broth
V parahaemolyticus 12-18 (<48) Shrimps & crab
Salmonella sp. 12-18 (<48) Egg, half-cooked poultry
meat
C botulinum 18-36 (<96) Can dishes

Other common causes:

- Campylobacter sp
- E coli (O157)  STEC O157
 Toxicodynamic Aspect of FP
Noniflammatory diarrhea
(leading to profound
dehydration)
Inflammatory diarrhea
(febrile, toxic appearance;
dehydration is less likely
e.c. smaller stool volume)
Pathogens: V cholerae,
ETEC, C perfringens, B
cereus, Staphylococcus, G
lamblia, Cryptosporidium,
Rotavirus, Norovirus,
Adenovirus
Pathogens: C jejuni, V
parahaemolyticus, EHEC,
EIEC, Y enterocolitica, C
difficile, E histolytica,
Salmonella sp., Shigella sp.
Toxicodynamics:
Enterotoxins (preformed
or intraintestinal) 
mucosal hypersecretion
(minus bloody or mucous
stool of severe abd. Pain)
Toxicodynamics:
Cytotoxin  mucosal
invasion & destruction
(commonly in colon or
distal small bowel).
Sometimes, Mo penetrate
mucosa & proliferate in
local lymphatic tissue
 Clinical Approach on FP Management

Cross-contamination
Strict personal hygiene
Prevention avoidance
Adequate cooking Proper storage & serving

Adequate RS
rehydration Supportive
Medication Antidiarrheals
Electrolyte Care
Antibiotics
supplementation
Prevention of Food Contamination
• 1. Cook the food under high temperature
• 2. Prevent cross contamination; always
maintain food preparation hygiene
• 3. Prevent the contamination of well-cooked
food by raw meat or seafood
• 4. Maintain warm food being warm and cold
food being cold. Temperature of warm food is
maintained to be keep > 65 oC & heated to e
served at 85 oC
• 5. Keep the food in the fridge at appropriate
temperature.
• 6. Do NOT defrost the food in room
temperature. Do defrost in the fridge, under
running water or by microwave
• 7. Packaged products should be placed
according to the manufacturer’s instructions
 What to Eat during FP?
The GOOD: The BAD
bland, low in fat, simple-to-digest
Saltine crackers, bananas, rice, toast Dairy products: milk, cheese
Oatmeal, cereal, gelatin Fatty food
Bland potatoes, boiled veggies Heavily-seasoned foods
Soda without caffeine (ginger ale, root beer) Food with high sugar content
Egg white, chicken broth Spicy food
Fried food
Caffeine: soda, energy drinks, coffee
Alcohol
 Rehydration Solutions (RS)

LACTATED RINGER SOLUTION Vs. NS

No demonstrable difference exists in hemodynamic effect, morbidity &

morbidity

ORAL ELECTROLYTE MIXTURES

MoA: C6H12O6 – facilitated absorption of Na+ & H2O (unaffected in

cholera)

Simple solution: 1 tsp salt + 4 heaping tsp sugar  1 L water

 Antidiarrheals
Attapulgite: Adsorbent, absorbs fluid in intestine & reduces stool liquidity (NA)

Aluminum hydroxide: Antacid, adsorbent, protectant & phosphate binder (C)

Bismuth subsalicylate: Antimicrobial, antisecretory, & antiinflammatory (C; D in

3rd trimester)

Diphenoxylate + Atropine: inhibits excessive GI propulsion & motility (C)

Loperamide: Inhibits peristalsis & slows intestinal motility via opioid receptor
(direct effects on circ. & long. muscle prolongs electrolyte & fluid movement
through bowel & increases viscosity (B)
 Antibiotics

Empirical tx may be considered in

high risk patients:
• Elderly
• Immunocompromised
• DM
• Liver cirrhosis
• Intestinal hypomotility
 Antibiotics
Antibiotic MoA Activity
Ciprofloxacin Inhibits DNA gyrase & Against pseudomonads,
(C) promotes dsDNA breakage streptococci, MRSA,
Staph. Epidermidis, &
most Gram (-) org., but no
activity against anaerobes
Norfloxacin idem idem
(C; crosses placenta)
TMP-SMX TMP: inhibits dihydrofolate Resistance is common in
(D; avoid near term reductase (blocking conversion tropics
 kernicterus) of dihydrofolic acid to
tetrahidrofolic acid)
SMX: inhibits dihydrofolic acid
synthesis by competing with
PABA
 Antibiotics (continued)
Antibiotics MoA Activity
Doxycycline • Binds to 30S & possibly 50S Active against: C jejuni, E
(D) bacterial ribosomal subunits coli, Shigella spp, MRSA,
• Block dissociation of peptidyl t- V. cholerae, V
RNA from ribosomes parahaemolyticus, Y
enterocolitica, &
mycobacteria other than
tuberculosis

Rifaximin Binds to β-subunit of bacterial Nonabsorbed (< 0,4%);

(C) DNA-dependent RNA polymerase Broad-spectrum ab
 transcription inhibition specific for enteric
pathogens.
Indicated for ETEC & EAEC
 References
• Syam, AF. 2006. Clinical Approach and Management of Food
Poisoning. Acta Medica Indonesiana. 38(2):174-5.
• Yuliastuti, T. 2013. Kuliah Keracunan Makanan S2 Farmakologi FK
UGM.
• Gamarra, R. M. 2016. Medscape Reference.
THANK YOU