FOO+D-BORNE DISEASES

/FOOD POISONING,
FOOD-BORNE INTOXICATIONS,
FOOD-BORNE INFECTION/
 Introduction
• Food borne disease (also referred to as food-borne
illness or food poisoning) is any illness that results from
the consumption of contaminated food and beverages,
contaminated with pathogenic bacteria, viruses, or
parasites.

• More than 250 different foodborne hazards have been

recognized including infectious bacteria, viruses and
parasites, and noninfectious chemicals and toxins
 Introduction----
• Foodborne diseases are acute illnesses, usually affecting the
gastrointestinal tract, brought on by consuming contaminated
food or beverages.

• Contamination of food may occur at any stage in the process

from “farm to fork” and can result from environmental
contamination, including pollution of water, soil or air.

• Many of these agents commonly cause diarrhea and vomiting,

but there is no single clinical syndrome for all foodborne
disease
 Global burden
• Foodborne diseases are an important public health problem
worldwide and have an important impact on travel, trade, and
development.

• The World Health Organization (WHO) estimated that 31

foodborne hazards caused 600 million foodborne illnesses
and 420,000 deaths worldwide in 2010 (Havelaar et al., 2015)

• Many of these foodborne illnesses and deaths were caused by

diarrheal diseases, a leading cause of global deaths in young
children.Because,
• Food born diseases are important cause of morbidity and mortality
worldwide, but the full extent and cause of unsafe food has been
unknown

• Determining whether an illness is foodborne can be difficult because the

illness may not develop for days or even weeks after exposure to a
pathogen, and the most recently eaten meal may incorrectly get the
blame

• One way to determine that a disease is foodborne is to find the agent that
caused the disease in a sample of the food that the ill person has eaten

• This is not always possible because leftover food may not be available or
no analytical technique may exist to detect the agent.
• Food-borne diseases, including food-borne intoxications and food-
borne infections, are terms applied to illnesses acquired by
consumption of contaminated food.

• They are frequently and inaccurately referred to as food poisoning.

• While these terms would include illnesses caused by chemical

contaminants (heavy metals and organic compounds), this chapter
will cover illnesses caused by toxins elaborated by bacterial
growth in the food before consumption (staphylococcus aureus and
botulism) and a food-borne infection (salmonellosis).
• Foodborn disease high in low or midle income /developing
countries than developed countries.

Food poisoning-Food poisoning may be defined as an acute

gastroenteritis caused by ingestion of food or drink
contaminated with bacteria/their toxins/chemicals or
poisons derived from plants and animals.
 Typical Characteristics of food poisoning

1.A group of people present with a history of ingestion of a

common food

2. Many persons are affected at the same time.

3. Most of the cases involved, present with similar clinical

features.
 Classification of Food Poisoning
Type of Poisoning Subtype Selected Specific Agents

Bacterial S. typhimurium
Salmonellosis S. enteritidis
Salmonella choleraesuis
Staphylococcal S. aureus

Botulism C. botulinum

Perfringens enteritis C. perfringens (welchii)

B. cereus B. cereus

E. coli E. coli
Virus Norovirus, Rotavirus

Inherently poisonous
Mushrooms Dhatura
foods
Shellfish
 Classification of Food Poisoning
Type of Poisoning Subtype Selected Specific Agents

Allergic foods Prawns

From utensils Zinc, Copper

Industrial metals Mercury, Lead, Arsenic

Chemicals Heavy metals Mercury, Lead,

Pesticides, insecticides DDT, BHC, Malathion

Alkaloids

Parasites From animals/meat Trichinella, Taenia

 1. Staphylococcal Food Poisoning (intoxication)

Definition

• An intoxication (not infection) of abrupt and sometimes

violent onset.
• Staphylococcal food poisoning is one of the most
common foodborne diseases worldwide
• It is caused by the ingestion of enterotoxins preformed in
the food, mainly by strains of coagulase-positive
staphylococci and, more rarely, by coagulase-negative
strains
Infectious agent (Toxic agent)

• Several enterotoxins of staphylococcus aureus, stable at

boiling temperature.

• Staphylococci multiply in food and produce the toxins.

Epidemiology
Occurrence- Widespread and relatively frequent
Reservoir- Humans in most instances; occasionally cows
with infected udders.
 Staphylococcal Food Poisoning (intoxication)…
Mode of transmission

• By ingestion of a food product containing staphylococcal

enterotoxin.

• Foods involved are particularly those that come in contact with food
handlers’ hands, either without subsequent cooking or with
inadequate heating or refrigeration, (e.g. salad, sandwiches, sliced
meat and meat products, pastries, etc.).

• When these foods remain room temperature for several hours before
being eaten, toxin-producing staphylococci multiply and elaborate
the heatstable toxin.
• The organisms may be of human origin, from purulent
discharges of an infected finger or eye, abscesses,
nasopharynyeal secretions.

Incubation period- 30 minutes to 8 hours, usually 2-4

hours.

Period of communicability- not applicable

Susceptibility and resistance- Most people are susceptible

 Staphylococcal Food Poisoning (intoxication)…
Clinical Manifestation

• Sudden onset of vomiting and watery diarrhea

• Fever and abdominal cramp

• The intensity of illness may require hospitalization.

Diagnosis

• Group of cases with characteristic acute predominantly upper gastrointestinal

symptoms and the short interval between eating a common food item and the onset
of symptoms.

• Culture –staphylococcal recovery (≥105organisms per gram of food) or detection

of enterotoxin from an epidemiologically implicated food item confirms the
diagnosis.
 Staphylococcal Food Poisoning (intoxication)…
Treatment
1. Fluid and electrolyte replacement if fluid loss is significant particularly in
severe cases.
Prevention and Control

1. Educate food handlers in strict food hygiene, sanitation and cleanliness of

kitchens, proper temperature control, handwashing, cleaning of finger nails,
need to cover wounds on the skin, etc.

2. Reduce food-handling time (initial preparation to service) to an absolute

minimum, with no more than 4 hours at ambient temperature. Keep perishable
food hot (>60c0) or cold (below 10c0).

3. Temporarily exclude people with boils, abscesses and other purulent lesions
of hands, face or nose from food handling.
 2. Botulism
Definition
• A paralytic disease that begins with cranial nerve involvement

and progresses gradually to involve the extremities.

Infectious agent (Toxic agent)

• Toxin produced by Clostridium botulinum (Neurotoxin)

Epidemiology

• Worldwide occurrence. Home-canned foods, particularly

vegetables, fruits and less commonly with meat and fish.

 Botulism---
• Outbreaks have occurred from contamination cans

damaged after processing.

• Commercial products occasionally cause outbreaks but

some of these outbreaks have resulted from improper

handling after purchase.

• Food-borne botulism can occur when a food to be

preserved is contaminated with spores.

 Botulism…
Reservoir- The bacteria is found in the soil and in the intestine of
animals.

Mode of transmission- Food ingestion in which preformed toxin is

found.

Incubation period- Neurological symptoms of food-borne botulism

usually appear within 12-36 hours, sometimes several days, after
eating contaminated food.

Period of communicability- not communicable

Susceptibility and resistance- Susceptibility is general.

 Botulism…
Clinical Manifestations

• Illness varies from a mild condition to very severe disease that can result in
death within 24 hours.

• Symmetric descending paralysis is characteristic and can lead to respiratory

failure and death.

• Cranial nerve involvement marks the onset of symptoms; usually produces

diplopia, dysphagia. Weakness progresses, often rapidly, from the head to
involve the neck, arms, thorax and legs; the weakness is occasionally
asymmetric.

• Nausea, vomiting, abdominal pain may proceed or follow the onset of

paralysis.
 Botulism…

• Dizziness, blurred vision, dry mouth, and occasionally sore throat are
common.

• No fever

• Ptosis is frequent.

• Papillary reflexes may be depressed: fixed or dilated pupils are noted in

half of patients.

• The gag reflex may be suppressed; deep tendon reflexes may be normal or
decreased.

• Paralytic illus, severe constipation and urinary retention are common.

 Botulism…
Diagnosis
• Clinical- afebrile, mentally intact patients who have symmetric
descending paralysis without sensory findings.
• Appropriate History.
• Demonstration of organisms or its toxin in vomitus, gastric fluid or
stool is strongly suggestive of the diagnosis
• Wound culture
Treatment
1. Hospitalize the patient and monitor closely.
2. Intubation and mechanical ventilation may be needed.
3. Antitoxin administration after hypersensitivity test to horse serum.
4. Emesis and lavage if short time after ingestion of food to decrease
the toxin.
 Botulism…

Prevention and control

1. Ensure effective control of processing and preparation of

commercially canned and preserved foods.

2. Education about home canning and other food preservation

techniques regarding the proper time, pressure and temperature
required to destroy spores, the need for adequate refrigeration,
storage, boiling with stirring home-canned vegetables for at least 10
minutes to destroy botulinal toxin.

3. Canned foods in bulging containers should not be used, eaten or

tasted.
 3. Salmonellosis
Definition

• A bacterial disease commonly manifested by an acute enterocolitis.

Infectious agent

• Salmonella typhimurium and Salmonella enteritidis are the two most

commonly reported.

Epidemiology:

Occurrence- Worldwide

Reservoir- Domestic and wild animals including poultry, swine, cattle,

rodents and pets (tortoises, dogs, cats and humans) and patients or
convalescents are carriers, especially of mild and unrecognized cases.
 Salmonellosis…
Mode of transmission

• Ingestion of organisms in food derived from infected food animals or

contaminated by feces of an infected animal or person.

• Raw and under-cooked eggs and egg products, raw milk and its
products, contaminated water, meat and its products, poultry and its
products.

• Consumption of raw fruits and vegetables contaminated during slicing.

Incubation period –from 6 –72 hours, usually about 12-36 hours

Period of communicability- extremely variable through the course of

infection; usually several days to several weeks.
 Salmonellosis…
Susceptibility and resistance- Susceptibility is general and increased
by achlorhydria, antacid therapy, gastrointestinal surgery, prior or
current broad spectrum antibiotic treatment, neoplastic disease,
immunosuppressive treatment and malnutrition.
Clinical manifestation
• Self limited fever and diarrhea (bloody or dysenteric when colon is
involved)
• Nausea, vomiting and abdominal cramp
• Microscopic leukocytosis.
Diagnosis
• Blood culture initially
• Stool, culture
 Salmonellosis…
Treatment

1. Symptomatic

2. If there is an underlying immunosuppressive disease (conditions like AIDS,

lymphoma, immunosuppressive treatment), treat the underlying cause.

Prevention and control

1. Improved animal rearing and animal marketing

2. Quality testing of the known and commonly contaminated foods

3. Avoid consuming raw or partially cooked eggs

4. Wear gowns and gloves when handling stool and urine and hand washing
after patient contact.
GOOD LUCK!!!