FOOD POISONING By: Dr. : Ragia Mahmoud Hegazy Assistant Professor of clinical toxicology Umm Al- Qura University What is food poisoning?? • any illness resulting from the consumption of food • There are two types of food poisoning: food infection and food intoxication. 1) Food infection refers to the presence of bacteria or other microbes which infect the body after consumption. 2) Food intoxication refers to the ingestion of toxins contained within the food, including bacterially produced exotoxins, which can happen even when the microbe that produced the toxin is no longer present or able to cause infection • Improper handling, preparation, or food storage. • large variety of toxins that affect the environment. • Pesticides or medicines in food and naturally toxic substances like toxic mushrooms • Food that has been exposed to environment with temperature 30 C Causes Causes of bacterial infection • In the United Kingdom during 2010 the individual bacteria involved were as follows: Campylobacter 77.3%, Salmonella 20.9%, Escherichia coli 1.4%, and all others less than 0.1%. 1) The main Bacterium • Campylobacter bacteria • Found in raw chicken and meat and also in un-pasteurised milk • Outbreak of illness usually involve the consumption of raw or cooked seafood. • Vomiting, diarrhea, fever, abdominal pain, & Blood in stool • Symptoms appear after 2-5 days after consumption of the food 2) Other bacteria a) b) c) d) e) f) g) Salmonella Escherichia coli Shigella sp Staphylococcus aureus Vibrio cholera Cl. botulinum E. Choli h) Uncommon types:Yersinia enterocolitica, Listeria monocytogenes Salmonella (S. typhi, S. paratyphi): Primary infection After digestion of products from ill animals – poultry meat or eggs (eggs that are not adequately cooked), meat products –forcemeat, salamies, sausages, or mayonnaise products. Secondary infections - Food was contaminated either directly from ill people or carriers (faecal-oral transmission) or indirectly via contaminated water, by insects, rodents or other animals. Most of all are comtaminated milk products (milk, icecream, sweets) The symptoms include diarrhoea, abdominal pain, vomiting and fever. Shigella —› Shigelosis / Bacillary Dysentery Secondary infection. The source of infection is excreta of infected individuals or convalescent carriers. (traveler's diarrhea ) Direct spread is by the fecal-oral route; indirect spread, and by contaminated food. Water-borne disease is unusual. Flies serve as mechanical vector. Epidemics occur most frequently in overcrowded populations with inadequate sanitation. Bacillary dysentery is particularly common in younger children, adults usually have less severe disease. Staphylococal food poisoning Staphylococcus aureus Caused by enterotoxin of staphylococci in contaminated food, not by the organism itself. The outbreaks is high when food handlers with skin infections contaminate foods left at room temperature. Staphylococcal enterotoxin is relatively thermostable. Optimal temperature for bacterial growth is 30 – 35oC. I P is: 2 to 8 h after eating food containing the toxin. Incriminated foods include: poultry, egg salads, milk products, and cheese. Cl/P: vomiting, diarrhea, fever with abdominal pain. • D.D. from E. choli: Watery diarrhea, Severe abdominal pain, Bloody diarrhea, Mild fever (or no fever) Vibrio cholerae An acute infection characterized by profuse watery diarrhea, vomiting, muscular cramps, dehydratation, oliguria and collapse. V. cholerae produces an enterotoxin, that induces hypersecretion of bowel mucosa. Cholera is spread by ingestion of water, seafoods and other foods contaminated by hand to mouth infection Outbreaks of the disease may be explosive and brief or may be protracted. Vibrio cholerae Cholera is endemic in portions of Asia, the Middle East, Africa and the Gulf Coast of the USA; a major epidemic has recently occured in South America. In endemic areas, outbreaks usually occur during warm months and incidence is highest in children; in newly infected areas, epidemics may occur during any season and all ages are equally susceptible. Incubation period of FP - This ranges from hours to days), depending on the agent, and on how much was consumed. - If symptoms occur within 1–6 hours after eating the food, it suggests that it is caused by a bacterial toxin (enterotoxicosis) or a chemical agent rather than live bacteria (enteroinfection e.g. S. aureus). Examples of food that prone to food poisoning • Milk and dairy products such as cheese • Coconut-milk-based food like nasi lemak • Bread • Raw meat or chicken F.P. Symptoms • • • • • • • • Nausea Abdominal pain Vomiting Diarrhea +/_ Fever Headache Fatigue +/_ bloody stool Treatment (at home) • Do not eat solid food while nauseous or vomiting but drink plenty of fluids. – Drink of clear liquids,diluted sports drinks – Avoid alcoholic, caffeinated, or sugary drinks. – Home remedies such as tea with lemon and ginger can be used for relief from symptoms. – eating should begin slowly, when nausea and vomiting have stopped. – Initially consider eating rice, wheat, breads, potatoes, low-sugar cereals, lean meats, and chicken (not fried). – Milk may experience additional stomach upset due to lactose intolerance. Treatment (cont.) • The main treatment for food poisoning is rehydration through IV and oral fluids. • Do not eat solid food but drink plenty of fluids. • MEDICATIONS: • • • • • • Anti-emetics (Metoclopramide) , Anti-diarrheal (Loperamide ) Antipyretics (APAP), Antispasmodics (anticholinergics) Intestinal antiseptics (Antinal ® nifuroxazide)  Antibiotics (falgyl) in severe cases AVOID NSAIDs, IRON Antibiotics may worsen the condition. The length of illness with traveler's diarrhea (shigellae) can be decreased with antibiotics, but shigellae usually runs its course and improves without treatment. Probiotics & Treatment • Probiotics appear to offer various health benefits. They create a more acidic environment in the intestine and vagina, which helps keep harmful bacterial growth in check. This natural balance can be disrupted, however, by antibiotic use and illness. In these cases, the bad bacteria proliferate, usually causing conditions such as diarrhea or vaginal infections. Taking probiotics may help reduce the symptoms of diarrhea and treat vaginal infections. Treatment (cont.) With mushroom poisoning or eating foods contaminated with pesticides aggressive treatment may include : • Intravenous (IV) fluids • Emergency intervention for life-threatening symptoms (ABC) • Medications such as antidotes, such as activated charcoal, atropine, oximes. • Dextrose 1ml/Kg 50% for adults( 25% for children) if Bl. Gl below 60 mg/dl • ICU admission in severe cases Amanita muscaria (cholinergic crisis) Amanita Phalloides (GIT symptoms, hypoglycemia, multiple organ failure) Symptoms fish poisoning • Fish poisoning causes nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache. Specific types of fish poisoning can cause other signs and symptoms, such as: • Ciguatera (caused by toxins in some fish, including grouper, snapper, mackerel, and barracuda): numbness or tingling around the mouth, feeling of loose teeth, impaired touch sensation of hot as cold and cold as hot, itching, muscle and joint pain, slow heart rate, low blood pressure grouper snapper mackerel barracuda Symptoms of fish poisoning • Pufferfish poisoning: numbness or tingling around the mouth, trouble coordinating movement, difficulty swallowing, excess saliva, twitching, loss of ability to talk, convulsions, paralysis that spreads upward(ascending) , respiratory failure, death. • Shellfish poisoning (caused by toxins in algae that are then eaten by shellfish): numbness or tingling around the mouth or in the arms and legs, trouble swallowing, difficulty speaking. Treatment for fish poisoning (cont.) • Amitriptyline to control the numbness and tingling from ciguatera poisoning • ipecac syrup to cause vomiting and help rid the body of toxins • Diphenhydramine and cimetidine • Mannitol for nerve-related symptoms of ciguatera poisoning Prevention • Proper handling, preparation and food storage • Practice good hygiene like washing hands before eating and preparing food or properly wash the knife or cooking utensils before and after using them • Do not expose the food-cover them properly • Eat well-cooked food (salmonella can be killed in high temperature) Prevention • Always refrigerate fish. • Don't eat wild mushrooms. • Promptly refrigerate any food you will not be eating right away. • When traveling where contamination is more likely, eat only hot, freshly cooked food. Boil water before drinking. Don't eat raw vegetables or unpeeled fruit. • Eat pufferfish only in specially licensed restaurants with chefs trained to cook it. • If others may have eaten a food that made you sick, let them know. If you think the food was contaminated when you bought it from a store or restaurant, tell the staff and your local health department. Acknowledgement • http://www.bharian.com.my/Current_News/BH/r?bodytext=statistik+k eracunan+makanan • http://www.emedicinehealth.com/food_poisoning/page6_em.htm • http://en.wikipedia.org/wiki/Special:Search?search=camphylobacter • http://en.wikipedia.org/wiki/E._coli • http://en.wikipedia.org/wiki/Food_contaminants • http://en.wikipedia.org/wiki/Food_poisoning • http://en.wikipedia.org/wiki/Foodborne_illness • http://www.myhealth.gov.my/myhealth/bm/dewasa_content.jsp?lang =dewasa&storyid=1155037613709&storymaster=1155036117659 • http://www.nhs.uk/Conditions/Foodpoisoning/Pages/Introduction.aspx?r=1&rtitle=Food+poisoning++Introduction • http://www.prn2.usm.my/mainsite/bulletin/racun/1995/makanan.html