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FOOD
POISONING
FOOD POISONING FOOD POISONING DEFINITION OF FOOD POISONING > Food poisoning is general term for health problem arising from eating contaminated food by bacteria, viruses, or environment toxins that present within the food it self characterized by nausea, vomiting with/without diarrhea. > The contamination of food may occur at any stage in the process from the food production to consumption Carta 5.16: Kadar kejadian keracunan makanan mengikut negeri, Malaysia, 2012 Chats 76° incidence rafe for food nosomng by alate, Malaya 20iz Kadar epaden bagi sebop 100 000 pemcucul AP tuoi Larger ibD cence Fane ee 100) OO) pee cnt Pulay Pinang Selanger Kelantan Pronak Perkin 1o23 Tons a =o 40 60 Lt] 100 12m Termmasuk WP, Putnagaypa Sumber: Kementenan Hesihatan decir EY Putra Sore Mirashy of hima Incidence Rate and Mortality Rate of Communicable Diseases, 2013 (per 100,000 Population) Communicable Incidence Mortality Diseases Rote Rate Food and Water Bome Diseases Cholera 0.56 0.00 Dysentery 0.28 0 Food Poisoning 47.79 0.04 Hepatitis A 0.4) fs] Typhoid 0.73 0.01 Salmonella Salmonell There are > 4000 salmonella serotypes Most common salmonella spps » Salmonella Enteritidis & Salmonella Typhi >» Two types of salmonella infections: i) Systemic infections (enteric fever): S. Typhi, S. Paratyphi A—C 2) Gastroenteritis (salmonellosis): S.enteritidis » Pathogenesis : with the invasion of intestinal epithelia i, invasion continues and infection becomes generalized = little or no diarrhea, but pronounced fever & other general symptoms 2. infection is localized to ileocaecal region > diarrhea, nausea & vomiting, abdominal pain, temperature may be elevated & ¢. perfringens is found frequently in the intestine of humans, animals, present in soil and areas contaminated by human or animal feces. results by eating improperly cooked and stored foods. > & Commonly infected foods = meats, meat products, and gravy. cause intense abdominal cramps and watery diarrhea. & “Stool culture and blood tests may be done to canfirm the diagnosis. *treat C. perfringens food poisoning by managing any complications (dehydration caused by diarrhea and vomiting) Clostridium botulinum ® Cl.botulinum-gram positive bacilli with sub terminal spores ® causes botulinism Pathogenesis by botulinum toxin, & Mode of infection by soil,contaminated food. Treatment with penicillin,antitoxin. Prevention Feood food manufacturing practice. adequate cooking of food before consumption Food containing protein is cooked (bacteria usually killed). | 2) Then food is contaminated by worker with staphylococci on hands (competing bacteria have been eliminated). | © Food is left at room temperature. Organisms incubate in food (temperature abuse) long enough to form and release toxins. (Reheating will eliminate staphylococci but not the toxins.) | 4) Food containing toxins is eaten. In 1-6 hours, staphylococcal intoxication occurs. > Specimens-suspected food,vomits & faeces. » Microscopy ® Culture on blood agar media grows beta haemolytic colonies. > Coagulase test-positive > Treatment: Cloxacillin,vancomycin,linezolid etc . T ‘eee ae A Shea cl forrest in a heel hutbes by Wea Codey Ue Frm ace c Vibrio cholerae F Vibrios-2 spps vibria cholerae V.parahaemolyticus-comma shaped re Mode of infection is faeco-oral route, Through ingestion of contaminated water or sea food or by exposure of disrupted skin and mucosal surfaces to contaminated water, e Pathogenesis: Cholera toxin activates adenylate cyclase 3 hyper secretion of water & electrolytes 4 death by dehydration and electrolyte abr ormalities “Rice-Woter” stools, painless, non-bloody diarrhoea Severe Dehydration-thirst, oliguria, anuria, cramps, weakness, decrease turgor Circulatory collapse- cyanosis, stupor, renal tubular necrosis, death ¥,YTfYT YT Metabolic Acidosis may be severe loss of bicrabonates. & Laboratory daignosis: ® specimen-stool,rectal swabs in acute phase of diarrhoea. Elisa Culture on TCBS agar media yellow — green coloured colonies. Serodiagnosis very less efficient agglutinatian& anti toxin test. ® Treatment: rehydration & antimicrobial agents like tetracycline or doxycycline Chloramphenicol,ampicillin or trimethoprim-sulfamethoxazole. » Prevention: Chemoprophylaxis. Investigation & Laboratory investigation & Gram staining and Loeffler methylene blue staining of the stool for WECs help to differentiate invasive disease from noninvasive disease. ® Perform microscopic examination of the stool for ova and parasites. ® Bacterial culture for enteric pathogens, such as Solmonella becomes mandatory if a stool sample shows positive results for increase WBCs or if patients have fever or symptoms persisting for longer than 3-4 days. » Perform blood culture if the patient is notably febrile. ® CBC with differential, serum electrolyte assessment, and BUN and creatinine levels help to assess the inflammatory response and the degree of dehydration. » Imaging investigation ® abdominal radiographs should be obtained if the patient experiences bloating, severe pain, or obstructive symptoms or if perforation is suggested. - Invasive investigation & When a stool examination is nondiagnostic, performing sigmoidoscopy/colonoscopy with biopsy and esophagogastroduodenoscopy (EGD) with duodenal aspirate and biopsy may be beneficial, ® Consider sigmoidoscopy in patients with bloody diarrhea. It can be useful in diagnosing inflammatory bowel disease, antibiotic-associated diarrhea, shigellosis, and amebic dysentery. 
