1. FOODBORNE INTOXICATIONS (Food poisoning)
Dr. Nadia Aziz
C.A.B.C.M.
Department of community medicine
Medical college, Baghdad University

2. objectives
1-Define what is food intoxication. 2-describe types of food poisoning. 3-discuss clinical features, diagnosis, occurrence & measures of control of food intoxication.

3. Foodborne diseases
Including foodborne intoxications and foodborne infections, are terms applied to illnesses acquired through consumption of contaminated food also include those caused by chemical contaminants such as heavy metals and organic compounds.

4. Foodborne diseases
The more frequent causes are: 1) Toxins elaborated by bacterial growth in the food before consumption Like : Clostridium botulinum, Staphylococcus aureus and Bacillus cereus or in the intestines Clostridium perfringens

5. Foodborne diseases
2) bacterial, viral, or parasitic infections (brucellosis, Escherichia coli, hepatitis A, salmonellosis and infection with vibrios etc…)
3) toxins produced by harmful algal species (ciguatera fish poisoning, paralytic, neurotoxic, diarrhoeic or amnesic shellfish poisoning).

6. Foodborne diseases
Foodborne disease outbreaks are recognized by the occurrence of
illness within usually short time period (a few hours to a few weeks)
after a meal, among individuals who have consumed foods in common.

7. Foodborne diseases
Prompt and thorough laboratory evaluation of cases and implicated foods is essential.
Single cases of foodborne disease are difficult to identify unless, as in botulism, there is a distinctive clinical syndrome.

8. Prevention
Ultimately, prevention depends on educating food handlers about proper practices in cooking and storage of food and personal hygiene.

9. WHO Five Keys to Safer Food
1. Keep Clean. 2. Separate raw and cooked. 3. Cook thoroughly. 4. Keep food at safe temperatures. 5. Use safe water and raw materials.

10. STAPHYLOCOCCAL FOOD INTOXICATION ICD-10 A05.0
An intoxication (not an infection) of abrupt severe nausea, vomiting , cramps, and prostration, often accompanied by diarrhea and sometimes with subnormal temperature and lowered blood pressure. Deaths are rare illness commonly lasts only a day or two

11. Diagnosis In outbreak:
Recovery of staphylococci (105/g of food) on culture media
Detection of enterotoxin from food item.
Absence of staphylococci on culture from heated food does not rule out the diagnosis

12. Diagnosis
A Gram stain of the food may disclose the organisms that have been heat killed.
Isolation of organisms from stools or vomitus of 2 or more ill persons

13. Toxic agent Occurrence
Several enterotoxins of Staphylococcus aureus, stable at boiling temperature.
Staphylococci produce the toxins at levels of water activity too low for the growth of many bacteria.
Occurrence
About 25% of people are carriers of this pathogen.

14. STAPHYLOCOCCAL INTOXICATION
Reservoir
Humans in most instances; occasionally cows with infected udders, as well as dogs and fowl.

15. Mode of transmission
Ingestion of a food containing staph enterotoxin like salad dressings, sandwiches, meat products & cheese. When these foods remain at room temperature for several hours before being eaten, toxin-producing staphylococci multiply and elaborate the heat-stable toxin.

16. Mode of transmission
Organisms may be of human origin from purulent discharges of an infected finger or eye, abscesses, acne form eruptions, nasopharyngeal secretions, or of bovine origin, such as contaminated milk or milk products, especially cheese.

17. STAPHYLOCOCCAL INTOXICATION
Incubation period
30 minutes to 8 hours, usually 2–4 hours.

18. Methods of control A. Preventive measures:
1) Educate food handlers about:
(a) Strict food hygiene, sanitation and cleanliness of kitchens, proper temperature control, hand washing, cleaning of fingernails
(b) The danger of working with exposed skin, nose or eye infections and uncovered wounds.

19. Methods of control
2) Reduce food-handling time (from initial preparation to service), no more than 4 hours at ambient temperature.
(above 60°C) or cold (below 4°C) in shallow containers and covered.
3) Temporarily exclude people with boils, abscesses and other purulent lesions of hands, face or nose from food handling.

20. Methods of control
B. Control of patient, contacts and the immediate environment:
1) Report to local health authority: Class 4.
Control is of outbreaks, single cases are rarely identified.
2) Specific treatment: Fluid replacement when indicated

21. CLOSTRIDIUM PERFRINGENS INTOXICATION ICD-10 A05.2
An intestinal disorder characterized by sudden onset of colic followed by diarrhea, nausea is common. Generally a mild disease of short duration, 1 day or less, rarely fatal in healthy people. Outbreaks of severe disease with high case-fatality rates associated with a necrotizing enteritis

22. Diagnosis In outbreak : Diagnosis is confirmed by demonstration of
Clostridium perfringens in anaerobic cultures of food (105/g) or patients’ stool (106/g).
Detection of enterotoxin in patients’ stool also confirms the diagnosis.

23. CLOSTRIDIUM PERFRINGENS INTOXICATION
Infectious agent
Type A strains of C. perfringens (C. welchii)
cause typical food poisoning outbreaks
Type C strains cause necrotizing enteritis.

24. CLOSTRIDIUM PERFRINGENS INTOXICATION
Reservoir
GI tract of healthy people and animals (cattle, fish, pigs and poultry).

25. Mode of transmission Incubation period
Ingestion of food containing soil or feces and then held under conditions that permit multiplication of the organism.
Almost all outbreaks are associated with inadequately heated or reheated Meats.
Spores survive normal cooking temperatures
Incubation period
From hours, usually 10–12 hours.

26. BACILLUS CEREUS FOOD INTOXICATION ICD-10 A05.4
An intoxication characterized by: sudden onset of nausea and vomiting in others by colic and diarrhea. Illness generally persists no longer than 24 hours and is rarely fatal.

27. Diagnosis In outbreak, diagnosis is confirmed through cultures
of suspected food (more than organisms per gram of food).
Enterotoxin testing is valuable but may not be widely available.

28. Toxic agent Bacillus cereus, an aerobic spore former.
Two enterotoxins have been identified:
1-Heat stable causing vomiting, is produced in food when B. cereus levels reach 105 colony /g of food.
2-Heat labile causing diarrhea, formed in the small intestine of the human host.

29. BACILLUS CEREUS INTOXICATION
Reservoir
A ubiquitous organism in soil and environment
Mode of transmission
Ingestion of food kept at ambient temperatures after cooking.
Outbreaks associated with vomiting have been most commonly associated with cooked rice.

30. BACILLUS CEREUS INTOXICATION
Incubation period
From 0.5 to 6 hours in cases where vomiting is the predominant symptom
From 6 to 24 hours where diarrhea predominates.
Preventive measures:
Foods should not remain at ambient temperature after cooking

31. BOTULISM ICD-10 A05.1
Human botulism is a serious but relatively rare intoxication caused by potent preformed toxins produced by Clostridium botulinum. There are 3 forms of botulism: 1- foodborne (the classic form) 2-wound 3-intestinal (infant and adult) botulism.

32. BOTULISM
All types share the flaccid paralysis that results from botulinum neurotoxin.
Foodborne botulism is a severe intoxication resulting from ingestion of preformed toxin present in contaminated food.

33. BOTULISM
The characteristic early symptoms and signs are: Marked fatigue, weakness and Vertigo, usually followed by Blurred vision, dry mouth, and difficulty in swallowing and speaking. Vomiting, diarrhea, constipation and abdominal swelling may occur.

34. BOTULISM Neurological symptoms always descend through the body
Paralysis of breathing muscles can cause loss of breathing and death.
There is no fever and no loss of consciousness.
The case-fatality rate is 5%–10%.

35. BOTULISM
Infant botulism has in some cases been associated with ingestion of honey contaminated with botulism spores.
It may cause an estimated 5% of cases of sudden infant death syndrome (SIDS).

36. Diagnosis & Infectious agent
demonstration of botulinum toxin in serum, stool, gastric aspirate or incriminated food, or through culture of C. botulinum from gastric aspirate or stool of the patients
Clostridium botulinum, a spore-forming anaerobic bacillus, isolated from soil, seafood and meat from marine mammals.
Toxin is produced in canned, low acid or alkaline foods.
Toxin is destroyed by boiling

37. BOTULISM Reservoir Incubation period
Spores, ubiquitous in soil, honey & in the intestinal tract of animals.
Incubation period
usually within 12–36 hours

38. Control of patient, contacts and the immediate environment
1) Report to local health authority: Class 2 2) Specific treatment: Intravenous administration of 1 vial of polyvalent (AB or ABE) botulinum antitoxin as soon as possible, Antibiotics do not improve the course of the disease.

39. SALMONELLOSIS ICD-10 A02 A bacterial disease manifested by:
Acute enterocolitis, headache, abdominal pain, diarrhea, nausea and sometimes vomiting.
Dehydration, especially among infants or in the elderly, may be severe.
Fever is almost always present.
Deaths are uncommon, except in the very young, the very old, the debilitated and the immunosuppressed.

40. Diagnosis & Infectious agents
Salmonella isolated from feces during acute stages of enterocolitis.
In the recently proposed nomenclature for Salmonella the agent formerly known as S. typhi is called S. enterica
Salmonella enterica serovar Typhimurium (commonly S. Typhimurium) and
Salmonella enterica serovar Enteritidis (S. Enteritidis) are the most commonly reported

41. SALMONELLOSIS
Occurrence Worldwide, contaminated food, mainly of animal origin, is the predominant mode of transmission. The incidence rate of infection is highest in infants and young children. person-to-person spread can also occur

42. SALMONELLOSIS Reservoir
Domestic and wild animals, including poultry, swine, cattle, rodents and pets such as iguanas, turtles, chicks, dogs and cats; also humans, i.e. patients,
convalescent carriers
Chronic carriers are rare in humans
but prevalent in animals and birds.

43. Mode of transmission
Ingestion of the organisms in food from infected animals or contaminated by feces of an infected animal or person. This includes eggs, raw milk, contaminated water, meat & poultry.
Maternity units with infected (at times asymptomatic) infants, are sources of further spread.

44. SALMONELLOSIS Incubation period Period of communicability
From 6 to 72 hours, usually about 12–36 hours.
Period of communicability
Throughout the course of infection.
A temporary carrier state occasionally continues for months, especially in infants.

45. Susceptibility Increased by:
Achlorhydria, antacid treatment, gastrointestinal surgery,
broad-spectrum antibiotherapy, neoplastic disease, immunosuppressive treatment and other debilitating conditions including malnutrition.

46. Methods of control
A. Preventive measures: 1) Educate all food handlers about the ways of proper preparation & handling of food. 2) Exclude individuals with diarrhea from food handling and from care of hospitalized patients, the elderly and children.

47. B. Control of patient, contacts and the immediate environment
Specific treatment: rehydration and electrolyte replacement Antibiotics may not eliminate the carrier state ciprofloxacin is highly effective ampicillin or amoxicillin may also be used. Patients infected with HIV may require lifelong treatment to prevent Salmonella septicemia.

48. Organism
Incubation period
Signs & Symptoms
Duration
Food Sources
Staphylococcus aureus
30 min- 8 hrs
Sudden onset of severe nausea and vomiting.
24-48 hours
meats, egg, salads, cream pastries
Clostridium perfringens
8–24 hours
Intense abdominal cramps, watery diarrhea
24 hours
Meats, poultry
Bacillus cereus
6 -24 hrs
Abdominal cramps, watery diarrhea,
Cooked rice
Clostridium botulinum
12-36 hours
Vomiting, diarrhea, blurred vision, muscle weakness, respiratory failure and death
Variable
Improperly canned foods, especially home-canned vegetables
Salmonella
6-72 hours
Diarrhea, fever, abdominal cramps, vomiting
4-7 days
Eggs, poultry, meat, unpasteurized milk or juice, cheese

49. Thank you & Good Luck