Food poisoning

original ppt creditis to dr rajalaxmi.

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2. FOOD POISONING Acute gastro-enteritis caused by the ingestion of the food or drink contaminated with either living bacteria or their toxins or inorganic chemical substances and poison delivered from plants and animals. 2

3. CHARACTERISTICS • There is history of the ingestion of a common food • Attack of the many persons at the same time • Similarity of the sign and symptoms in majority of the cases 3

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7. T YP ES B AC T ER I A L N O N -B A CTE R I A L 8

8. BACTERIAL FOOD POISONING 9 • It is caused by the ingestion of the food contaminated by the living bacteria or their toxins. Food infection the presence of bacteria or other microbes which infect the body after consumption. Food intoxication ingestion of toxins contained within the food, including bacterially produced exotoxins .

9. SALMONELLA FOOD POISONING 11

10. SALMONELLA 12 Common form of the food poisoning An increase in communal feeding An increase in international trade in human food A higher incidences of the salmonellosis in farm animals Wide spread use of the household detergents interfering with the sewage treatment Wide distribution of the prepared food

11. AG E NT Rod-shaped, flagellated, aerobic, Gram- negative ba c ter i u m n eg a t i v 13 Rod-shaped, R fla o g d e - l s la h t a e p d e , d, f a la e g ro e b ll i a c t , e G d, ram a n er g o a b ti i v c e , Gram- n b e a g c a te ti r v i e um ba c ter i u m n eg a t i v

12. SOURCE • • Disease of the animals Man get infection from the farm animal & poultry- • Contaminated Meat Milk & Milk Products Sausages Custards Eggs & Eggs Products Rat & mice are another source, they are often heavily infected and contaminate the foodstuffs by their urine & faeces. 14

13. INCUBATION PERIOD 15 • 12 – 24 hours

14. MECHANISM OF ACTION 16 • After ingestion the organisms multiply in the Intestine & give rise into acute enteritis & colitis .

15. SIGNS & SYMPTOMS 17 • • • The onset is generally sudden with Chills Fever Nausea V o m i ting Profuse Watery Diarrhea (Lasts 2 – 3 days) Convalescent carrier state may last for several weeks. The mortality rate is 1%.

16. S TAPHYLOCOCCAL FOOD POISONING 18

17. AG E NT 19 • • • • • • Staphylococcus aureus Gram positive anaerobic coccal bacteria that appears in clusters. Enterotoxins of the certain strain of the coagulase positive staphylococcus aureus. At least five different enterotoxins have been identified, Toxins can be formed at optimum temperature of 35 o C to 37 o C. These toxins are relatively heat stable and resist a boiling of 30 minutes or more.

18. SOURCE • • • • Staphylococci are ubiquitous in nature Found on the Skin Nose T h roat They are common agents of the boil and pyogenic infection in man and animals. Cow suffering from the mastitis have been responsible for the outbreaks of the food poisoning involving the milk and milk products. 20

19. INCUBATION PERIOD 21 • 1-6 hrs, short because of preformed toxin.

20. MECHANISM OF ACTION 22 • • • Food poisoning resulting from the ingestion of the preformed toxins in the food. In food bacteria have grown (Intradietetic toxins). Toxin remain in the food after the organism have been died. Action of The toxins: The toxin act directly on the intestine and CNS.

21. SIGNS & SYMPTOMS 23 • • • • Sudden onset of- vomiting Diarrhoea Abdominal Cramps In severe cases blood & mucus may appear. Unlike salmonella food poisoning the staphylococci food poisoning rarely cause the fever. Death is uncommon .

22. DIAGNOS IS 24 Stool culture A stool culture is used to detect the presence of disease- causing bacteria (pathogenic) and help diagnose an infection of the digestive tract. In the case of Staphylococcal enteritis it is conducted to see if the stool is +ve for a pathogenic bacterium.

23. B OTULISM 25

24. BOTULISM 26 • • • Botulism derived its name from Latin word (Sausage = Botulus). Most serious type but occurs rarely. It kills about 2/3 rd of the victims.

25. AG E NT • • • • Botulinum toxin is broken into 8 neurotoxins A, B, C, D, E, F, G which are antigenically and serologically distinct but structurally similar. Discovery of H toxin- Oct 2013 Exotoxin of the clostridium botulinum generally type A, B or E cause toxicity in man. Cl. Botulinum C and D cause toxicity in animals. 27

26. S O U R CE • The bacteria is widely distributed in soil, dust and intestinal tract of the animals. The organism enters into the food as spores. • Food Responsible For The Botulism: These are preserved home food such as Home – canned vegetables Smoked or pickled fish Home made cheese Other low – acid foods 28

27. INCUBATION PERIOD 29 • 12 – 36 hours

28. MECHANISM OF ACTION 30 • • • • • Under suitable anaerobic condition the toxins will be preformed into the foods. It act on the parasympathetic nervous system . Its action on the GI – Tract is very slight. Botulinum toxin is one of the most powerful known toxins: about one microgram is lethal to humans when inhaled. It acts by blocking nerve function through inhibition of the excitatory neurotransmitter acetylcholine's release from the presynaptic membrane of neuromuscular junctions in the SNS.

29. SIGNS & SYMPTOMS • • • • • • • • • • D y spha g i a Diplopia Ptosis Dysarthria Blurring of the vision Muscle weakness & even quadriplegia Fever is generally absent. Consciousness is generally retained. The condition is generally fatal. Death occurs 4 – 8 days later due to respiratory or cardiac failure. 29

30. CHARACTERISICS OF BOTULISM TOXINS • • Botulism toxin is thermolabile. Foods contaminated with the botulism toxins heated for 100 o C for a few minutes are safe for consumption. 30

31. INFANT BOTULISM • • • • The botulism occurring in the infants less than 6 months of age. It is due to the infection of the gut by the Cl.botulinum, with subsequent in vivo production of the toxins. Toxins are then absorbed into the bloodstream and taken throughout the body causing paralysis by blocking the release of acetylcholine at the neuromuscular junction. Constipation, lethargy, weakness, difficulty feeding and an altered cry, often progressing to a complete descending flaccid paralysis. 31

32. WOUND BOTULISM • • Wound botulism results from the contamination of a wound with the bacteria, which then secrete the toxin into the bloodstream. This has become more common in intravenous drug users since the 1990s, especially people using black tar heroin and those injecting heroin into the skin rather than the veins . 34

33. BOTULISM ANTITOXINS • When a case of the botulism have occurred, antitoxins should be given to all individuals partaking of the food. • The dose varies from the 50,000 – 100,000 unit IV. • The antitoxin is of no value if the toxin is already fixed to the nervous tissues. • Guanidine hydrochloride given orally in doses of the 15 – 40 mg/kg of the body weight have been shown to reverse the neuromuscular block of the botulism. • Active immunization with botulism toxoid is available. 35

34. PR E V E N TI ON 36 A recommended prevention measure for infant botulism is to avoid giving honey to infants less than 12 months of age, as botulinum spores are often present. In older children and adults the normal intestinal bacteria suppress development of C. botulinum . Commercially canned goods are required to undergo a "botulinum cook" in a pressure cooker at 121 °C (250 °F) for 3 minutes.

35. Cl. PERFRINGENS FOOD POISONING 37

36. AGENT • Cl. perfringens (Welchii) 38

37. S OURCE 39 • • The organism have been found in the faeces of the human and animals, soil, water and air. The majority of the outbreak have been associated with the ingestion of the meat, meal dishes and poultry.

38. INCUBATION PERIOD 40 • 6-24 hrs with peak from 10 to 14 hrs.

39. MECHANISM OF ACTION 41 • • • The spores are able to survive the cooking. If the cooked meat and poultry are not cooled enough, they will germinate. The organism multiply between the 30 o C – 50 o C and produce a variety of the toxins such as alpha – toxin, theta – toxins etc.

40. SIGNS & SYMPTOMS • • • Diarrhoea Abdominal Cramps Little or no fever • • • Nausea & vomiting are rare. Illness is usually of the short duration (1 day or less). Recovery is rapid and no death have been reported. Occurs 8-24hrs after food consumption 42

41. D I AGNOSIS • • • C. perfringens can be diagnosed by Nagler's reaction where the suspect organism is cultured on an egg yolk media plate. One side of the plate contains anti-alpha-toxin, while the other side does not. A streak of suspect organism is placed through both sides. An area of turbidity will form around the side that does not have the anti-alpha-toxin, indicating uninhibited lecithinase activity. 41

42. PR E V E N TI ON 44 • Cooking food just prior to its consumption or if it has to be stored, by rapid and adequate cooling .

43. B. CEREUS FOOD POISONING 45

44. AGENT 46 • • • • Bacillus – cereus is an aerobic, spore – bearing, motile gram positive rod. It is ubiquitous in soil and in raw, dried and processed foods. The spore can survive cooking and germinate and multiply rapidly when the food is held at favorable temperature. B – cereus has been recognized as a cause of the food poisoning with increasing in frequency in recent years .

45. ENTEROTOXINS 47 • • • B – cereus produce at least two distinct enterotoxins causing two distinct form of the food poisoning Emetic form of food poisoning Diarrheal form Of food Poisoning

46. EMETIC FORM 48 • • • • • Short incubation period in between 1 – 6 hours It is characterized pre-dominantly by the upper gastro – intestinal tract symptoms. The 'emetic' form is commonly caused by rice cooked for a time and temperature insufficient to kill any spores present, then improperly refrigerated. It can produce a toxin cereulide, which is not inactivated by later reheating. This form leads to nausea and vomiting one to five hours after consumption. Emetic toxin can withstand 121 °C (250 °F) for 90 minutes.

47. DIARRHOEAL FORM 49 • • • • • longer incubation period of about 12 – 24 hours It is characterized predominantly by the Diarrhoea Abdominal pain Nausea with little or no vomiting and no fever The recovery within the 24 – hours is usual The toxins are preformed and stable. Enterotoxin can be inactivated after heating at 56 °C (133 °F) for 5 minutes.

48. DIAGNOS IS 50 • Diagnosis can be confirmed by the isolation of the organism of 10 5 or more B – cereus organism per gram of the epidemiologically incriminated food.

49. PROGNOSIS 51 • • Most emetic patients recover within six to 24 hours, but in some cases, the toxin can be fatal. In 2014, 23 neonates receiving total parenteral nutrition contaminated with B. cereus developed septicaemia, with three of the infants later dying as a result of infection.

50. DIFFERENTIAL DIAGNOSIS 52 • • • Cholera Acute bacillary dysentery Arsenic poisoning

51. CHOLERA & FOOD POISONING 53 Cholera Food poisoning Epidemology Occur often in epidemic form associated with other cases in the neighbourhood Often a single group of persons who shared a common meal Incubation From a few hours upto 5 days 1 to 24 hrs Onset With purging With vomiting Nausea & retching None Present Vomiting Projectile, effortless, watery and continuous Often single, severe vomit, mucuous and blood streaked

52. Cholera Food poisoning Stools Copious, rice watery, frequent, may contain inoffensive mucus and blood, offensive Tenesmus None Yes Abdominal tenderness None Yes Dehydration Very marked Distinct Muscular cramps Constant and severe Less constant Surface temp Subnormal Often upto 100-102 deg F Headache None Often Urine Suppressed Seldom suppressed Blood Leucocytosis Normal 54

53. INVESTIGATION OF FOOD POISONING 59 Secure complete list of the people involved and their history Laboratory Investigation Animal Experiments Blood for the antibodies Environmental Study Analysis of the data according to descriptive method of time, place and person A case control study may be undertaken to establish the epidemiologic association between illness and the intake of the particular foods.

54. PREVENTION & CONTROL Food sanitation Refrigeration Meat inspection Personal hygiene Excluding diseased foodhandlers Food handling techiques Sanitary improvements Health education ‘ Cook and eat the food same day immediately’ Food held between 10 o C and 49 o C are in danger zone for bacterial growth. Surveillance To avoid outbreaks of foodborne illness 60

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