Food poisoning Botulism (1).pdf and pptx

By the end of this lecture the student will be able to:
• 1- Identify the food poisoning and its different causes
• 2- Describe the diagnosis and management of food poisoning
• 3-Describe clinical picture, diagnosis and management of food born

2. Food Poisoning & Botulism
By
Heba Allah Abd El Rahman
Lecturer of Forensic Medicine and
Clinical Toxicology
[email protected], Tel:[phone]

3. ILOS
•By the end of this lecture the student will be able to:
•1- Identify the food poisoning and its different causes
•2- Describe the diagnosis and management of food poisoning
•3-Describe clinical picture, diagnosis and management of food born
Botulism.

4. Definition of Food Poisoning
Acute illness related to eating food or drinking water
contaminated with bacteria, parasite, virus or
chemical .

5. Common Causes of Food Poisoning
Toxic Food
Chemical food
poisoning
Infectious
Toxic
Mushroom
Toxic Fish
Pesticides
Food
additives
Botulism
Bacterial
Fungal
Food Allergy
and
idiosyncrasy
Viral

6. Clinical Picture Of Food Poisoning
•A foodborne disease outbreak
is defined by 2 criteria: similar
illness, usually GI in 2 or more
persons & epidemiologic or
laboratory investigation
implicating food as the source.
• Brief interval between eating
& symptoms.
• Group of people present the
same illness after a common
meal.

7. Differential Diagnosis Of Food Poisoning
•Carbon monoxide poisoning
•Organophosphate poisoning

8. Investigation of Food Poisoning
1-Chemical analysis of vomitus.
2. Urine & stool analysis & culture in outbreaks.
• Complete blood picture, blood urea nitrogen,
creatinine.
•Arterial blood gases

9. Treatment Of Food Poisoning
Preventive
Curative

10. Preventive

11. Treatment
A
B
C
D
E
S
Standard Management
Curative
a. Emergency:
* Control hypotension & dehydration.
* Assess ventilation.
b. Decontamination:
not needed usually.
c. Symptomatic: Antispasmodics, antiemetics, antipyretics,
proper antibiotics.

12. Botulism

13. A 16 y old male patient was
brought by his family to the
Emergency Hospital-Toxicology
Unit.
Complaining of repeated
vomiting, difficulty in breathing,
movement and swallowing.
Case

14. The condition started 3
days ago by history of
ingestion of Fesekh, sharing
this food with his family.
After ingestion of this food,
patient developed repeated
vomiting and GIT upset.
He was diagnosed as
gastro-enteritis and
received treatment for that
with no improvement.

15. Patient's condition deteriorated with
difficulty in swallowing, dyspnea, and easy
fatigability.
Patient presented to hospital with, ptosis,
blurring of vision, repeated vomiting, sore
throat, dyspnea,
Dysphagia to both solids and fluids,
hoarseness of voice and inability to micturate.

16. On examination, he was conscious, his
pulse was 100 beat/min, Bl. pressure:
160/100 mmHg, Temp: 37.5°C, respiratory
rate: 25 resp. cycle / min. shallow
breathing.
Pupils were dilated, regular, equal and
with sluggish reaction to light.

17. Descending muscle paresis with
generalized hypotonia and hyporeflexia
allover the body with lost gag reflex.
No abnormal signs were detected by
cardiac and abdominal examination.

18. Arterial blood gases showed respiratory
acidosis
Serum pseudocholine estrase level was 2325
IU/L. (with in normal range)
Toxicological screen was negative for
benzodiazepines, barbiturates, alcohol,
salicylate, phenytoin and valproic acid.

19. The patient was intubated and put on mechanical ventilator.
The patient was admitted to the I.C.U for continuation of therapy
and Botulism antitoxin administration.
The patient improved and discharged after complete the therapy.

20. Botulism
•Spore-forming, anaerobic, gram +ve bacillus. The
spores contain one of 8 strains of potent neurotoxins
A, B, C-α, C-β, D, E, F & G. (commonest human types:
A, B, C & E).
•The toxin: Heat labile destroyed
• by boiling for 10 minutes.
Clostridium botulinum

21. Types of Botulism
•Food born
•Infantile
•Wound
•Aerosolized

22. •1. Food-borne botulism:
•Sources:
1.Home canned foods.
2.Fish without evisceration
3.Improperly prepared commercial products.

23. Toxic Action
❑Spores germinate in an anaerobic conditions
with a pH greater than 4.6. producing
Botulinum neurotoxin.
❑The toxin doesn’t pass the BBB.
❑Paralytic infectious disease caused by
botulinum toxin life-threatening bilateral
symmetrical descending muscle paralysis.
❑The neurotoxin irreversibly binds to presynaptic
cholinergic nerve terminals inhibiting the
release of acetylcholine from the axon blocking
the nerve impulses at the myoneural junction
block muscle contraction.

24. Clinical Picture
▪Initial gastro-intestinal symptoms:
Nausea, vomiting & abdominal pain.
▪Incubation period: 18-36 hours (up to 8 days).
▪ Dry mouth. Difficult swallowing
▪Blurred vision
▪Late signs: Descending symmetrical weakness
& paralysis with intact mentation.

25. •Serum, stool, vomitus, gastric contents & suspect foods should be
obtained for anaerobic culture for C. botulinum & toxin analysis by
ELISA.
•General investigations as: ABG, CBC, Liver and Kidney functions

26. Treatment
A
B
C
D
E
S
Standard Management

27. •Indication: Food borne & wound botulism. It neutralizes activity against
•A, B, C, D, E, F & G.
•Dose:
•One vial (10 ml) in 100 ml saline (1-10 dilution) i.v. infusion.
•Repeated every 2-4 hours till symptoms disappear.
•Side Effects:
•Anaphylactic reaction.
•Serum sickness.

28. In infant botulism. Children less than 1 year of age are most frequently
afflicted. Children ranging from 1–38 weeks old are most susceptible.
Honey is implicated in 5 per cent of cases

29. References
text
•Olson Kent R. Poisoning and
Drug Overdose 2017
•https://drive.google.com/file/d
/1I2-
rRGIM42uv8Ooz9AKuPSb_iiL
dMOUV/view?usp=sharing