FOOD POISONING By: Dr. : Ragia Mahmoud Hegazy Assistant Professor of clinical toxicology

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