Download Food poisoning

Dnepropetrovsk State Medical Academy
Chair of general hygiene
Head of the chair, prof. Belitskaya A.N.
Training appliance for practical lessons.
FOOD POISONING. Methods of the food poisoning
investigation.
Author: senior lecturer Antonova E.V.
Dnepropetrovsk - 2005
According statistical data Ukraine population health condition is characterized by the
negative tendencies. Infectious morbidity and no infectious morbidity of the digestive apparatus
directly depend on the nourishment quality. Taking the food the pathogenic microorganisms can
get into the human organism. By the way, health condition disorder can be the result of an edible
and inedible food mixing (mushrooms, harmful additions in the food, and harmful characteristics
of the food which acquire during cooking).
Microbe diseases with food transmission mechanism (table 1).
Zoonosises:
- anthrax, aphthous fever, brucellosis (through milk and meat of the sick animal);
- tularemia (through milk and meat of the sick animal, water, grain-crops);
- pig plague (it’s dangerous owing to the secondary infection – salmonellas);
- leptospirosis (water is the main way, milk);
- ornithosis (through the eggs of the sick poultry);
- ku-fever (through milk, airborne way);
- endemic encephalitis (through milk, ticks);
- salmonellosis (through milk and meat of the sick animals, airborne way is possible too)
Anthropozoonosises:
- bacillary dysentery (ways of transmission: fecal-oral and food transmission);
- typhoid fever (ways of transmission: fecal-oral and food transmission (milk, salads, fruits,
berries), water);
- paratyphoid A and B;
- hepatitis A and E (water and food);
- amebiasis (ways of transmission: fecal-oral, water, food transmission);
- helminthosis
Let’s go into detail on the question of the food poisoning. There are different points of view on
the definition of the food poisoning conception. Hygienists consider that food toxic infection,
food bacterial toxicosis, organic nature toxic substance intoxication and inorganic nature toxic
substance intoxication are the food poisonings.
Table 1
Microbe diseases of the food transmission mechanism
Zoonosises:
- anthrax, aphthous fever, brucellosis;
- tularemia;
- leptospirosis;
- ornithosis;
- ku-fever;
- endemic encephalitis
- salmonellosis.
Anthropozoonosises:
- bacillary dysentery;
- typhoid fever;
- paratyphoid A and B;
- hepatitis A and E;
- amebiasis;
- helminthosis.
Food poisoning of microbe nature:
- toxic infection;
- bacterial toxicosis;
- micotoxicosis.
Epidemiologists have another point of view. They don’t recognize the food poisoning of
bacterial mechanism or refer the intestinal infections ( paratitis, dysentery) to the bacterial food
poisoning, because clinical aspects resemble the food toxic infection.
Food poisonings are the acute (seldom chronic ones) uncontacted illnesses, they arise owing to
the food with the definite kinds of the microorganism or/and theirs toxins or toxic substances of
microbe nature or no microbe nature.
They are not referred to the F.P.:
- food intolerance: food allergies, anaphylactic reaction (reaction for strawberry, raspberries),
it is a question for the allergologists; idiosyncrasies – reaction for taking unusual food,
psychogenetic reaction for the food;
- reaction for taking food in plenty (hypervitaminosis, excess of mineral substances, for ex.
Fluorine – fluorosis);
- disease of not only food transmission factor: salmonellosis (airborne way is possible;
salmonellosis in the maternity hospitals; that’s why it’s out of the food poisoning
classification);
- dysentery – water is a possible transmission way too; states connected with taking alcohol
drinks;
- states connected with mistaken taking no food substance instead of food (nitrite sodium);
- states connected with infringement of the nourishment rules (milk+fish, unripe fruits using);
- intentional poison taking with food to murder smb or oneself;
- dyspepsias connected with congenital or gain enzymepations.
Now we consider the classification of 1981, which is used by the hygienists. The etiologic and
pathogenic principles underlined the food poisoning classification.
This classification has some defects.
1. Food poisoning caused by Citrobacter, psendomonas, aeromonas, clebsiela referred to the
food poisoning group of the microbe nature. It’s wrong. These microorganisms don’t cause the
food poisoning but intestinal infection which refers to the infection diseases, because these are
the contagious diseases.
2. The definition “toxic infections” isn’t good one. It’s impossible to poison smb. with the
microorganisms.
3. Botulism can be offered to the toxicosis and toxic infections. There is a no food botulism: cl.
Botulinum can develop in organism after the open fractures, lacerated wounds with wound
crushing, wound pollution after bad debridement, wound pollutered with cl. Botulinum, wound
botulism develops.
The clinical picture is the same as food botulism clinical picture, botulism develops with
dysbacteriosis (infants); otitis, autritis had similar clinical picture with food botulism. So food
way of transmission isn’t sole one. In spite of this according last IDC botulism and
staphylococcus toxicisis are related to the food poisoning.
4. The food poisoning with histamine isn’t included.
5. Section food poisoning with mushrooms is needed to become more exactly.
According the classification:
1 group – food poisoning of microbe etiology:
- toxic infections;
- toxicosis;
- mixed infections
Toxic infections
(table 2)
 Bacteria E. coli
 Pathogenic
galophylis
(Vibrio
parahemoliticus)
 Bacteria Proteus
 Explored
microorganisms
 Enterococcuses
(Citrobacter,
Hafnia,
Klebsiella
 Sporogenous
Anaerobes
(Cl.
Yersinia, Pseudomonas, Aeromonas
Perfringens)
and etc.)
 Sporogenous Aerobes (Bas. Cereus)
Toxic infection is an acute illness connected with taking food gone to seed with E. coli and
etc. It’s necessary to divide the toxic infections and infection diseases.
Common sings:
- mass character (centralized food sale);
- sudden beginning;
- acute process;
- damage of the gastrointestinal tract;
- sings of the intoxication (fever, damage of the central nervous system).
Distinctive sings of the toxic infections are:
- sudden beginning and short incubate period;
- short and light process, complete recovery in 2-3 days;
- people fall sick taking food gone to seed with pathogenic microorganisms simultaneously;
- disease is closely connected with the disorder of the sanitary rules;
- territory limitation of the disease;
- Prompt stopping of the outbreak when health hazard products are withdrawn of use;
- Mass character (centralized food sale)
- Pathogenic degree of the microorganism – quantity of the microorganism in 1 gr or 1 ml
is nor less than 105 – 106 (infection disease – 102 – 103 );
- uncontagious factor;
- Lack of the immunity;
- Lack of the “epidemiologic tail”.
Clinical and epidemiological signs of the food toxic infections are typical owing to
infectious agents (enterotoxicogenic and pathogenic strains) which have low pathogenic level
and haven’t ability for reproduction in the health human organism. It’s not typical for the
infectious agents. So, preliminary accumulation of the specific microorganisms in the food
products is necessary for food infection beginning. That’s why it’s important not to create the
conditions for infectious agent reproduction in the food. It’s necessary to look for the conditions
promoted diseases.
(table 3)
Bacteriotoxicosis
Enterotoxigenic
(staphylococcus aureus)
Toxicisis
Micotoxicosis
staphylococcus Fung Fusarium
Cl. Botulinum Fung Aspergillus
Fung Claviceps purpurea
Toxicosis – acute (or chronic – micotoxicosis) diseases connected with food contained
toxins as the result of the agent development and reproduction. If there are no cells of the agent
in food or quantity of them is too small they don’t take part in the pathogenesis.
Toxicosises are divided into:
1) bacterial toxicosis
- occasioned with staphylococcus
- occasioned with agent of botulism
2) microtoxicosis (toxins of microscopic fungus) (Asprgillus, Fusarium, Claviceps).
Mixed infection – some groups of the agents or/and agents’ toxins are in the food product.
The 2nd group - Food poisoning of the no microbe etiology.
1. Food poisoning occasioned with the toxic products:
a) Of vegetable origin (toxic mushrooms, berries, seeds of the weed, wild plants);
b) Of animal 2nd group is origin (fish, pancreas, adrenal gland)
2000
1800
1600
1400
1200
1000
800
600
400
200
0
1997 г.
1998 г.
1999 г.
2000 г.
2001 г.
2002 г.
years
2.
Food poisoning occasioned with products which are toxic for the human under definite
conditions:
a) of vegetable origin (stone-fruits, sprouted potatoes, haricot);
b) of animal origin (liver, caviar, milt, some kinds of fish, mead) .
3. Food poisoning occasioned with chemical admixtures:
* chemical weed-killers;
* salts of the heavy metals;
* food additions;
* compounds from package, equipment.
The 3d group is the food poisoning of unknown etiology.
Myogeobinuria, Gaffskaya, Uksovsko-Sartlandskaya disease.
Some other types of the food poisoning
Botulism
During last five years sickness rate and death rate of botulism have increased (picture 1).
Dniepropetrovsk region is a “leader” among other regions in Ukraine.
Home-made tinned product is the main factor of transmission.
- meat products – 51,5%
- fish products – 29,4%
- mushroom products – 10,8% and etc.
The main reasons are the decline in living standards and increase of the home-made products,
use the product of bad quality, purchase on the spontaneous markets.
Morbidity depends on seasons. Morbidity increasing is in spring and at the first summer
months, in autumn. Every year in Ukraine hundred of people fall in sick but scores of people
die. Mortality is 70-80% if there aren’t timely measures with antibotulism serum. “Risk
factors” are the tinned products (meat, fish, vegetables), dried fish, marinated mushrooms.
Last year botulism was registered in the group of new-born children, because of the honey
using in the new-born child food. Tinned products are infected with botulism if there are
botulism agents and botulism toxins after agents’ reproduction. In this case food products
have not to change theirs characteristics and have no signs of the spoiling. That’s why
botulism is so insidious disease.
Micotoxicosis
-
ergotism;
fusariotoxicosis;
-
aphlotoxicosis
Micotoxicosis signs:
- diseases have different clinical pictures. It depends not only on fungus origin;
- There are acute and chronicle forms;
- Grain-crops products are damaged more often;
- toxins are steady in environment and don’t perish from the heat treatment.
Prophylaxis of microtoxicosis
1. To prevent the development of the mould funguses on the food products (temperature and
humidity control).
2. To add the food additions which prevent the development of the micotoxins (ascorbic acid
and etc.).
3. To change wrong public opinions, for ex.: food products with mould fungus are innocuous
ones.
4. Laboratory control of the mould funguses and toxins being in the food products.
5. To fix regulations.
- milk – 0,5 mkg/kg accord. M1;
- all products – 5 mkg/kg accord B1.
6. Do not use food products contained micotoxins even according regulations in the child or
diet nourishments.
Mushroom food poisoning
Mushroom is the national Russian food. Chemical composition, protein 2-3% corresponds to
the animal protein according amino acid composition, fat 0,5% corresponds to the animal fat,
carbohydrate 3% (as glycogen).Calorie content is 100 gr – 25-30 kcal.
Quantity of the mushroom poisoning in Ukraine during last 5 years is represented on the picture
2. Mushroom poisonings are registered in August and September most of all. Now death cases
after mushroom poisoning connect with taking toadstool in general.
There are edible mushrooms and no edible mushrooms only but not relative edible mushrooms.
The mushroom poisoning prophylaxis.
1. To keep the mushroom harvest rules.
2. To prohibit the sale of the mushrooms, mushroom salads and etc. on the markets.
3. Mushroom harvest needs to be done under the radiological control in Kievskiy,
Chernigivskiy, Rovensky regions.
4. To control the additions of the heavy metal salts in the mushrooms.
5. To carry on the sanitary campaign.
Alimentary toxic myoglobinuria
Inhabitants of the see regions fall sick taking fish. Cats are the biologic markers; cats fall
sick too and die. First this disease was described in 1924. It was among sailors of the Baltic Sea
bay.
The disease was registered in the USSR among sailors of Yuksovsky Lake and Saptlan Lake.
The reason is unknown.
There are such theories:
- accumulation of the poisonous substance in phytoplankton;
- ergot in the reservoirs;
- fish eats seeds of the poisonous plants.
Clinical picture: acute and sudden beginning; attack of muscular pain. Fatal outcome may be
owing to the respiratory musculature and breath breaks. There is lack of urine, it is of the dark
brown colour. It contains protein and erythrocytes. The lethal outcome because of asphyhia and
uremia is registered in 1-2% cases. After the heat treatment the toxin doesn’t destroy.
Symptomatic treatment.
Food poisoning of the unknown ethyology :
- quail meat poisoning;
- water melon stone poisoning.
Every case of the food poisoning must be registered and examined. The examination is carried
out in accordance to the rules of the food poisoning investigation, registration and laboratory
analyses in sanitary epidemiologic inspection.
Investigation stages are in the table 5.
Table 4
Stages of the food poisoning investigation
1. To confirm the diagnosis, find out its nature.
2. To ascertain the cause of the F.P.
3. To determine how the food product takes the toxic properties.
4. To work up operative measures to liquidate the F.P. outbreak.
5. To work up the prophylactic measures.
6. To draw up a statement of investigation.
First medical personnel meet with people fall in sick. That’s why theirs actions are important
to
investigate and liquid the F.P. outbreak. They have to investigate the circumstances of the
disease, have to take the rest of the suspected food in sterile crock. It takes for the laboratory
analyses.
Laboratory analyses are not necessary when the food product is an unfavorable habitat for
microorganism development (sugar, salt, flour). Besides, doctor has to collect the secretion
omitive and feces, urine, first part water of the lavage of the stomach. Then doctor takes the
history taking into consideration the incubation period to clear up the toxic product, asks people
eating common food in last 2 days, in botulism case in10 days. On the food poisoning suspicion
the special notice is sent to sanitary inspection in 24 hours.
Such information about F.P. has to be produced in the notice:
- area where the F.P. took place;
- date the F.P. took place;
- place where the people took place;
- quantity of the people felt sick among them children;
- quantity of the hospitalized people, place;
- severity of the disease;
- quantity of the lethal outcome cases;
- suspected product;
- supposed cause of the F.P.;
- measures;
- signature indication of the post and place of the work.
Side by side with clearing up the infection transmission, it’s necessary to clear up the
conditions promoted the toxin accumulation in the food.
Conditions of the food storing and term of realization are the important factors. The last
point of the investigation is the statement of investigation. Sanitary inspection makes
registration of the F.P. and prepares reports of the F.P. On the basis of the information the main
sanitary inspection analyses all cases of the F.P. in the country maps out concrete preventive
measures every year.