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FOOD POISONING Food poisoning is an acute gastro - enteritis caused by ingestion of food or drink contaminated with either living bacteria or their toxins or inorganic chemical substances and poisons derived from plants and animals. Clinical features: *Abdominal pain * Vomitting & or diarrhoea * With or without fever Epidemiological features: Features of food poisoning outbreaks: * Sudden occurrences of an illness in a group of people * History of ingestion of common food * Similar signs and symptoms * Short incubation period * Absence of secondary cases Causes of food poisoning Non bacterial 1. Mushroom poisoning 2. Chemical poisoning Bacterial 1. Salmonella 2. Clostridium 3. Staphylococcus 4. Bacillus cereus 5. Botulism Mushroom poisoning: Causes: Eating fungi like Amanita phylloides instead of edible mushroom or eating sprouting potatoes which contains excess of alkaloid Solanine. Symptoms: Abd. Pain, vomitting, diarrhoea, sweating, miosis, diplopia, muscular incoordination, convulsion, coma. Antidote: Atropine. Chemical poisoning: * Contaminated by fertilizers, pesticides (agricultural / industrial). * Food contaminated @ metallic poisons due to faulty cooking. * Contamination from storage such as use of cheap enamel dishes or galvanized pans. Salmonella Food Poisoning: Inflammatory diarrhoea Causative agent Salmonella Reservoir Source / Food Poultry, Pigs, Milk & milk *typhimurium Rats & mice, products, egg, pork, poultry, * enteritidis * cholera-suis Temporary contaminated * gallinorum human carrier meat, contaminated with rat urine, human carrier I. P. 12 – 24 hours Clinical features D,V, AP, F Clostridium Food Poisoning: Causative Reservoir agent * 5 strains of * Dust & Cl. welchii soil, faeces – reservoir of spores * Type C severe form (enteritis necroticans) Source / Food *Reheated stale cooked food – meat, fish, poultry. * Prior to ingestion spores germinate. I. P. Clinical features 6 – 24 *D hours (explosive) (peak 10 – , AP, V 14 hours) * No fever Staphyllococcal Food Poisoning: Causative agent Reservoir * Staph aureus * Enterotoxin (heat stable) & resist boiling for 30 mins * Preformed intradietetic toxin Animal: Mastitis of cow Source / Food Milk & milk products Salads Human: Boils & Custards pyogenic skin Ice-cream lesions, nasal & Curd throat carriers. I. P. Clinical features 1 – 6 * V, D,AP hours * In severe cases – blood & mucus * No fever Bacillus cereus Food Poisoning: Causative agent * Gram positive Aerobic * Spore forming motile bacilli * Produces 2 distinct enterotoxin – emetic form & enteric form Reservoir Source / Food Food * Cereal grains – based diet, mainly Contaminat cereals ed fried rice - emetic * Soup, sauce enteric I. P. Clinical features * Emetic * V form: 1-6 emetic hrs * D, AP * Enteric enteric form: 1224 hrs Botulinum Food Poisoning: Causative agent Reservoir Source / Food * Clostridium botulinum * Strictly anaerobic * Blocks release of acetyl choline by exotoxin * Type A, B, E (preformed toxin) – intradietetic Dust & soil, intestinal tract of animals & enters food as spores I. P. Canned food, 12 – smoked fish, 36 pickled fish, hrs tinned vegetable food, home made cheese etc. (low acid food) Clinical features Diplopia, blurring vision, paralysis, ptosis, dysarthria, muscle weakness, Constipation No F, GIslight Condition very fatal; death 4 – 8 days, due to resp / cardiac failure Guanidine hydrochloride - to reverse neuromuscular blockade. Vibrio parahemolyticus Food Poisoning: Causative Reservoir Source / agent Food * Gram negative * nonagglutinati ng group I. P. Clinical features Sea food Improperly 12 - 18 D (blood like shell cooked sea hrs mucus), fish, crabs, foods AP, V, F lobsters Campylobacter food poisoning: Causative Reservoir Source / agent Food C. Jejuni (most common), C. coli, C. Laridis Poultry, raw milk. I. P. Poultry, raw 3 to 5 milk, Days raw meat and mushrooms Clinical features V, D (bloody), AP, F * They are known to cause epidemics of food poisoning in nurseries, paediatric wards, and communities in developing countries. * Disease is usually self - limiting with complete recovery in 5 7 days. E coli O157 food poisoning: Causative agent Reservoir Source / Food I. P. Clinical features E. coli O157 : Mud, beef, Beef, raw 3 to 4 D H7 – most raw milk, raw milk, raw Days (bloody), common apple juice apple juice AP form of all EHEC * While most food poisoning events are short lived and resolve spontaneously, 2 - 7% of individuals develop Haemolytic uraemic syndrome about a week after onset of diarrhoea Prevention and Control of Food Poisoning * To Eat Freshly cooked and hot food * Strict supervision on the whole cycle of meat processing * Milk should be pasteurized or boiled * Protection of Foods: - In storage & processing - Food items should not be left overnight in warm pantries - Not eaten items should be kept immediately in cold storage to prevent bacterial multiplication and toxin production * Food Handlers: - Periodical examination - Suffering from boils, ulcers throat or eye infections – Not allowed - Suffered from enteric fever or diarrhoea in recent past – Not allowed - Personal hygiene & clean habit. * Environmental care: - Clean & dry kitchen & dining hall - Utensils & equipment: wash @ soap & hot water - Rodent & insect control - Periodic surveillance of food establishments Investigation of food poisoning: * Verification of diagnosis – clinical & laboratory * Confirmation of existence of an epidemic * Collection of data: location, place, no. of people affected * Secure complete list: Nature of food eaten in last few days, time of onset, symptoms, personal data (age, occupation etc.), no. of deaths. * Assessment of environmental factors: kitchen, dining hall & their sanitations, storage of food grains & cooked food, presence of rodents. * Interrogation & examination of food handlers, hygiene, habits * Lab report: Vomitus, stool of patients for culture, sample of suspected food, serological test of blood for antibody titre, urine & stool culture of food handlers & kitchen employees. * Data analysis, * Formulation of etiolo…. Testing ……* Report writing.