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FOODBORN INFECTIONS AND INTOXICATIONS Mgr. Dana Hrnčířová Dpt. of Nutrition 3rd Faculty of Medicine Charles University in Prague FOODBORNE INFECTIONS AND INTOXICATIONS wide group of infectious diseases spread through contaminated food and water by contact with vomit or feces caused by pathogens and toxins more than 250 infectious agents INFECTIOUS AGENTS microorganisms and microbial toxins: bacteria, bacterial toxins, viruses, fungi, protozoans enter the body through the gastrointestinal tract, and often causes the first symptoms there: nausea, vomiting, abdominal cramps and diarrhea secreted by faeces and urine TRANSMISSION Arthropods and other organisms transmit pathogens to animals (including humans): at the end of an incubation period in the course of an illness during reconvalescence Primary contamination Secondary contamination (cross contamination) FOODBORNE OUTBREAKS two or more people get sick from the same food Size and extent is based on: which pathogen or toxin is involved how much food is contaminated where in the food production chain contamination occurs where the food is served how many people eat it FOODBORNE OUTBREAKS Sporadic: illnesses that are not part of outbreaks Small (local) outbreak Regional, statewide outbreak Endemic (local limitation) Epidemic (local and time limitation) Pandemic (without local and time limitation) THE MOST COMMON FOODBORN ILLNESSES US Pathogen Estimated No of illnesses % Norovirus 5,461,731 58 Salmonella (nontyphoidal) 1,027,561 11 Clostridium perfringens 965,958 10 Campylobacter spp. 845,024 9 Staphylococcus aureus 241,148 3 Subtotal Source: CDC's 2011 estimates for foodborne illness 91 40,000 35,000 33,594 30,724 30,000 25,492 25,102 25,000 22,713 21,653 21,161 20,000 15,000 8,622 10,000 5,000 0 2001 2004 2006 Salmonellosis 2010 2001 2004 2006 2010 Campylobacteriosis 1000 900 800 700 600 500 400 300 200 100 0 2001 2004 2006 2010 Shigellosis 2001 2004 2006 2010 Listeriosis 2001 2004 2006 2010 Hepatitis A SALMONELLOSIS 2 species Salmonella enterica Salmonella bongori intestines of birds, reptiles and mammals most important in foodborne disease: S. enterica subspecies enterica (cca 1500 serotypes) serotype Enteritidis abbreviated to S. Enteritidis serotype Typhimurium (≠ S. Typhi!) serotype Infantis SALMONELLA - growth and survival Growth: 7 - 48 ºC pH 3.7- 9.5 Resistant to: drying low temperatures survives chill and freezing temperatures Facultative anaerob Inactivated by: heat above 70 °C (pasteurization, …) pH below 3,8 disinfection (sanitizers) SALMONELLA - infective dose Infective dose vary widely: 105-106 cells the young or the elderly: 10 - 100 cells Period of infectivity: during illness, reconvalescence SALMONELLA - transmission Salmonellosis - a zoonotic infection S. lives in intestines of humans and other animals - reptiles, chickens, young birds Feces of infected animals → enviroment (soil, surface water) ↓ Food animals (pigs, polutry) ← feed, infected animals Fresh produce Direct contact by hands of an infected food handler Via food preparation surfaces or equipment SALMONELLA - occurrence in foods Foods of animal origin (meat, poultry, eggs and raw milk) Fresh produce Cooked ready-to-eat foods (cross contamination) Processed food Examples: Confectionery, pastries (custard, egg white coating) Cooked ready to eat food containing eggs Bologna sausage, tripe sausage, meat loaf, liver paste SALMONELLOSIS - symptoms non-typhoid salmonellae incubation period: 12 – 36 hours 1-7 days diarrhea, abdominal pains, nausea, vomiting, chills dehydration and headaches Susceptible individuals: more severe symptoms septicaemia, or chronic conditions (reactive arthritis) Salmonella Typhi Typhoid fever (≠ typhus - rickettsia) vaccination SALMONELLOSIS - treatment Gastroenteric form: oral fluids severe diarrhea - rehydration with intravenous fluids Typhoid form: ATB (e.g. ampicillin, chloramphenicol) SALMONELLOSIS - prevention Raw eggs! Undercooked poultry and meat! Raw or unpasteurized milk Produce – washed thoroughly Prevent cross-contamination! Hand washing …. CAMPYLOBACTERIOSIS Bacteria C. jejuni (birds) C. coli (pigs) Low resistance to enviroment: Microaerophilic (require reduced levels of oxygen) to grow Heat sensitive: destroyed at temperatures above 48 °C Sensitive to salt: 1 % or more – bactericidal Inactivation: pH < 4.0 Can survive for a short time at refrigeration temperatures! CAMPYLOBACTERIOSIS - transmission and sources Intestines of warm-blooded animals (esp. birds – poultry) Poor hygiene (faecal/oral route) Fresh poultry and related products Other fresh meats Raw milk Shellfish Salads, … CAMPYLOBACTERIOSIS Incubation period: 3 – 5 days Length of infection: 1-7 days Infective dose: 103 Symptoms: diarrhea, cramping, abdominal pain, and fever SHIGELLOSIS Shigella - a family of bacteria that causes diarrhea in humans Shigella sonnei (" Group D" Shigella) over 2/3 of shigellosis in the US, in CR over 90 % of cases Shigella flexneri ("group B" Shigella) almost all the rest Other types, e.g. Shigella dysenteriae type 1 – developing world SHIGELLOSIS highly infective disease, infective dose 200 cells incubation period 1-3 days duration: 5-7 days SYMPTOMS: diarrhea (distal part of colon) – with mucus and blood fever stomach cramps risk of dehydration and perforation of colon SHIGELLOSIS Sources of infection: infected person (diarrheal stools – poor hygiene) contaminated food contaminated water LISTERIOSIS bacteria Listeria monocytogenes syrotype 1/2a, 1/2b and 4b grows at chill temperatures tolerant of high sodium chloride levels grows well in aerobic and anaerobic conditions inactivated at temperatures above 70 ºC Infectious dose: healthy persons: 103 LISTERIOSIS Incubation period: 1 to 90 days (mean 30 days) SYMPTOMS: flu-like symptoms, nausea, vomiting, diarrhea meningitis, septicaemia Pregnant women: mild flu-like ilness (fever, headache) ! infection of the fetus → miscarriage, stillbirth, birth of an infected infant (meningitis) Overall mortality rate: 30 % LISTERIOSIS - sources of infection Row foods (vegetable) Cooked foods – post-process contamination Processed foods: soft cheeses unpasteurized milk confectionery, pastries cooked meat products pâtés, ice cream smoked and lightly processed fish/seafood products ESCHERICHIA COLI (VTEC, STEC) verocytotoxin producing (Shiga-like toxin-producing ) E. coli subset of serotypes: enterohaemorrhagic E. coli (EHEC) highly pathogenic haemorrhagic colitis, HUS outbreaks of severe foodborn disease in many countries (serotype Escherichia coli O157:H7, Germany 2011- O104:H4) Foods derived from cattle (minced beef – Hamburger disease) Dairy products derived from raw milk TOXOPLASMOSIS protozoan parasite Toxoplazma gondii Foodborne transmission (undercooked, contaminated meat) Animal-to-human transmission (cat’s feces) Mother-to-child transmission Mothers often without symptoms Miscarriage, stillborn child Congenitally infected infants - later in life: mental disability, potential eye loss Incubation period: 5 – 23 days TOXOPLASMOSIS – life cycle TAENIASIS parasitic infection tapeworm species: Taenia saginata (beef tapeworm) – e. Africa Taenia solium (pork tapeworm) – India, s. Africa, s. America Taenia asiatica (Asian tapeworm) – Republic of Korea, China, Taiwan, Indonesia, Thailand raw or undercooked beef or pork! TAENIASIS - symptoms Most people – no / mild symptoms: abdominal pain, loss of appetite, weight loss, upset stomach T. saginata: more symptoms because of the size (up to 10 meters) T. solium: cysticercosis neurocysticercosis (epileptic seizures) eye damage in muscles – often asymptomatic TAENIA – life cycle TRICHINELA parasitic infection Roundworms (nematodes), genus Trichinella classical agent T. spiralis (worldwide, carnivorous and omnivorous animals) other species T. pseudospiralis (mammals and birds worldwide) T. nativa (Arctic bears) T. nelsoni (African predators and scavengers) T. britovi (carnivores of Europe and western Asia) Row, undercooked meat! TRICHINELA - life cycle VIRAL INFECTIONS Hepatitis A, E Tick-borne encephalitis Norovirus and rotavirus (small children up to 5 yrs) Norovirus - Norwalk-like virus (Norwalk, Ohio in 1968) - extremely infectious enteric virus - acute viral gastroenteritis - infected persons, contaminated food/water/ surfaces HEPATITIS A Hepatitis A virus Foodborne hepatitis Transmission: direct person-to-person contact via the faecal-oral route foodborne transmission infected food handler foods faecally contaminated (water) Long incubation period (aprox. 4 weeks) Often asymptomatic (esp. Children – source of the virus!) Shellfish, fresh fruits/ vegetable, iced beverages, milk products etc. resistant at 70°C for up to 10 mins, inactivated at 85°C for 1 min. HEPATITIS E Foodborne disease No chronic infection Contaminated water! Countries with poor sanitation No approved vaccination in US and Europe Hepatitis A and E 1800 1600 1400 1200 Hepatitis A 1000 Hepatitis E 800 600 400 200 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 FOODBORNE INTOXICATIONS Intoxication consumption of toxins produced by bacteria in food Staphylococcus aureus, Clostridium botulinum,Vibrio parahemoliticus Toxin-mediated infection toxin is produced in the intestine Clostridium perfringens type A Bacillus cereus: two types of toxins 1. Type A - heat resistent toxin, produced in food (staphylococ-like symptoms) 2. Type B - heat labile toxin, produced in GIT (clostridium-like symptoms) Staphylococcal intoxication Staphylococcus aureus heat resistant toxin produced in food incubation period: 1-6 hours Symptoms: nausea, abdominal cramps, vomiting, exhaustion Source: people (nose, throat, infected skin wounds, pimples) Cream fillings (esp. with eggs), potato and meat salads, processed meats, minced meats Clostridium perfringens type A heat labile toxin produced in the intestine incubation period: 10-12 hours Symptoms: diarrhea, abdominal cramps, nausea holding meats at warm room temperature for several hours or cooling large pots of meat or gravy too slowly in the refrigerator Bacillus cereus Type A toxin (emetic form) heat resistant toxin produced in food staphylococcus-like symptoms (nausea, vomiting) incubation period:1-5 hours cooked pasta, rice Type B toxin (diarrheal form) heat labile toxin produced in the intestine clostridium-like symptoms (watery diarrhea, abdominal cramps) incubation period: 5-16 hours meat, milk, vegetable Botulism heat labile paralytic neuro-toxin produced in food incubation period: 12-36 hours Three main types: foodborne botulism (food) wound botulism (toxin produced in a wound) infant botulism (consumed botulinum spores release toxin in GIT) Spores – destroyed at 120 °C for 20 min. Toxin – inactivated by boiling for 10 min. Botulism Growth of C. botulinum: Acidity - inhibited at a pH of 4.6 or lower Oxygen – anaerobic organism Home-canned and home-cooked food (meat and vegetable) Symptoms: blurred double vision, difficulty in swallowing and speaking Paralysis (respiratory muscles, peristalsis, urination) Botulism Treatment: remove any unabsorbed toxin in GIT neutralize the circulating toxin with an antitoxin keep a patient breathing by a mechanical respirator as necessary Recovery – weeks to months Use of toxin (BOTOX): Strabismus wrinkles and frown lines underarm sweating etc. THANK YOU FOR YOUR ATTENTION.