The Digestive System

Figure 25.1
 Normal Microbiota
• >300 species in mouth
• Large numbers in large intestine, including:
• Bacteroides
• E. coli
• Enterobacter
• Klebsiella
• Lactobacillus
• Proteus
• Bacteria in the large intestine assist in degrading food and
synthesizing vitamins.
• Up to 40% of fecal mass is microbial cells
A. Bacterial Food poisoning

1. food infection 2. food intoxication

• Food infection • Food intoxication

refers to the presence of bacteria refers to the ingestion of toxins

or other microbes which infect contained within the food,
the body after consumption. including bacterially produced
exotoxins

Bacteria and bacterial toxins

 Gastroenteritis
• Traveler’s diarrhea may be caused by enterotoxigenic or
enteroinvasive strains of Escherichia coli.
• The disease is usually self-limiting and does not require chemotherapy.
• Enterohemorrhagic E. coli, such as E. coli O157:H7,
• Produces Shiga toxins cause
• inflammation
• bleeding of the colon, including
• hemorrhagic colitis
• affect the kidneys hemolytic uremic syndrome.
• Campylobacter is the second most common cause of diarrhea in the United
States.
• Campylobacter is transmitted in cow’s milk.
• Yersinia enterocolitica and Y. pseudotuberculosis
• Can reproduce at 4°C
• Usually transmitted in meat and milk
• Clostridium perfringens
• Grow in intestinal tract producing exotoxin
• Bacillus cereus
• Ingestion of bacterial exotoxin produces mild symptoms
Common Food borne Bacteria
common bacterial food borne pathogens are:

Staphylococcus
 Streptococcus
 Vibrio cholerae,
 Shigella spp.
 Escherichia coli,
 Salmonella

 Others:-
 Campylobacter jejuni (periodontitis)
• Clostridium perfringens, the "cafeteria germ
 Staphylococcal Food Poisoning

Staphylococcus aureus
enterotoxin

Figure 25.6
Shigellosis
• Shigella spp.
• producing Shiga toxin
• mucosal abscess
• Symptoms include
• blood and mucus in stools,
• abdominal cramps
• fever.
• Infections by S. dysenteriae
result in ulceration of the
intestinal mucosa.
• Shigellosis is diagnosed by
isolating and identifying the
bacteria from rectal swabs.

Figure 25.8
 Salmonellosis
• Food Poisoning
• Salmonella enterica serovars such as
• S. enteritidis
• S. enterica Typhimurium
• Mortality (<1%) due to septic shock
caused by endotoxin
• Cooking food will usually kill
Salmonella.
• Laboratory diagnosis is based on
isolating and identifying Salmonella
from feces and foods.

• Typhoid Fever
• Salmonella enterica Typhi
• Bacteria spread throughout body in
phagocytes
• 1-3% recovered patients become carriers,
harboring Salmonella in their gallbladder

Figure 25.9
 Cholera
• Vibrio cholerae
• Gram negative comma shaped bacterium
• Serotypes that produce cholera toxin
• Toxin causes host cells to secrete Cl–, HCO–, and water
• Vibrio cholerae O:1 and O:139 produce an exotoxin that alters the
membrane permeability of the intestinal mucosa
• vomiting
• diarrhea
• a loss of body fluids.
• The symptoms last for a few days. Untreated cholera has a 50% mortality
rate.
• Fluid and electrolyte replacement provide effective treatment.
• Ingestion of noncholera Vibrios can result in mild diarrhea. Usually from
contaminated crustaceans or mollusks

Figure 25.12
• Exotoxins
• In addition to disease caused by direct bacterial infection, some
food borne illnesses are caused by exotoxins which are excreted
by the cell as the bacterium grows. Exotoxins can produce
illness even when the microbes that produced them have been
killed.

Clostridium botulinum

• Bacillus cereus
 Viruses

 Hepatitis A
 Norovirus
 Rotavirus
• Parasites • Protozoa:
Giardia lamblia

 Entamoeba histolytica
• Many of these cases have been attributed to
contamination of food and drinking water.

• Additionally, diarrhea is a major cause of

malnutrition in infants and young children.

Even in industrialized countries, up to 30% of the population

of people have been reported to suffer from food borne
diseases every year.
 Temperatures control

 Most types of pathogenic bacteria can grow in temperature

from 41ºF to 140ºF (5ºC to 60ºC) which called temperatures
danger zone (TDZ),
 To prevent bacteria from growing, we must set the
refrigerator temperature not higher than 39ºF (4ºC).
 Refrigerator must not be too full, as Cold air must circulate
to keep food safe.
People at high risk

Elderly People Pregnant

Women

Babies

People with Chronic diseases

 Botulism poisoning
Staphylococcal Salmonellas
poisoning poisoning

Everywhere in Nature
Men & Animals
skin, Nose & throats
Common agent of Boil & pyogenic - Nature
Infection - Poultry
-Farm Animals Preserved Foods
Cows (Mastitis) involving Milk & Egg, Egg products, Meat Home made cheese
milk products ( shami kebab, Biryani, chicken canned foods (Tin)
Tikka) Vacuum packed food
Low acid foods
 Staphylococcal Salmonellas poisoning Botulism
poisoning ( common Form ) poisoning
( common Form ) ( Rare )
But Most serious

1. Agent Staphylococcal 1.S.Typhi Clostridium

Aureus Botulinium
2.S.Paratyphi
A, B, E type
Others:
Typhi murium
Relatively heat stable Enteritidis
Cholera- suis Heating 1000 C for few
Resistant- Boiling 30 minutes minutes

2. source Everywhere in Nature - Nature Preserved Foods

Men & Animals
skin, hair, Nose & throats
Common agent of Boil & pyogenic
Infection
Cows (Mastitis) involving
Milk & milk products
Bakery products, Salads, Macroni.
- Poultry
-Farm Animals
Egg, Egg products, Meat ( shami
kebab, Biryani, chicken Tikka)
Urine & feces of Rats
Home made cheese
canned foods ( Tin)
vegetables , Fruits & salted
fishes, Vacuum packed
food
Low acid foods

3. Incubation 1 – 6 Hours 12 -24 Hours 12 – 36 Hours

Period
 Staphylococcal Salmonellas Botulism
poisoning poisoning poisoning

5. Toxin performed in Causative Org: Exotoxin absorbed

Food ( Heat resistant ) multiply in from Gut
Pathogenesis / Ingested after taking Intestine Via Blood—
Food
Mechanism Ac: Enteritis & peripheral Nerve
Act on Intestine & CNS colitis synapses—Block
release of
Acetylcholine

6. Cl / Findings Acute onset of vomiting Onset generally sudden

With chills, Fever,
Diplopia, Ptosis,
Blurring of vision
Abd: cramps & Diarrhea Nausea, Vomiting Muscle weakness
Blood & mucus (If severe) Profuse watery Diarrh: Dysphagia,
(Lasts 2-3 days ) Quadriplegia, Paralysis
of Resp: Muscles
Fever --- Rarely Mortality About 1%

7. Treatment B- lactamase Ciproflaxacin Antitoxin

Penicillin Chloramphenicol Guanidine Hcl
Cephalosporin Active Immunization
Co trimoxazole
vancomycin Resp: support
Amoxycillin
Trimethoprim
8.Prevention Cleanliness Adequate Food Inspect
Septic Animals condemned
Adequate Food cooking
Proper sterilization
Frequent Hand washing Septic Food be condemned
Discard swollen cans
Aseptic Management of proper cooking
Boiled properly
Lesions

Chopping boards (clean)

Staphylococcus aureus
 It is commonly found on the skin , hair ,
noses and throats of people and animals.
 It can multiply quickly at room
temperature and produce a toxin
that causes Food poisoning

Source ;
 Salads, macaroni
 Bakery products, cream pies,

 Milk and dairy products,

8-Dec-18
 Bacillus cereus
It is type of bacteria that produces toxins.
(diarrheal toxin, emetic toxin)

IP 1-6 hours

Source :
 Soil, and in raw, dried and processed foods

23
Bacillus cereus
• Disease entities:

• Two types of food borne illness:

• Emetic --- emetic toxin, food intoxication
• circular peptide, 1.2 kDa, called cereulide
• Stimulates the vagus nerve leading to the emetic response.

• Diarrheal --- enterotoxin, food infection

• At least three enterotoxins have been described
Bacillus cereus
Diarrheal vs.Emetic Disease
Characteristic Diarrheal Emetic
Infective Dose 105 - 107 cells 105 - 108 per g
Toxin produced: In small In food
intestine
Toxin type Protein- Cyclic peptide
enterotoxin
Incubation 8-16 hours 30 min-5 hours
period
Duration 1 to several days 6-24 hours
C.botulinum
Most strains of Escherichia coli bacteria
are harmless and found in the intestines of
warm blooded animals.
We need E. coli to breakdown cellulose
and assist in the absorption of vitamin K,
the vitamin that helps blood clotting.
However there is one type called E. coli
0157:H7, which was first discovered in
1982, that can cause illness.
The number following this bacteria’s
name is referring to chemical compounds
found on its surface.
E. coli 0157:H7 can be found in the intestines of healthy cattle, which
can contaminate meat during slaughter.
These organisms can also be thoroughly mixed into
beef when it is ground. Bacteria may in addition
contaminate the cow’s udders or milking equipment,
which may then cause the bacteria to get into raw milk.

Eating the infected meat, that has not been cooked sufficiently to kill the
E. coli can cause illness. Contaminated meat looks and smells normal.
It is also possible to become infected by eating sprouts, lettuce salami,
unpasteurized fruit juice, and swimming in or drinking sewage
contaminated water.
If personal hygiene is not adequate in an infected
person, the bacteria contained in diarrhoeal stools
can be passed to other people.
•Severe bloody diarrhoea
•Abdominal cramps
•Nausea
•And occasionally non-bloody diarrhoea or no symptoms.
•The infection can additionally, particularly in young children and old
people, cause a disease called hemolytic uremic syndrome. This
destroys red blood cells and causes the kidney to fail. This affects 2-
7% of people with E. coli.
•It is diagnosed by identifying the bacterium in the stool.
 It is estimated that it takes as few as 10 organisms to infect a
person with E. coli.
Once E. coli 0157:H7 get into the small intestine it destroys the
microvilli and becomes firmly attached through a pedestal made of
actin and actin binding proteins.

pedestal Then when inside the cell shiga toxins

are released and taken up in coated pits
in the epithelial cells, which then
transports them to the golgi.
The toxins then travel from the golgi
to the endoplasmic recticulum , where
they destroy ribosomes, which results in
the death of the cell.
This happens through out the gut
lining.
Salmonella is another type of food poisoning. It has
been known to cause illness for over 100 years.
There are many types of Salmonella, but Salmonella
sereptype Typhimurium and Salmonella serotype
Enteritidis are the most common.
Salmonella is a rod-shaped, motile bacterium
especially found in poultry.
Salmonella is found in the gut of many farm animals,
especially those reared intensively with highly
concentrated feeds.
The majority of chickens in deep litter houses
have Salmonella in their gut.
One of the main causes of Salmonella food
poisoning is eating contaminated raw or
inadequately cooked eggs or products made of
raw eggs, such as homemade mayonnaise.

Newly laid eggs can also be contaminated with poultry

faeces, which contains salmonella bacteria.

A more serious type of Salmonella called Salmonella

typhi can produce typhoid or typhoid-like fever in humans.

Contaminated food is usually from animal origin but

all foods, including vegetables can become infected by,
for example insufficient washing of the hands after
handling raw contaminated meat.

It is estimated that approximately 600 people die each year with
severe salmonella.
 Abdominal cramps
Nausea
Vomiting
Diarrhoea
Chills
Headache
Fatigue
Fever.
Salmonella is diagnosed by identifying the bacteria in the
stools of an infected person.
Depending on the age and health of the host it can take only 15-20 cells
to start an infection.

The onset time for the disease is 6-48 hours and it can last 5-7 days.

Salmonella invasion triggers actin polymerisation and depolymerisation

in the epithelial cell (this is sometimes called ‘membrane ruffling’) by the
bacteria releasing a toxin.

This causes the epithelial cell to form pseudopods that engulf the
Salmonella and place it in an endocytic vacuole.

The Salmonella replicate within the endocytic vacuole, killing the host
cell and causing a inflammatory response.

The bacteria are then released from the cell to infect other cells.
Gut Associated Lymphatic Tissue
Peyer’s Patch
M Cell
Listeria monocytogenes

• Gram positive rods

• Faculative anaerobe
• No spores
• No capsule
• Motile 10-25o C
• Closely related to Bacillus, Clostridium, Enterococcus,
Streptococcus and Staphylococcus
• Genus has 6 species-- L. monocytogenes and L. ivanovii
are pathogenic
Listeria monocytogenes
• Major public health concern because:

• Severe, non-enteric nature of the disease:

• High case fatality rate  can be as high as 20-30%

• Long incubation time

Listeria monocytogenes
Risk groups

Pregnant women and neonates

Elderly

Immunocompromised or debilitated people:

Malignancy, antineoplastic treatment, immunosuppressed, chronic liver
disease, collagen diseases (lupus), diabetes, AIDS
Listeria monocytogenes
• Properties of the Organism:

• Habitat and sources -- widely distributed! - (next slide)

• Bottom line  Many foods have been implicated but foods marketed
as refrigerated and ready to eat are the ones that have been
associated with most of the outbreaks.
• Human Carriage
Listeria monocytogenes
• Habitat and sources
Listeria monocytogenes
• The organism is beta hemolytic and is easily confused with 
hemolytic streptococci. Listeria may also grow in short chains. Do
catalase test!
Listeria monocytogenes
• Growth and Laboratory Characteristics
• Facultative anaerobe
• The organism is -hemolytic.
• It is catalase positive
• It is a gram positive rod
• It is psychrotropic
• The organism is motile
Listeria monocytogenes
• Clinical signs are similar in all hosts:
• Perinatal listeriosis
• Adult listeriosis
• Both are disseminated infection often with CNS involvement
Listeria monocytogenes
• Neuromeningeal listeriosis in sheep -- Circling
Disease
Listeria monocytogenes
• Listeriosis in sheep -- pyogranulomatous lesions
Listeria monocytogenes
• Human stillborn -- Granulomaosis infantiseptica
Listeria monocytogenes
• The Disease Entity:
Listeria monocytogenes
• Brain lesions in sheep
Salmonella
 one of the most common causes of food poisoning.
 Symptoms last 4-7 days without treatment.
 Salmonella is killed by cooking and pasteurization,
 But it can contaminate the food processing area and transmitted
to another food item.
Source
Raw poultry and eggs
 Undercooked poultry and meat

52 8-Dec-18
 Clostridium perfringens
 One of the most common spore forming bacteria
causing food poisoning.

When food prepared in large quantities and kept long time

before serving it cause infection

IP 6-24 hours

 Outbreaks usually linked to institutions (hospitals,

school cafeterias, and prisons).

 Sources
such
53 as Beef and Poultry 8-Dec-18
Symptoms of food poisoning
 General symptoms
Fever, chills, malaise , aches, swollen lymph nodes
• Salmonella typhi,

Upper GIT signs

Nausea, vomiting, abdominal pain, diarrhea &
• S. aureus and its toxins
• B. cereus and its toxin

55 8-Dec-18
Lower GIT signs
Lower abdominal cramps & diarrhea :
• Clostridium perfringens,
• Bacillus cereus
• Salmonella, Shigella,
Neurological signs
Visual disturbances, vertigo
& paralysis
Clostridium botulinum

56 8-Dec-18
 Symptoms
• Nausea
• Abdominal pain
• Vomiting
• Diarrhea
• Gastroenteritis
• Fever
• Headache
• Fatigue
Treatment
• The main treatment for food poisoning is putting
fluids back in the body (rehydration) through an IV
and by drinking.
• Do not eat solid food while
nauseous or vomiting but
drink plenty of fluids.
• Anti-vomiting and diarrhea
medications
Antibiotics
The WHO Golden Rules for Safe Food Preparation

• 1. Choose foods processed for safety

• 2. Cook food thoroughly
• 3. Eat cooked foods immediately
• 4. Store cooked foods carefully
• 5. Reheat cooked foods thoroughly
• 6. Avoid contact between raw foods and cooked foods
• 7. Wash hands repeatedly
• 8. Keep all kitchen surfaces meticulously clean
• 9. Protect foods from insects, rodents, and other animals
• 10. Use safe water
 Prevention& Control
• (A)Food Sanitation:

• 1. Food/ Meat Inspection

• 2. Personal Hygiene
• 3. Medical Inspection of Food handlers.
• 4. Food handling Technique (Golden rules).
• 5. Sanitary improvements.
• 6. Health Education

• (B) Refrigeration

• 7. Surveillance (Lab: Analysis)

 Strategies to prevent food
poisoning
1. Keep hands and nails clean

We need to:
• wash hands and nails thoroughly
with warm, running water and
soap
• dry hands thoroughly
• cover cuts and infections
on hands
Keeping the kitchen
clean
When cleaning plates and equipment, we need to:
• scrape and rinse off surface food
• wash in clean, soapy water
• rinse in clean water
• air dry where possible
• if drying immediately, use only a clean, dry towel.
Pest control and animals
• stop pests such as cockroaches and mice coming into the area where food is kept
• discourage pests by not leaving food or dirty dishes out on the benches
• keep animals out of the kitchen.
Handling food
safely
• avoid preparing food when sick or feeling
unwell
• keep raw meats, poultry and seafood
separated from cooked food and food to be
eaten raw
• protect food in the refrigerator by placing in
covered
containers or covering with plastic wrap
• use clean equipment, plates or containers to
prevent
contamination of cooked food
• use clean equipment, rather than hands, to
pick up food
• wear clean clothes or a clean apron
• wash fruit and vegetables to be