FOOD POISONING CLASSIFICATION BACTERIAL FOOD POISONING

By Sr. Mary Preethi

Definition:
WHO defines food poisoning as diseases usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food.

Classification Poisoning due to bacteria and toxins Poisons of vegetable origin Poisons of animal origin Chemicals

Bacterial food poisoning

Due to

ingestion of contaminated food, uncooked food or imperfectly cooked food.

Types
# Infection type # Toxin Type

Infection Type
Which follows, the multiplication within the body of

pathogenic organisms contained in the food. Organisms - mainly Salmonella group * S. enteritidis of Gaertner * S. typhimurium * S. cholerasuis It invades and destroy the mucosa of small intestine produce watery diarrhoea stained with blood or mucus in twelve hours to two days.

Contd..
Diarrhoea in several patients after 24 to 48 hours of

eating same meal indicates the ingestion of salmonella. Other organisms are proteus, coli group, streptococci, sh. Flexneri and sh. Sonnei. Vibrio parahaemolyticus contained in sea food also produce watery diarrhoea and vomitting in 6 hours to 4 days.

Toxic Type
Which follows the ingestion of food in which

poisonous substances have been formed due to bacterial proliferation. Due to ingestion of preformed toxin in prepared food such as canned or preserved food. Toxins enterotoxin of staphylococci, Cl. Perfringens type A, C, Bacillus, Boutulinum toxin. Cheese, meat, fish, sandwiches and other canned and preserved meats, imperfectly cooked food serves as a medium.

Contd..
Enterotoxin resists boiling for 30 mts and action of

intestinal enzymes. Symptoms: Diarrhoea, Nausea, Abdominal cramps and the patients recover as soon as the enterotoxin have been neutralized and metabolized within 24 hours of poisoning. Recovery more rapid within 24 hours Mortality is very low.

Diagnosis This is made from

History
Clinical features Isolation of organism from the remnants of suspected

food, vomit, faeces, blood of the sick person The injection of portion of food into mice or guinea pigs, if the animals get sick isolate organism from them.

Treatment and Prophylaxis

Washout the stomach and give purgatives
Glucose saline infusion - to promote elimination of the

toxin from the system. The rodents should be driven out from the places where food industry is carried out. Carriers should not be employed in dairies and in food industry Preserved food and dried egg powder should be properly cooked.

Autopsy Findings
Mucosa of the stomach and intestine are swollen and

congested and there may be minute ulcers. Microscopic examination shows fatty degeneration of the liver. Causative organism can be isolated from the blood and viscera.

Botulism
It is an intoxication, not an infection
Results from absorption of neurotoxin from the

elementary canal produced by Cl. Botulinum. Organism normally present in the soil and by soil contamination food may become infected especially fruits and vegetables. The toxin inhibits acetylcholine, paralyses the nerve endings, by blocking the nerve impulses at myoneural junctions.

Signs and Symptoms

Incubation period- 12 to 30 hours but may be

prolonged to 72 hours. Initially G I Symptoms: nausea, vomiting, abdominal distention and pain. Later: dry or sore mouth, difficulty with visual accommodation, dysphonia, diplopia, descending bilaterally symmetrical motor paralysis initiated by abduscent or occulomotor nerve palsy, dysphagia, respiratory insufficiency, urinary retention.

Contd
Fatal dose 0.01mg Death may occur within 24 hours from the onset of

symptoms or it may be delayed for a week.

Diagnosis
History.
Clinical Features. Isolation of bacteria from food, patients vomitus,

intestinal contents, viscera. Isolation of toxin in the blood and tissues.

Treatment
Gastric Lavage
Activated Charcol Purgatives (Sorbitol)

Whole bowl irrigation

Botulinum antitoxin one vial by slow IV in normal

saline and one vial IM repeated at 2 to 4 hours intervals. Botulinum immunoglobulin Pentavalent types (A,B,C,D,E) 50 ml IV daily till patient recovers

Contd.
Guanidine 15 to 35 mg /Kg daily orally.
Adequate respiration.

Autopsy Findings
Kidneys, liver and meninges are congested.
Histologically examination of organs show thrombosis.

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