Pg - 1

Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings.
Definition - Food poisoning is if acute illness with mainly gastrointestinal or neurologic manifestations
that results from eating food that is contaminated either by bacteria or bacterial toxins or by chemicals.
Symptoms usually commence 1-24 hours after ingestion and include vomiting, diarrhoea, abdominal pain and
nausea.
Can be divided in to (a) microbial
(b) Chemicals of nonmicrobial origin.

(a) Microbial Food Poisoning

IP Bacteria Tosxins/mecha Symptoms & Diagnosis Source

nismo recovery time
location
1-6hrs 1.Staphylo -Noninflam A/ -Culture -Contaminated food
c-occus matory 1 Diarrhoea, organism in usually by human.
aureus (enterotoxine) 2 vomiting vomit or -Milk, sweet corn,
-Proximal 3 dehydration remaining mayonnaise, egg,
small bowel 4 shock food salad, ham, cream
B/ Recovers -No faecal
rapidly (few leukocytes
hours)

2.Bacillus " A/ Same -Culture -Spores in food

cereus " clinics organism in (often rice) survives
(emetic B/ Recovers foeces & boiling
form) rapidly food -Fried rice
-No faecal
leukocytes

8-16hrs 1.Cl. Noninflammat A/1.Watery -Culture in -Spores in food

perfringes ory diarrhoea faeces & survives boiling
(enterotoxins) 2.Cramping food -Beet, poultry
-Proximal pain -No faecal legumes
small bowel B/Recovery leukocytes
2-3days

2.B.cereus " A/Clinics as -Spores in food

(diarrhoea " watery " survives boiling
form) diarrhoea & " -Meats, vegetables,
cramp dried beans, cereals
B/Recovery
rapid

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 IP Bacteria Toxins/mecha Symptoms & Diagnosis Source
nisms. recovery time
location
>16hrs
16- 1.Salmonel -Inflammatory A/1.Fever, -Culture -Bowels of animals
48hrs la (Invasion or malaise organism in -Salads, cheese,
2.Shigella cytoxin) 2Abdominal stools meats, eggs, dairy,
3.Enteroto -Colon or cramps, pain -Feacal proclucts, patato,
xigenic distal small 3.Diarrhoea+ PMN raw vegetables,
E.Coli bowel RBC,WBC & leulcocytes lettuce ,beef
4.Campylo mucus
bacter 4.Vomiting-
jejuni salmonella
B/Recovery
some days
(2-5days
salmonella &
c.jejuni 3-5
days)
16- Vibrio -Inflammatory A/1Watery -Stools & shell fish & other
72hrs paraheamo (Invasion or dearrhoea rectal swabs sea food
lyticus cytotoxic) "Abdominal for culture &
-Colon or cramps fresh stools
distal small 3Vomiting for motile
bowel B/Recovers organisms
in days (1-3d) -No feacal
leucocytes
18- Cl. A/1Nausea -Demonstrati
36hrs botulinum Preformed 2Vomiting on of the -Canned food
toxin 3Dearrhoea organism or -Bottled food
neurotoxic 4Paralysis its toxins in
B/Recovers vomitus,
in 10-14d gastric fluid,
stool.
-Isolation of
(Paralysis organism
laryngeal from food
pharyngeal
later
generalized
Resp. insu

1 Preformed toxins 1 Toxin production in vivo

-Staph. aureus - C.perfringes
- B cereus - B.cereus
- Cl. botulinum - ETEC
- V.cholera
3 Tissue invasion 4 Toxin production &/or Tissue invasion
- Salmolella - V.parahaemolyticus
- ETEC - Y.enterocolitica
- Shgella - C.jejuni

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(b) Chemicals of non microbial origin
(1) Food - mushrooms, shellfish
Salivation sweating, vomiting, abdominal pain/cramps, diarrhea, vertigo, confusion, coma.
 (p) May die within few hours but complete recovery in 24 hrs usual with appropriate therapy
(2) Others - Organophosphates, heavy metals Pb, Hg etc.
Summary of symptoms
M:O Diarr Vomiting Nausea Fever Abdominal Paralysis
hoea cramps
1 S.aureus}  
2 B.cereus}

3 C.perfringens}  
4 B.cereus} (watery)

5 Salmonella
6 Snigella   
7 C.jejuni
8 ETEC

9 V.cholera  (watery)  
10 ETEC

11 C.botulinum    

Treatment
(a) Microbial - I Rehydrahon - oral in mild or moderate
Parenteral if severe
II Antibiotics - If shigella, cholera
(b) Chemical - I Gastric lavage - Inducing vomiting is contraindicated.

General principles:
1 Supportive treatment
2 Rehydration with glucose, electrolyte solution orally if mild - moderate dehydration (even if vomiting -
small sips should be taken to replace volume)
3 If vomiting is severe antiemetic (chlorpromazine >25-100mg/d IM) may be beneficial.
4 Meperidine 50mg Im - severe abdominal cramps.
5 When (p) can tolerate fluids without vomiting semisolid food (cereals, gelatin, bananas, toast) may be
added.
6 Antibiotics - shigellosis, cholera
7 In botulinism - maintain adequate respiration with assisted ventilation in addition to I/V administration of
antitoxins. Guanidine hydrochloride 15-40 mg/kg. Improves botulism induced paralysis by reversing
intramuscular blockade (Botulinum leads to marked neuromuscular blockade).

Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings
Report prepared by
1. Sajid Mahmood, Accident & Emergency Department, NHS Liverpool United Kingdom,
2. Adnan Akram, Infectious Diseases Department. University Hospital Riga Latvia.
3. Aftab Ahmed, Infection Control Department, Kaunas Medical University Clinic. Lithuania.

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