Food- and Waterborne diseases

Causes Roles of microbes Contributing factors

Three overlapping groups of GI disorders

Pathogenic microbes and toxins that they form (most common) Algae and parasites Other
Toxins formed from breakdown of food Toxic chemicals Allergens Digestive or nutritional disorders

Investigating foodborne disease

Regulatory agencies (USDA, FDA, CDC) Outbreak: two or more people get sick from eating the same food (with the same symptoms) Chemical poisoning, highly fatal disease: one case is enough

Major pathogens (in terms of cost)

Campylobacter jejuni Clostridium perfringens E. coli O157:H7 Listeria monocytogenes Salmonella Staphylococcus aureus Toxoplasma gondii

Categories of microbial infection

Intoxication (toxin is preformed) Infection (microbes can grow in body) Toxicoinfection (organisms ingested, die, and release toxins) Opportunistic pathogens

Major pathogens associated with foodborne diseases

Intoxication
C. botulinum highest mortality S. aureus most cases

Pathogens
Salmonella, Listeria monocytogenes

Toxicoinfection
C. perfringens, followed by B. cereus

Viral diseases
Hepatitis, Norwalk-type viruses

Why certain foods?

Raw vs finished foods Food environment favors the growth of a pathogen Quality control is lacking More handling

Predominant food types

Meats- Salmonella S. aureus Egg products- Salmonella Fish- Salmonella, C. botulinum Fruits and vegetables- C. botulinum Processed meats, unpasteurized milk- L. monocytogenes Salmonella is ubiquitous

Incidence of foodborne illness

Restaurants, fast-food, cafeterias, schools
High volume, much handling

Homes
Improper cooling and storage, crosscontamination

Outings (picnics, etc.)

Mishandling, temperature abuse

Commercial preparation- outbreaks rare, but can affect large numbers of people

Factors contributing to outbreaks from pathogenic bacteria and viruses

Improper refrigeration most common factor (according to data from 1980s) Poor personal hygiene Survival of pathogens due to improper cooking Cross-contamination Unsafe food sources

Tis the season

Foodborne outbreaks more common during the summer months Why do you think so? Regional conditions Migration patterns Different susceptibilities to disease (age, general health, immune status) Innate virulence of pathogen

FoodNet established 1996

Objectives:
Determine frequency and severity of foodborne diseases Trace foodborne diseases to specific foods Determine the epidemiology of new bacterial, viral, parasitic pathogens Use epidemiological studies and surveillance of outbreaks to reduce foodborne illnesses (are initiatives working?)

Nine pathogens evaluated over 10-year period (1996-2005, > 25 million persons)
Campylobacter ssp.- declined 30% Salmonella- decreased, then increased Shigella ssp.- decreased 43% E. coli O157:H7 -decreased 29% Listeria monocytogenes- decreased 32% Yersinia enterocolitica decreased 43% Vibrio spp. increased 41% Cryptosporidia much fluctuation; unchanged overall Cyclospora- unchanged Highest incidence (Salmonella) ca 14 per 100,000 populaiton

Is foodborne illness underreported?

Studied surveillance and reporting systems like FoodNet (Mead et al., Emerg. Infect Dis, 1999) Total number of foodborne illness from known and unknown causes: 76 million
Known pathogens accounted for about 25% of all foodborne illnesses 75% of deaths caused by Salmonella, Listeria, and Toxoplasma

Not all outbreaks can be documented accurately Some cases are sporadic, some outbreak Some pathogens are transmitted by food, but also other sources Answer: yes

Foodborne intoxications: features

Can be produced while pathogen is growing in food or preformed (presence of viable microbes not always necessary) May be heat sensitive or heat stable Onset of symptoms may be very rapid (30 minutes) Fever not usually produced Toxins tend to affect body systems (enterotoxins, neurotoxins)

Gram-positive coccus Transmitted from skin and hair (by handling) Multiplies in foods held at room temperature

Staphylococcus aureus

Toxin does not affect food quality More than 17 enterotoxins Heat stable Microbiologyinpictures.org Stimulates vagus nerve, induces vomiting Grows in a wide variety of foods

Citizendick.org

Neurotoxins: Clo. botulinum (Gram-positive anaerobe)

Foodborne
Preformed; spreads from intestines to peripheral nerves

Infant- ingestion of spores Hidden- in feces but food source unknown Wound- anaerobes can grow in deep wounds Inadvertent- BoTox gone awry

Mycotoxicosis
Secondary metabolites, not toxins Can be carcinogenic, Hallucinogenic (ergot) Aflatoxin Aspergillus species liver damage

Air.ky.gov

Foodborne infections
Live cells are consumed and penetrate gut lining Produce toxins and/or cause cell damage Does levels vary greatly Symptoms usually occur after 24 hours Some can spread out of the digestive system

Salmonellosis
Most common cause of foodborne illness- and most persistent Carrier state persists after recovery Inflammation leads to loss of fluid and diarrhea Associated with wide variety of foods Gram-negative rod, non-lactose fermenting

Listeriosis
Recently recognized as foodborne pathogenoppotunistic? Psychrotroph- can grow in refrigerators, so low-level contamination can increase Highly fatal to young, old, pregnant, immune compromised Zero tolerance because of high fatality rate

Listeriosis forms of disease

Febrile gastroenteritis
High infectious dose Flu-like symptoms Bacteria shed for weeks or months in feces

Invasive systemic disease

Infectious dose of 100-1000 Passes through intestines into body; can affect liver, brain, placenta

Listeriosis is usually sporadic

Strict controls in place for ca 20 years High-risk people told to avoid soft cheeses and ready-to-eat foods without heating Rapid testing possible with serological methods

Pathogenic E. coli
Most E. coli are harmless and at very high levels in intestines Six groups can cause disease Enterotoxigenic (ETEC)
Travelers diarrhea; toxin; no inflammation; high dose required

Enteropathogenic (EPEC)- infant diarrhea Enteroinvasive (EIEC)-dysentery (bloody diarrhea) Enterohemorrhagic(EHEC)- bloody diarrhea and HUS (hemorrhagic uremic syndrome)
Shiga-like toxin kills cells

Enteroaggregative (EAEC) Diffuse-adhering (DAEC)

Toxicoinfections
Spore formers: cells do not multiply but form spores and release toxins
Clostridium perfringens (meats) Bacillus cereus (variety of foods)

Gram-negative cells multiply, or die and release toxins

Vibrio cholerae- contaminated food and water ETEC- fecally contaminated food and water

Opportunistic pathogens or toxins

Dont normally cause disease Breakdown products of proteins Algal toxins (Gonyaulax catenella) Parasites (worms and protozoans)

New and emerging food borne pathogens

Are they really new, or newly confirmed? Pathogens can increase or decrease as causative agents for illness
Food consumption patterns Changes in food processing and marketing Changes in agricultural practices Migration of food and people Health of individuals

More knowledge of pathogens

Many are discovered in large outbreaks
Campylobacter jejuni EHEC O157:H7 Listeria monocytogenes, among others

More data New testing technology Regulatory practices, education

Food habits
More seafood, more vibrio and hepatitis More low-heat-processed foods stored longer More consumption of raw foods Fruits, vegetables, and juices: organisms modified to lowpH and low temperature environments New pathogens Hepatitis E H. pylori BSE Aeromonas

Summary
Foodborne illness has been recognized for centuries New pathogens are regularly added to the list- and this will continue Illness may be sporadic or due to an outbreak Much is known about many organisms, their symptoms, and the onset of disease Not everyone reacts to exposure the same way