FOOD POISONING

Definition of food An illness caused by the consumption of food or water

poisoning contaminated with bacteria and/or their toxins or with
parasites, viruses or chemicals
Criteria of food-borne 1. Similar illness, often GI in a minimum 2 people
disease outbreak 2. Evidence of food as the source
Epidemiology • 1 in 6 Americans is affected annually
• Higher in elderly (increased in susceptibility,
decreased production of gastric acid and intestinal
motility, malnutrition, lack of exercise, habitation in
nursing home & excessive use of antibiotic)

General Sign & Symptoms Comment

Abdominal Pain Most severe in inflammatory processes;
abdominal muscle cramps suggest
underlying electrolyte loss
Vomiting Major presenting symptoms of S.aureus,
Bacillus cereus, Norovirus
Diarrhoea Last < 2 weeks
Headache -
Fever May be an invasive disease or an infection
outside the GIT
Stool changes Bloody or mucousy if invasion of intestinal
or colonic mucosa; profuse rice-watery if
cholera
Reactive arthritis Seen with Salmonella, Shigella,
Campylobacter and Yersinia infections
Bloating May be due to giardiasis

Clinical Presentations
Salient Features Comments
Acute diarrhoea • Commonly last < 2 weeks
• Persistent: Last 2-4 weeks
• Chronic: > 4 weeks
Fever • Suggest invasive disease
• Maybe infection outside of GIT like
malaria
Bloody/ mucoid stool • Indicates invasion of the intestinal
or colonic mucosa
Vomiting • Suspect: Staph. aureus, B. cereus,
Norovirus
Reactive arthritis • Seen in: Salmonella, Campylobacter
& Yersinia infections
Profuse rice-water stool • Suggest cholera
Abdominal pain • Most severe inflammatory
processes
• Suggest underlying electrolyte loss
as in severe cholera
Bloating • Suspicion of giardiasis
Mimic symptoms of appendicitis • Yersinia enterocolitis
Proctitis syndrome • Seen in shigellosis
• Character: Frequent painful bowel
movements containing blood, pus &
mucus. Tenesmus & rectal
discomfort are prominent features
Consumption of undercooked • Salmonella, Campylobacter, Shiga
meat/poultry toxin E. coli & C. perferingens
Consumption of raw seafood • Norwalk-like virus, Vibrio organism,
hepatitis A
Consumption of homemade canned foods • C. botulinum
Consumption of unpasteurized soft • Listeria, Salmonella, Campylobacter,
cheeses Shiga toxins E.coli & Yersinia
Consumption of deli meats • Listeriosis
Consumption of unpasteurized milk or • Campylobacter, Salmonella, Shiga
juice toxin E. coli & Yersinia
Consumption of raw eggs • Salmonella
From Physical Examination Comments
Dry mouth, decreased axillary sweat & • Mild dehydration
decreased urine output • Severe depletion: + orthostasis,
tachycardia, hypotension
Rose spot macules on upper abdomen and • Salmonella typhi infection
hepatosplenomegaly
Erythema nodosum & exudative • Yersinia infection
pharyngitis
Cellulitis & otitis media • Vibrio vulnificus or Vibrio
alginolyticus
Causes:
Pathogenesis:

Diarrhoe

Noninflammatory Inflammatory

Action of enterotoxins on
secretory mechanisms of the Action of cytotoxins on the
mucosa of the small mucosa
intestine, without invasion

Enterotoxins may be either

preformed before ingestion Leads to invasion &
or produced in the gut after destruction
ingestion

Leads to large volume

watery stools in the absenc Colon/ distal small bowel
of blood, pus or severe commonly involved
abdominal pain

Diarrhoe: bloody, mucoid &

Results in dehydration
leukocytes

EXP: Vibrio cholerae,

Patiens febrile and may
Staphylococcus organisms,
appear toxic
Bacillus cereus

Dehydration is less likely;

smaller stool volumes

Fecal leukocytes or a positive

stool lactoferin test indicates
an inflmmatory process &
sheets of leukocytes indicate
colitis

Exp: Botulinum
Toxins act on inhibits
central nervous Vomiting acetylcholine
system release in nerve
endings
Lab and Imaging Diagnosis:

Laboratory Diagnosis
Gram stain & Loeffler methylene blue For WBC help to differentiate invasive
staining of stool disease from non-invasive
Microscopic examination of stool For ova and parasites
Bacterial culture • For enteric pathogens
• Mandatory if stool sample shows
positive results for WBC or blood or
if patients have fever or symptoms
persisting longer than 3-4 days
Blood culture If patient is notably febrile
CBC with differential, serum electrolyte Asses the inflammatory response and the
assessment & BUN & Creatinine levels degree of dehydration
Assay for C difficile Rule out antibiotic-associated diarrhoea in
patients receiving antibiotic or with a
history of recent antibiotic use

Imaging studies: Flat & upright radiographs should be obtained if patient experiences
bloating, severe pain or obstructive symptoms or if perforation is suggested

Medication:

Rehydration Solutions: Adequate rehydration & electrolyte supplementation

Lactated ringer solution with NS Isotonic & have volume-restorative
properties
Oral electrolyte mixtures (Rehydralyte, • Acts by glucose-facilitated
Pedialyte) absorption of sodium and water
• Achieved by using clear liquids &
sodium-containing & glucose-
containing solutions
• Solution of 3.5 g sodium chloride +
2.5 g sodium bicarbonate + 1.5 g
potassium chloride + 20 g glucose
per liter of water
• Simple solution = 1 level tsp salt + 4
heaping tsp sugar + 1L water

Antidiarrheals – Adsorbents help patients have more control over the timing of
defecation but do not alter the course of disease or reduce fluid loss
- Antiperistaltics should not be used in patients with fever, systemic
toxicity, bloody diarrhoea or in patients with no improvement &
deteriorating
Attapulgite Adsorbent and protectant that controls
diarrhoea
Aluminium hydroxide -Commonly used as an antacid
-Adsorbent and protectant that controls
diarrhoea
Bismuth subsalicylate Antisecretory agent that also may have
antimicrobial & anti-inflammatory effects
Diphenoxylate and atropine Drug combination that consists of
diphenoxylate, which is a constipating
meperidine congener and atropine to
discouraged abuse. Inhibits excessive GI
propulsion and motility
Loperamide Acts on intestinal muscles to inhibit
peristalsis and slow intestinal motility.
Prolonged movement of electrolytes and
fluid through bowel and increases viscosity
and loss of fluids and electrolytes

Antibiotics- Empiric antimicrobial therapy. The selection should be guided by blood culture
sensitivity
Ciprofloxacin - First line therapy
- Against pseudomonas,
streptococci, MRSA,
Staphylococcus
epidermidis & most gram-
negative organisms
- Does not against
anaerobes
- Inhibits bacterial DNA
synthesis & consequently
growth
Norfloxacin - Against pseudomonas,
streptococci, MRSA,
Staphylococcus
epidermidis & most gram-
negative organisms
- Does not against
anaerobes
- Inhibits bacterial DNA
synthesis & consequently
growth

Trimethoprim/ sulfamethoxazole - Alternative therapy

- Resistant organisms
common in tropics
 - Inhibits bacterial growth
by inhibiting synthesis of
dihydrofolic acid
Doxycycline - For V cholerae/ V
parahaemolyticus
infections
- Inhibits protein synthesis
and thus bacterial growth
by binding to 30S &
possibly 50S ribosomal
subunits of susceptible
bacteria
Rifaximin - Nonabsorbed, broad
spectrum antibiotic
specific for enteric
patogens of GIT
- Binds to beta-subunit of
bacterial DNA-dependent
RNA polymerase, thereby
inhibiting RNA synthesis
- Indicated for E. coli
(Enterotoxigenic &
enteroaggregative strains)
assoc. with travelers’

Principle of management:
Medication (refers to Medication section, above)
Diet
During ep of acute diarrhoea, patients often develop an acquired disaccharidase deficiency
due to washout of the brush-border enzymes.
Avoid (highly advisable):
Milk, dairy products, other lactose-containing foods

Prevention:

• Practice strict personal hygiene

• Cook all foods adequately
• Avoid cross-contamination of raw and cooked foods
• Keep all foods at appropriate temperatures
• Avoid eating wild mushrooms, prevent food poisoning
• Avoid large tropical fish and compliance with seasonal or emergency quarantines of
shellfish harvesting areas 9prevent fish and shellfish poisoning)
• Avoid raw or undercooked milk, poultry, eggs, meat and seafood
• Alert the health authorities in case of outbreak
• Irradiation of food eliminate food0borne pathogens
• Use low-temp gas plasma in food industry reduce the incidence of foodborne disease