Food Poisoning

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Introduction

A spectrum of disorders arising from:

Ingestion of food and water contaminated by micro-organisms, and/or their toxins, or by chemicals from non-infectious sources

Clinical forms

  • Staphylococcal food poisoning:
    • Food is contaminated by Staphylococcus aureus (S. aureus) when prepared unhygienically by individuals who are carriers
    • Subsequent growth of aureus in the food and enterotoxin production occurs if the food is not cooked at temperatures sufficient to kill the bacteria, or is not refrigerated
  • Food-borne botulism
  • Non-typhoidal Salmonellosis
  • Shigellosis
  • E. coli food poisoning
  • Campylobacter food poisoning
  • Listeria monocytogenes food poisoning
  • Yersinia enterocolitica food poisoning
  • Norwalk (Norovirus) virus food poisoning
  • Hepatitis A virus food poisoning
  • Giardiasis
  • Helminthic parasitic food poisoning
  • Others: Bacillus cereus, Vibrio cholera,

Clinical features

Variable depending on cause and severity:

  • Abdominal pains
  • Nausea and Vomiting
  • Diarrhoea
  • Fever
  • Dehydration
  • Fatigue
  • Other systemic symptoms

Staphylococcal food poisoning: symptoms begin 30 minutes – 6 hours after exposure to microbial toxins.

  • Nausea
  • Abdominal cramps
  • Vomiting
  • Diarrhoea

Clostridium perfringens: symptoms begin 6 – 24 hours after exposure.

  • Diarrhoea
  • Abdominal

Food-borne Clostridium botulism

  • Incubation period is 18 - 36 hours, but depending on toxin dose, can extend from a few hours to several days.
  • Symmetric descending paralysis
  • Diplopia
  • Dysarthria/dysphagia
  • Nausea, vomiting and abdominal pain may precede or follow the onset of paralysis

Non-typhoidal Salmonellosis: symptoms begin 6 hours to 6 days after exposure.

  • Diarrhoea
  • Nausea
  • Vomiting
  • Abdominal cramps
  • Fever
  • Headache
  • Myalgia

Shigellosis: symptoms begin 24hours to 48 hours after exposure

  • Fever
  • Self-limiting watery diarrhoea
  • Bloody diarrhoea
  • Dysentery
  • Frequent passage, 10 - 30 times/day of small volume stools containing blood, mucus, and pus
  • Abdominal cramps
  • Tenesmus

Campylobacter food poisoning: symptoms begin 2 to 5 days after exposure.

  • Diarrhoea (frequently bloody)
  • Abdominal pain
  • Fever, headache, nausea, and/or vomiting
  • The symptoms typically last 3 to 6 days

E. coli food poisoning: symptoms begin 3 to 5 days after exposure.

  • Watery diarrhoea (often bloody) accompanied by abdominal cramps
  • Vomiting
  • Around 5–10% of people diagnosed with E. coli food poisoning develop a life-threatening complication.

L. monocytogenes food poisoning: Symptoms begin 1 – 4 weeks after exposure.

  • Non-invasive listeriosis – fever and diarrhoea
  • Invasive listeriosis-pregnancy losses and meningoencephalitis in immunosuppressed person

Norwalk virus food poisoning: Symptoms begin 12 – 48 hours after exposure:

  • Abrupt onset of nausea and abdominal cramps followed by vomiting and/or diarrhoea

Hepatitis A virus food poisoning:

  • May cause large outbreaks of diarrhoea and vomiting from contaminated food, water, milk and shellfish. Intra-family and intra- institutional spread common.

Diagnosis

  • Essentially clinical
  • Laboratory confirmation of the specific microbe(s) involved

Differential Diagnoses

  • Other causes of acute onset diarrhoea, nausea, abdominal cramps and vomiting with or without systemic manifestations.

Complications

Variable depending on cause and severity:

  • Fluid and electrolyte derangements, Dehydration
  • Rectal prolapse.
  • Protein-losing enteropathy, Malnutrition
  • Haemolytic-uraemic syndrome
  • Toxic megacolon, perforation
  • Bacteraemia, Cholecystitis, Pancreatitis, Cystitis, Meningitis, Endocarditis, Arthritis, Peritonitis, Cellulitis or Septic abortion

Treatment Goals

  • Restore fluid and electrolyte balance
  • Neutralize toxin
  • Eradicate the microbe

Non-drug Treatment

Gastric lavage in food-borne botulism

Drug Treatment

Appropriate fluid and electrolyte replacement

  • Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G) - (Equine) should be administered as soon as possible after specimens are obtained for laboratory analysis for food-borne botulism.
  • Emetics in food-borne botulism
  • Administer appropriate medicines

Shigellosis

  • Oral Rehydration Therapy
  • Plus:
    • Amoxicillin:
      • Adult: 50 - 100 mg/kg/day orally every 8 hours; up to 2 g/day
      • Child up to 10 years: 125 mg every 8 hours, doubled in severe infections.

Or:

  • Trimethoprim/sulfamethoxazole (co-trimoxazole)
    • Adult: 960 mg orally every 12 hours for 5 days
    • Child :
      • Few weeks to 5 months: 120 mg orally
      • 6 months - 5 years: 240 mg
      • 6 - 12 years: 480 mg given every 12 hours for 5 days

Or:

  • Ceftriaxone:
    • Adult: 1 g intravenously slowly for 5 days
    • Child: 50 mg/kg/day intravenously for 5 days

Campylobacter food poisoning

  • Fluid and electrolyte replacement

Plus:

  • Erythromycin
    • Adult: 250 mg orally every 6 hours for 5 - 7 days
    • Child: 30-50 mg/kg orally every 6 hours for 5 - 7 days
  • Infections involving macrolide resistance could be treated with amoxicillin-clavulanate.

E. coli food poisoning

  • Antibiotics are not recommended for patients with suspected shiga-toxin producing E. coli (STEC) infections, also referred to as enterohemorrhagic E. coli (EHEC). Administering antibiotics to patients with STEC infections might increase their risk of developing haemolytic uraemic syndrome (characterized by low platelet, anaemia and kidney failure)

L. monocytogenes food poisoning

  • Ampicillin 50 mg/kg/day in divided doses

Plus:

  • Gentamicin 3 - 5- mg/kg daily

Treat specific complications as appropriate e.g.

  • Antibiotic-unresponsive toxic megacolon: colectomy
  • Haemolytic-uraemic syndrome: dialysis
  • Malnutrition from protein-losing enteropathy: nutritional support; optimal nutritional management.

Prevention

  • Environmental and personal hygiene
    • Hand washing with soap and water
    • Decontamination of water supplies by chlorination
    • Use of sanitary latrines or toilets
    • Identify and treat chronic carriers among food handlers
  • Hygienic preparation and storage of food and water
  • Ensure that food is cooked at temperatures sufficient to kill bacteria.
  • Refrigerate food whenever possible.
  • Encourage exclusive breastfeeding.
  • Encourage measures to reduce the burden of malnutrition (with its attendant predisposition to severe infections)
  • Administer a pentavalent vaccine (A, B, C, D, and E) for persons at high risk of botulism.
  • Report new cases to public health authorities