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Food-borne and Water-borne Diseases

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Food-borne and Water-borne Diseases Tintinalli s Chap. 150 Listeria monocytogenes Incubation period 9-48h for GI, 2-6 weeks for invasive disease Signs and ... – PowerPoint PPT presentation

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Title: Food-borne and Water-borne Diseases


1
Food-borne and Water-borne Diseases
  • Tintinallis Chap. 150

2
Definition
  • Food-borne illness two or more cases of a
    similar illness resulting from the ingestion of a
    common food
  • Water-borne illness an illness that occurs
    after consumption or use of water intended for
    drinking or as illness associated with
    recreational water such as swimming pools,
    whirlpools, hot tubs, spas, water parks, and
    naturally occurring fresh and marine surface
    waters

3
Epidemiology - Food-borne
  • In the U.S. per year
  • 76 million illness
  • 325,000 hospitalizations
  • 5000 deaths - most unknown pathogens
  • Three known pathogens cause 1500 deaths
  • Salmonella
  • Listeria
  • Toxoplasma

4
Epidemiology - Food-borne
  • Cholera only bacterial food-borne illness that
    must be reported internationally
  • Hepatitis A only viral food-borne illness that is
    reported
  • Globally only 1-10 of food-borne illness
    incidences are reported.

5
Epidemiology - Food-borne
  • List of most common bacterial food-borne illness,
    listed in order of occurrence
  • 1) Campylobacter
  • 2) Salmonella
  • 3) Shigella
  • 4) E. Coli

6
Epidemiology - Food-borne
  • List of most common viral food-borne illness
  • 1) Norwalk virus
  • 2) Astroviruses
  • 3) Rotaviruses
  • 4) Enteric adenoviruses
  • 23,000,000 incidences per year in the U.S
  • Spread person to person via fecal-oral route
  • Infectious at low doses foods act as transfer
    media only

7
Pathophysiology
  • Normal physiologic defenses
  • 1) gastric acid
  • 2) normal flora of GI tract
  • 3) intestinal motility
  • 4) mucous glycoproteins of the
  • intestinal mucus

8
Pathophysiology
  • Gastric pH 3 kills most organisms but
    medications and diseases can raise the PH
  • a) antacids, H2 blockers, proton-pump
  • inhibitors
  • b) DM, pernicious anemia, gastric surgery
  • c) Helicobacter pylori

9
Pathophysiology
  • Normal flora inhibit colonization of pathogens by
    competition for nutrients and production of
    fatty-acids or chemicals that are bactericidal.
    Conditions that alter flora are
  • a) antibiotic use
  • b) radiation therapy
  • c) chemotherapy
  • d) abdominal surgery

10
Pathophysiology
  • Normal motility minimizes the contact between the
    mucosal surface and potential pathogens. Can
    alter (usually slowing) motility by
  • a) antiperistaltic agents
  • b) narcotics
  • c) previous radiation

11
Pathophysiology
  • Infectivity of bacteria occurs by
  • Protein toxins produced by bacteria alter fluid
    electrolyte movement across the mucosal surface
    producing large volumes of fluid in excess of the
    absorptive capacity of the colon
  • Vibrio cholerae, enterotoxic E. coli
  • Bacteria can adhere to mucosal surface via
    surface pili or fimbria that bind to intestinal
    epithelial cell receptors
  • E. coli
  • Invasion of mucosal cells directly, causing cell
    death
  • Shigella, salmonella, enteroinvasive E.coli,
    campylobacter, vibrio parahaemolyticus
  • Cytotoxins cause cellular membrane disruption and
    cell lysis

12
Diagnosis
  • Important to the history is the exact time of
    exposure which can help narrow down the causative
    agent

13
History
  • 1-6h
  • Norwalk viruses
  • Astroviruses, calcivirus
  • Staphyloccus aureus
  • Bacillus cerus vomiting toxin
  • Ciguatoxin
  • Scombroid toxin
  • Paralytic or neurotoxic shellfish
    poisoning
  • Puffer fish, tetrotoxin
  • Heavy metals
  • Monosodium glutamates
  • Short-acting mushroom toxins

14
History
  • 6-24h
  • Bacillus cereus diarrheal toxin
  • Clostridium perfringens
  • Vibrio parahaemolyticus
  • Long-acting mushroom toxins
  • 24-48h
  • Nontyphoidal salmonella
  • Enterotoxigenic E.coli (ETEC)
  • Clostridium botulinum
  • Trichinella spp. intestinal phase

15
History
  • 2-6d
  • Shigella
  • Campylobacter
  • E. Coli 0157H7
  • Vibrio cholerae
  • Yersinia enterocolitica
  • Streptococcus group A

16
History
  • 6-14d
  • Crytosporidium parvum
  • Salmonella typhi
  • Giardia lamblia
  • Cyclospora
  • gt14d
  • Hepatitis A
  • Brucella
  • Listeria monocytogenes invasive disease
  • Trichinella spp. Systemic phase

17
History
  • History of two or more people within a
    household becoming ill at the same time more
    likely food-borne vs. two people becoming ill
    within 24-36h.

18
History
  • Identify food handling practices
  • a) length of preparation before
  • consumption
  • b) cooking time and reheating
  • c) possible cross contamination
  • d) people with poor hygiene

19
History
  • Identify activities that increase risk of
    exposure
  • restaurants
  • day care centers
  • street-vended food or raw seafood
  • overseas travel
  • camping-ingestion of lake/stream water
  • Check to see if patient is on antibiotics or
    medications that reduce gastric acidity

20
Physical Examination
  • Determine hydration status
  • Presence of blood in the stool
  • Exclude other diarrheal illness

21
Diagnostic Tests
  • Blood cultures suspect bateremia
  • Gram stain - identifies campylobacter with 66-99
    sensitivity
  • Fecal leukocytes - if positive higher culture
    yield
  • Ova and parasites - done in the ER

22
Diagnostic Tests
  • Stool cultures only if pt
  • 1) febrile
  • 2) bloody diarrhea
  • 3) severe abdominal pain
  • 4) clinically severe or persistent
  • 5) significant historical risk factors for
  • food-borne illness

23
Treatment
  • Most episodes are self-limiting and fluid
    replacement with supportive care is all that is
    needed.
  • If determined that a severe case of bacterial
    infectious diarrhea has occurred then antibiotic
    of choice is either
  • Ciprofloxacin 500mg PO BID x3-5 days
  • Ciprofloxacin 1 gm PO x 1 dose
  • Bactrim DS PO BID x 3-5 days

24
Bacillus anthracis
  • Incubation period 2d-weeks
  • Signs and symptoms nausea, vomiting, bloody
    diarrhea, abdominal pain
  • Duration weeks
  • Food Source contaminated meat
  • Lab testing blood
  • Treatment penicillin, ciprofloxacin

25
Bacillus cereus
  • Enterotoxin
  • Incubation period 1-6h
  • Signs and symptoms sudden fever, nausea,
    vomiting, may have diarrhea
  • Duration 24h
  • Food Source rice, meat
  • Lab testing none
  • Treatment supportive only

26
Bacillus cereus
  • Diarrheal toxin
  • Incubation period - 10-16h
  • Signs and symptoms - watery diarrhea, nausea,
    cramps
  • Duration - 24-28h
  • Food Source meat, stew, gravy, vanilla sauce
  • Lab testing none
  • Treatment supportive only

27
Brucella spp.
  • Incubation period 7-21d
  • Signs and symptoms fever, chills, headache,
    myalgias, arthralgias, bloody diarrhea
  • Duration weeks
  • Food Source raw milk, goat cheese, meats
  • Lab testing blood, serology
  • Treatment rifampin and doxycycline

28
Clostridium botulinum
  • Adults, children
  • Incubation period 12-72h
  • Signs and symptoms vomiting, diarrhea,
    diplopia, dysphagia, descending muscle weakness
  • Duration variable, can end in death
  • Food Source improperly canned foods, fermented
    fish, garlic, herb-infused oils, baked potato in
    foil, foods kept in a warm oven for hours
  • Lab testing stool, serum, and food assayed for
    toxin at CDC or state labs
  • Treatment botulinum antitoxin

29
Clostridium botulinum
  • Infants
  • Incubation period 3-30d
  • Signs and symptoms lethargy, poor feeding,
    hypotonia
  • Duration variable
  • Food Source honey, home-canned foods
  • Lab testing stool, serum, and food assayed for
    toxin at CDC or state lab
  • Treatment botulinum immune globulin

30
Campylobacter
  • Incubation period 2-5d
  • Signs and symptoms bloody or watery diarrhea,
    cramps, fever
  • Duration 2-10d
  • Food Source Poultry, milk, water
  • Lab testing special stool culture
  • Treatment erythromycin or ciprofloxacin-antibiot
    ic for severe cases only

31
Clostridium perfringens
  • Incubation period 8-16h
  • Signs and symptoms watery diarrhea, nausea,
    cramps
  • Duration 24-48h
  • Food Source meat, poultry, gravy, dried or
    precooked foods
  • Lab testing quantitative culture of stool
  • Treatment supportive only

32
Enterohemorrhagic E. coli
  • Incubation period 1-8d
  • Signs and symptoms bloody diarrhea, abdominal
    pain, vomiting
  • Duration 5-10d
  • Food Source undercooked meat, unpasteurized
    dairy products, milk, raw fruit and vegetables,
    salami, contaminated water, salad dressing,
    yogurt, acidic foods
  • Lab testing specific stool culture
  • Treatment supportive only

33
Enterotoxigenic E. coli (travelers diarrhea)
  • Incubation period 1-3d
  • Signs and symptoms watery diarrhea, vomiting,
    cramps
  • Duration 3-10d
  • Food Source fecal contamination of food
  • Lab testing specific stool culture
  • Treatment ciprofloxacin-antibiotic for severe
    cases only or TMP-SMX

34
Listeria monocytogenes
  • Incubation period 9-48h for GI, 2-6 weeks for
    invasive disease
  • Signs and symptoms fever, myalgias, nausea,
    diarrhea in pregnant women, flu-like illness, can
    lead to premature delivery, elderly or
    immunocompromised can have sepsis or meningitis
  • Duration variable
  • Food Source soft cheese, unpasteurized milk,
    deli meat, and hot dogs
  • Lab testing blood or CSF cultures
  • Treatment IV ampicillin or TMP-SMX. Antibiotics
    for severe cases only

35
Salmonella spp.
  • Incubation period 1-3d
  • Signs and symptoms diarrhea, fever, cramps,
    vomiting, s. typhi and paratyphi cause chills,
    myalgia, headache, with rare diarrhea
  • Duration 4-7d
  • Food Source eggs, poultry, unpasteurized milk
    or juice, raw fruits and vegetables, street
    venders, fecal water contamination
  • Lab testing stool cultures
  • Treatment ciprofloxacin or TMP-SMX. Antibiotics
    for severe cases only
  • Necessitates typhoid immunization for travelers

36
Shigella spp.
  • Incubation period 24-48h
  • Signs and symptoms bloody diarrhea, fever,
    cramps
  • Duration 4-7d
  • Food Source fecal food or water contamination,
    person-person spread by fecal-oral contamination
  • Lab testing stool cultures
  • Treatment TMP-SMX if susceptible

37
S. Aureus
  • Incubation period 1-6h
  • Signs and symptoms sudden severe nausea,
    vomiting, diarrhea
  • Duration 24-48h
  • Food Source unrefrigerated meats, potato and
    egg salad, cream pastries
  • Lab testing none
  • Treatment supportive only

38
Vibrio cholerae
  • Incubation period 24-72h
  • Signs and symptoms severe watery diarrhea and
    vomiting
  • Duration 3-7d death from dehydration
  • Food Source contaminated water, fish,
    shellfish, street vendors
  • Lab testing specific stool cultures
  • Treatment ciprofloxacin in adults, TMP-SMX in
    children

39
Vibrio vulnificus
  • Incubation period 1-7d
  • Signs and symptoms vomiting, diarrhea,
    abdominal pain, sepsis, wound infections, liver
    disease, and elderly can have skin bullae
  • Duration 2-8d death can result
  • Food Source raw shellfish, open wound exposure
    to seawater
  • Lab testing specific wound or blood cultures
  • Treatment doxycycline or ceftazidime

40
Yersinia spp.
  • Incubation period 24-48h
  • Signs and symptoms mimics appendicitis, can
    have a rash
  • Duration 1-3 weeks
  • Food Source undercooked pork, unpasteurized
    milk, contaminated water
  • Lab testing specific stool or blood cultures
  • Treatment ciprofloxacin, doxycycline,
    ceftriaxone, or gentamycin. Antibiotics for
    severe cases only

41
Chronic sequelae
  • Occurs in 2-3 of pts
  • Seronegative reactive arthritis salmonella,
    shigella campylobacter
  • GBS campylobacter
  • HUS E. coli 0157H7
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