INTRODUCTION:

Food poisoning is an acute inflammatory disease of the gastrointestinal tract, caused by the ingestion of food
contaminated with either toxin producing bacteriae or by their preformed toxins or chemical substances or
other poisonous food substances. Clinically it is characterized by short incubation period, pain in the
abdomen, vomiting and/or diarrhoea, with or without fever.

DEFINITION:

Food poisoning is an acute gastroenteritis caused by ingestion of food or drink contaminated with either
living bacteria or their toxins or inorganic chemical substances and poisons derived from plants and animals.

CHARACTERISTICS:

a. The history of the ingestion of the common foods

b. Attack of many persons at the same time
c. Similarity of signs and symptoms in the majority of cases

TYPES OF FOOD POISONING:

Food poisoning may be of two types

a. Non-bacterial:
 It is caused by chemicals such as arsenic, certain plant and sea foods.
 The contamination of the food by the chemicals such as fertilizers, pesticides, cadmium,
mercury etc.
b. Bacterial:
 It is caused by the ingestion of foods contaminated by living bacteria or their toxins.
 The conventional classification of bacterial food poisoning into the toxic and infective types
is becoming increasingly blurred with the knowledge that in some types, both multiplication
and toxin production are involved;

1. SALMONELLA FOOD POISONING:

It is the common form of food poisoning. There is increasing incidences of food poisoning because
of
i. An increase in community feeding
ii. Increase in international trade in human food
iii. A higher incidence of salmonellosis in farm animals
iv. Widespread use of household detergents interfering with sewage treatment
v. Wide distribution of prepared foods.

CAUSATIVE AGENTS:

The species most often incriminated in human outbreaks are; S.typhimurium, S.cholera-suis, S.enteritidis

SOURCE:

 Salmonellosis is primarily a disease of animals.

 Man gets the infection from farm animals and poultry-through contaminated meat, milk and milk
products custards, egg and egg products.
 Rates and mice are another source; they are often heavily infected and contaminate foodstuffs by
their urine and faeces.
  Temporary human carriers can also contribute to the problem.

INCUBATION PERIOD:

The incubation period is 12- 24 hours commonly

MECHIMISM OF FOOD POISONING:

 The causative organisms, on ingestion multiply in the intestine and give rise to acute enteritis and
colitis.
 The onset is generally sudden with chills, fever, nausea, vomiting and a profuse watery diarrhoea
which usually lasts 2-3 days.

2. STAPHYLOCOCCAL FOOD POISONING:

It is about as common as salmonella food poisoning.

CAUSATIVE AGENT:

 Enterotoxins of certain strains of coagulase positive Staphylococcus aureus.

 At least 5 different enterotoxins have been identified and a sixth may exist.
 Toxins can be formed at optimum temperatures of 35 degree to 37 degree C.
 These toxins are relatively heat stable and resist boiling for 30 minutes or more.

SOURCE:

 Staphylococci are ubiquitous in nature and are found on the skin and in the nose and throat of men
and animals.
 They are a common agent of boils and pyogenic infection of man and animals.
 Cows suffering from masititis have been responsible for outbreaks of food poisoning involving milk
and milk products.
 The foods involved are salads, custards, milk and milk products which get contaminated by
staphylococci.

INCUBATION PERIOD:

Incubation period is from 1-6 hours.

The incubation period is short because of preformed toxin.

MECHANISM OF FOOD POISONING:

 Food poisoning results from ingestion of toxins preformed in the food in which bacteria have grown.
 Since the toxin is heat resistant, it can remain in food after the organisms have died.
 The toxins act directly on the intestine and CNS.

SIGN AND SYMPTOMS:

 The illness becomes manifest by the sudden onset of vomiting, abdominal cramps and diarrhoea.
 In severe case mucus and blood may appear.
 Unlike salmonella food poisoning, staphylococcal food poisoning rarely causes fever.
 Death is uncommon
3. BOTULISM:
Most serious but rare. It kills two-thirds of its victims

CAUSATIVE AGENT:

Exotoxin of Clostridium botulinum generally type A,B and E.

SOURCE:

 The organism is widely distributed in soil, dust and the intestinal tract of animals and enters food as
spores.
 The food most frequently responsible for botulism are home reserved foods such as home canned
vegetables, smoked home-made cheese and similar low acid foods.

INCUBATION PERIOD:

Incubation period is between 12 to 36 hours

MECHANISM OF FOOD POISONING:

 The toxin is preformed in the food under suitable anaerobic conditions.

 It acts on the parasympathetic nervous system.
 Botulism differs from other forms of food poisoning in that the gastrointestinal symptoms are very
slight.

SIGN AND SYMPTOMS:

 The prominent symptoms are dysphagia, diplopia, ptosis, dysarthria, blurring of vision, muscle
weakness and even quadriplegia.
 Fever is generally absent, and consciousness is retained.
 The condition is frequently fatal.
 Death occurring 4-8 days later due to respiratory or cardiac failure.
4. CL. PERFRINGENS FOOD POISONING:
 It is less common type of the food poisoning.
 There is rapid recovery no any death due to this type of the poisoning.

CAUSATIVE AGENT:

Clostridium (Cl.) perfringens (welchii)

SOURCE:

 The organism has been found in faeces of humans and animals, and in soil, water and air.
 The majority of outbreaks have been associated with the ingestion of meat, meat dishes and poultry.
 The usual story is that the food has been prepared and cooked 24 hours or more before consumption
and allowed to cool slowly at room temperature and then heated immediately prior to serving.

INCUBATION PERIOD:

Incubation period is between 6 to 24 hours, with a peak from 10 to 14 hours

MECHANISM OF FOOD POISONING:

 The spores are able to survive cooking, and if the cooked meat and poultry, and if the cooked meat
and poultry are not cooled enough, they will germinate.
  The organisms multiply between 30 degree and 50 degree C and produce a variety of toxins, such as
alpha toxin, theta toxin etc.

CLINICAL SYMPTOMS:

 The most common symptoms are diarrhoea, abdominal cramps and little or no fever, occurring 8 to
24 hours after consumption of the food.
 Nausea and vomiting are rare.
 Illness is usually of short duration, usually 1 day or less.
 Recovery is rapid and no deaths have been reported.
5. BACILUS CEREUS FOOD POISONING:
 Bacillus cereus is an aerobic, spore-bearing, motile, gram positive rod.
 It is dried and processed foods.
 The spores can survive cooking and germinate and multiply rapidly when the food is held at
favourable temperatures.

DIAGNOSIS:

Diagnosis can be confirmed by isolation of 100000 or more B.cereus organisms per gram of
epidemiologically incriminated food. Treatment is symptomatic.

DIFFERENTIAL DIAGNOSIS:

Food poisoning may be mistaken for cholera, acute bacillary dysentery and chemical (arsenic) poisoning.

INVESTIGATION OF THE FOOD POISONING:

 Secure complete list of the people involved and their history

 Laboratory investigation
 Animal Experiments
 Blood for the antibodies
 Environmental study

PREVENTION AND CONTROL:

FOOD HYGINE:

a. Purchase of food:
 Select fresh meat and vegetable.
 Purchase food from hygienic, reliable and reputable sources to ensure quality.
 Do not patronise unlicensed hawkers or food stalls selling cooked food.
 Read and follow the storage instructions, and pay attention to the "use by" or "best
before" date on food labels when buying prepacked food.
 Do not buy any food that is abnormal in appearance, for example: canned food in
rusty, expanded or dented cans.
b. Handling of food:
 Food should be thoroughly washed before storage or cooking.
 Meat and seafood must be thoroughly cooked.
 Food should be consumed as soon as it is served.
 Hot food should be eaten when it is still hot and cold dishes should be stored in the
refrigerator until consumption.
  Use different sets of chopping blocks and knives for cutting raw and cooked food.
c. Storage of food:
 Raw and cooked food should be stored separately to avoid cross contamination.
 Place cooked food in the upper compartment of refrigerator.
 Cooked food, unless consumed at once, should be kept below 4oC or above 63oC.
 Do not store food under room temperature to avoid multiplication of bacteria.
 Leftover food should be stored in the refrigerator and re-heated thoroughly before
consumption.
 Refrigerator should be cleaned properly and regularly and its temperature should be
kept below 4oC.
 Do not store excessive amount of food in the refrigerator to avoid affecting cold air
circulation.

PERSONAL HYGIENE

 Wash hands with soap and water after going to the toilet and before handling food.
 Anybody who suffers from diarrhoea or vomiting should not handle or touch any food to avoid
bacteria contaminating the food.
 Bandage wounds with waterproof plasters before handling any food.

ENVIRONMENTAL HYGIENE

 Put all rubbish & food remains into a dustbin and cover it up tightly.
 Dustbin must be emptied frequently and regularly.
 Clean the kitchen frequently and regularly to prevent harbouring rats and insects.

MANAGEMENT OF FOOD POISONING:

 A sudden illness due to the ingestion of contaminated food or drink

 Treat fluid and electrolyte imbalances
 Control nausea and vomiting
 Provide clear liquid diet and progression of diet after nausea and vomiting subside

CONCLUSION:

Food poisoning is caused by the consumption of food or drinks contaminated with pathogens (including
bacteria, viruses and parasites), bacterial or biochemical toxins or toxic chemicals. Affected persons usually
show gastrointestinal symptoms like nausea, abdominal pain, diarrhoea and vomiting, although other
symptoms like fever may also develop. The incubation period varies from hours to days depending on the
causative agent. Food which can cause food poisoning may appear harmless, i.e. the colour, taste and
appearance are normal.
BIBLIOGRAPHY:

1. Dash Bijayalaskhmi.(2017) A Comprehensive Textbook of Community Health Nursing. 1st

Edition. New Delhi: Jaypee Brother; P.234-239.

2. Gulani k.k.(2013) Community Health Nursing. 2nd Edition. Delhi: Neelam Kumar; p.235-242.

3. https://en.wikipedia.org/wiki/Air_pollution

4. Park K.(2013) Textbook of Preventive and Social Medicine. Twenty second edition.Jabalpur:
M/s Banarsidas Bhanot; P. 216-218.

5. Swarnkar Keshav.(2004) Community Health Nursing. 1st Edition. Indore: N.R. Brothers; P. 133-
137.