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2-1. Bacterial Food Poisoning (Infective)
2-1. Bacterial Food Poisoning (Infective)
Pathogenesis
Nontyphoidal Salmonella
Shigella spp.
EHEC, EIEC
Listeria monocytogens
Lab diagnosis
+ Sterilization
Boiling 100
90
40
Bacteria
multiply Bacteria Bacteria
Mesophilic 30 rapidly multiply multiply
slowly
20
Psychrophilic
10
-18
Cold storage
+
Improper cooking Poor personal
or reheating hygiene
Chemicals
in food Cross- contamination
with toxin
WHO, 2016
+ Food poisoning caused by Food poisoning caused by
bacterial infection bacterial toxins
Vibrio parahemolyticus
+
Food-borne disease in India
Top 6 organism causing foodborne illnesses
E. coli
Staphylococcus aureus
Vibrio sp
Yersinia enteroclitica
Norwalk-like virus
Cooked food held for extended period at low Listeria monocytogenes, Yersinia enterocolitica
temperature
Cooked food held for extended periods under Clostridium botulinum
anaerobiosis
Retorted food under-processed Clostridium botulinum
Vomiting Staphylococcus aureus 1-6 hours Prepared food (salads, dairy, meat)
Shiga toxin-producing 1-8 days Ground beef, unpasteurized milk, and juice, raw vegetables, water
Escherichia coli
Campylobacter species 2-5 days Poultry, unpasteurized milk, water
+
Food-borne illnesses passive surveillance systems
+ (Tip of the iceberg )
CDC estimates each year 48
million people get sick 128,000
are hospitalized, and 3,000 die
Most patients have mild symptoms of short duration,
Those that do access clinical care will not have the laboratory test
performed to determine a specific etiology
WHO estimates that food-borne diseases are notified in only 10% of cases
in developed countries and 1% in developing countries
Non- typhoidal salmonella enterica caused 2.3 lakh deaths Source: WHO Estimate of the global burden of foodborne disease 2015
+
Development of new and emerging pathogens
changed agricultural production methods
consumption habits
modern harvesting, processing and packaging
technologies
Sources:
Ingestion of contaminated food (poultry and meat, raw
milk and dairy products, juice and seafood)
raw or undercooked eggs (egg shells contaminated
with chicken feeds/feaces)
Fecal-oral route
Infective dose: 10-102 bacilli
Human beings are the only natural host
Incubation period: usually 48hrs
Dysentery: freq. loose stool with scanty feacal matter
containing blood & mucus
+ Pathogenesis
Site of infection: M cells in payer’s patch of large intestine
Virulence factors
1. Shiga toxin: stxA, stxB
A sub unit (A1, A2): helps in the biological processing
A1 portion affects the eukaryotic ribosome specially involved
in inhibition of protein synthesis
B sub unit (5B): binding to ganglioside receptor
primarily a toxin for the vascular endothelium
accounts for dysentery & severity of infections
mucosal damage
Source:
hamburger meat, unpasteurized apple juice,
unpasteurized milk
+
Virulence factor
Enterohemolysin
+
Diarrhea
Hemorrhagic colitis
V. parahemolyticus, V. vulnificus
+
Food poisoning by vibrio
Features Vibrio parahaemolyticus Vibrio vulnificus
Fever
Headache
Muscle pain
+
How Does Campylobacter affect individual
cells in the intestines?
Guillain-BarreSyndrome
Immune system attacks own nerves
40% caused by C. jejuni infection
Septicemia
Leadingto infection of nearly any organ, including appendix,
abdominal cavity, heart, nervous system, etc.
+ LISTERIA MONOCYTOGENES
Common source
Antibiotic use
Travel history
H/O immunocomproise / immunosupression
Presence and severity of dehydration
Patient Food handler Environ.
bacterial stool vomitus urine blood stool nose hands food Food
prep.
environ.
salmonella C C C C C
Staphylococcus C C C C C,T
aureus
Campylobacter C C C C
jejuni
Clostridium C,T C,T T C,T
botulinum
Clostridium C,T C
perfringens
shigella C C C
Vibrio C C c
parahaemolyticu
s
Bacillus cereus C C C,T
Yersinia C S C C C
enterocolitica
viral
Sample Collection
early stages of disease (heavy load of pathogens)
before starting antibiotics
in a clean tight-fitting container
Investigation of outbreak – samples from multiple ill people
Sample processing
Immediately (<2 hours)
If late (>2 hours), inoculate into transport medium / chilled
+ Transport Media For Clinical Specimens
Cary-Blair medium
Salmonella, E.coli, Shigella, Vibrio,
Yersinia
Alkaline peptone water
Stable, storage for future use
Venkatraman-Ramakrishnan (VR)
Reduced APW & Thioglycollate
Amies medium broth - Campylobacter
Stuart’s medium
Buffered glycerol saline
Mainly for shigella
Others salmonella, E.coli
Not suitable for Vibrio
+
Direct examination
Macroscopic
Colour
Volume
Consistency
Presence of blood, mucus, frank pus
Microscopic
Faecal leucocyte count
Presence of ≥3 leukocytes/ HPF in 4 or more fields
Simple, rapid and useful test for shigellosis,
campylobacteriosis, salmonellosis, EIEC (>50 pus cells /
HPF suggestive of shigellosis)
Sensitivity 60-70%
+
O157:H7 do not ferment sorbitol (MacConkey agar with
Sorbitol)
Toxin assay
Antigen detection by ELISA
Detection of enzymes
Detection of genes encoding toxins by PCR
Laboratory diagnosis of Salmonella
samples
Stool
Blood
Specimen- faeces or suspected food stuff Suspected food
Culture
Enrichment media- after 6 hrs of incubation
subculture on selective media.
Selenite F broth
Tetrathionate broth
Selective media- incubated at 370c for 24 hours
MAC (NLF colony)
DCA (NLF colony)
XLD (red colonies with black center)
Wilson and Blair medium (shiny black colonies)
+Laboratory diagnosis of Listeria
Samples
Microscopy CSF
Gram- staining: Gram positive rods Blood
Wet mount: tumbling motility Amniotic fluid
Placental tissue
Stool
Culture Suspected food
(100g)
Clinical specimen from sterile sites
Tryptic soy agar with 5% sheep blood
Blood on conventional blood culture bottle
Culture
Clinical specimen from sterile sites
Mac conkey agar
Blood in conventional blood culture bottle
3. Cook thoroughly
Cook food thoroughly, especially meat, poultry, eggs and seafood
Reheat cooked food thoroughly