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Food Intoxication

Dr. dr. I Gede Arinton,SpPD-KGEHThe Internal Medicine DepartmentFKIK Unsoed/Margono Hospital

Purwokerto,2010.

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Introduction

Classifying Foodborne Illness : Foodborne Infections – Result when a person eats food containing

pathogens, which then grow in the intestines and cause illness

Foodborne Intoxications– Result when a person eats food containing toxins

that cause illness Foodborne Toxin-Mediated Infections– Result when a person eats food containing

pathogens, which then produce illness-causing toxins in the intestines

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Introduction

Adverse reactions to food :

Food intolerance (most common) :

– toxins

– infections

– pharmacological properties of food

– host factors (lactase deficiency)

Food allergy (hypersensitivity)

Food aversion (phobia)

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Introduction

Toxicology = the science of poisons/toxicants/toxins- substance capable of causing harm - = seriously injuring or, ultimately, causing the death

Food toxicology - substances found/contaminate food - consume sufficient quantities - harmful

Poisons were known and studied by the ancient Greeks.

The fundamental concept of toxicology - Paracelsus (1493 - 1541) - his commentary :

– all substances are potential to be a poison poisons

– the right dose - cure.

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TOXICANTS IN FOODS

Potential sources of toxicants in food

Nutrients :

– = A food substance that provides energy or is necessary for growth and repair.-- Ex. vitamins, minerals, carbohydrates, fats, and proteins.

Natural food toxicants:

– plants and some animals that are sources of food

Contaminants- Chemical & pathogen

Chemicals or substances - food additives- food reservation+ processing.

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GIT Physiology

The primary function of the GI tract :

– break down complex food components into substances

appropriate for absorption into the body.

– waste removal

– keep substances that are of no value or are potentially

dangerous out of the body.

Food enters the mouth- chewing mixes it with saliva -

Amylase - destroys some of the bacteria.

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GIT Physiology

The stomach - hormone gastrin is released- stimulates the release of HCl & pepsinogen- pH ≤ 2.0 critical defense & protects from many pathogens by the partial denaturation of proteins- eg. Salmonella

4 - 6 h chyme - intestine - absorption

Bile- Enterohepatic circulation- excretion toxicants metabolic degradation to urinary excretion - eliminates the toxicant from the body.

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Food microbiology

Bacteria :• Salmonellosis• Shigellosis• Vibrio Gastroenteritis• Hemorrhagic Colitis• Staphylococcal Intoxication• Botulism

Virus- Hepatitis A Parasite Fungus Two groups of food contaminates

– Pathogen (cannot see or smell or taste)– Spoilage (can be seen or smelled or tasted)

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Food microbiology

Staphylococcal food intoxication :– most prevalent foodborne disease.– Onset may 30 min - 8 hrs– Symptoms: nausea, vomiting, cramps, sweating, chills,

weak pulse, shallow respiration, subnormal body temperature.

– Recovery usually occurs within 24-48 hrs. – Source of infections:

• infected wounds and lesions of food handlers• coughing and sneezing

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Food microbiology

Salmonellosis :

– 40% of all recorded foodborne diseases

– usually self limiting acute gastroenteritis

– the incubation period 6-48hrs (12-36hrs]

– symptoms: diarrhea, abdominal cramps, vomiting and

fever. Generally last 1-7 days.

– Associated both with animals both wild and domestic

– Food associated: beef, turkey, home-made ice cream, pork,

chicken and raw eggs.

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Food microbiology

Clostridium botulinum

– Sporeforming anaerobic bacteria that produces very potent

toxin

– Symptoms: double vision, inability to swallow, speech

difficulty, progressive respiratory paralysis.

– Onset: after 12-36 hrs or even 8 days.

– Food implicated: canned low-acid food, smoked fish

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Outbreaks

E. coli 0157:H7 (Northwest)

Cryptosporidium (Milwaukee)

Norwalk virus (Cruise ships)

Vibrio cholerae (South America)

Listeria (New York, New Jersey, CT)

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Prevention

Application of heat

Adequate refrigeration

Adequate time and storage conditions

Sanitation

Safe thawing practices

Food additives (antimicrobials)

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Manifestations of food allergy

SKIN: urticaria – angioedema > eczema

RESPIRATORY: rhinitis – asthma

GI TRACT: diarrhea – vomiting

GENERAL: anaphylactic shock

OTHER: migraine, hyperactivity, sleep disturbances etc… ?

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Sensitization to food…

eating, touching and

smelling…

peanutsfishhen’s egg

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Future immunomodulatory therapies for food allergy

Humanized monoclonal anti-IgE

Mutated allergen protein immunotherapy

Peptide immunotherapy

Immuno-stimulatory sequences

Probiotics