FOOD POISIONING

Also known as food borne illness It is any illness resulting from the consumption of

contaminated food , pathogenic bacteria , viruses or parasites that contaminates food, as well as chemical or natural toxins such as poisonous mushrooms.

Most cases of food poisoning are from clostridium botulinum and other bacteria such as Staphylococcus or E. coli.

Causes of food poisoning due to microbes, bacteria, viruses, protozoa, parasites, fungi, plants, fish, chemical additives

Common germs causing food poisioning

Clostridium botulinum Campylobacter enteritis Cholera E. coli enteritis Fish poisoning Staphylococcus aureus Salmonella Shigella

CLOSTRIDIUM BOTULINUM

Clostridium consists of gram positive anaerobic, spore forming bacilli which are responsible for 3 major diseases.

Tetanus(cl.tetani),gas gangrene(cl.septicum,cl.fallax),food poisoning(cl.botulinum).

Clostridium botulinum-8types A,B,C,C2,D,E,F&G. A,B&E account for almost all cases of human botulism. F&G are very rare in humans. C&D are associated with botulism in mammalian animals

&birds.

Source : results from consumption of contaminated preserved food,canned meat and meat products , vegetables and fish.

Wound botulism results from wound infection with cl.botulinum.

Infant botulism most probably is caused by contaminated honey.

Toxins : cl.botulinum produce a powerful exotoxin which is produced intracellularly and is released only on the death and autolysis of organism.

Lethal dose:1-2 microgram Sunlight or heating at 80’C for 30 min or 100’C for 10 min

denatures the active toxin.

CLINICAL FEATURES

Symptoms start within 2 - 6 hours after eating the food.

Initial signs & symptoms of botulism may be GI & can include abdominal pain, nausea, vomiting & diarrhea.

most common serious complication of food poisoning is dehydration — a severe loss of water and essential salts and minerals

Pt may also present initially with only neurologic signs & symptoms due to cholinergic blockade.

Visual disturbance, dysarthria, dysphagia & dry mouth are 4 most specific neurologic symptoms.

Additional non specific neurologic symptoms: Malaise Generalized weakness Head ache, dizziness & paresthesia. Oculo bulbar symptoms: blurring of vision , lateral rectus

palsy , ptosis , dilated pupils.

MODE OF ACTION Botulinum toxin(heavy & light chain)

toxin absorbed binds to pre synaptic nerve terminal pre synaptic blockade

DIAGNOSIS

Laboratory analysis Tensilon test Electromyography History

General principles of treatment

1. Oral rehydration therapy It is preferred in mild dehydration 3-5% or

moderate dehydration 6-10% In mild dehydration 50ml/kg should be

administered over a period of 2-4hrs which should contain 50-90meq/l of sodium.

From moderate dehydration 100ml/kg is administered

Later hydration status should be assessed if found normal ,maintenance therapy can began.

2. Maintenance therapy 1ml for diarrheal stool 10ml/kg for every watery stool passed 2ml/kg for each episode of vomiting3.Intravenous rehydration It is necessary when dehydration is

severe(>10% fluid loss) 20ml/kg boluses of ringer’s lactate,NS Solution is administered until pulse ,

perfusion and mental status returns to normal.

Non –specific anti diarrheal agentsAgents such as kaolin –pectinAnti motility drugsAnti-secretary drugs

Treatment of botulism Monitoring of respiratory status vital capacity peak expiratory flow pulse oxymetry Attempt to evaluate GI tract of spores and

toxin with help of activated charcoal emesis gastric lavage catharsis

BOTULINUM ANTI TOXINTrivalent botulinum anti toxin types A,B and E is an

equene globulinGUANIDINE HClIt shows low efficacy and high incidence of ADRDose-15-40mg/kg/day until improvement occursPENICILLINBenefit in wound botulism, penicillinG is preferred.HUMAN –DERIVED BOTULISM IMMUNE GLOBULESIt’s a pentavalent types A,B,C,D and E harvested by

plasma pheresis from donors who received multiple immunizations.

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