Title: Food Poisoning
1Food Poisoning
- Richard S. Weisman, Pharm.D.
- Director, Florida Poison Center Miami
- Research Associate Professor of Pediatrics
- University of Miami, School of Medicine
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3Overview
- Salmonella
- Clostridium
- Staphylococcus
- Ciguatera
- Scombroid
- Japanese Restaurant Syndrome
- Chinese Restaurant Syndrome
4Salmonella enteritidis
- Outbrakes associated with grade A eggs
- Preparation of Poultry
- Sources
- Chocolate mousse
- Ceasar salad
- Chicken
- Gram - rod
- Killed by high temperatures
5Salmonella
- Signs and symptoms
- 5-72 hours
- low grade fever
- abdominal pain
- diarrhea
- chills
6Salmonella
- Diagnosis
- patient history
- stool culture
- Microscopic examination
- leukocytes
- occult blood
7Salmonella
- Treatment
- Supportive
- fluid and electrolyte
- NO antibiotics
- does not alter the severity
- prolongs the carrier state
- Do NOT give anti-motility drugs
- lead to intestinal perforation
8BOTULISM
9Clostridium botulinum
- Four different types
- food borne
- infant
- wound
- undetermined
- Resistant
- heating, freezing, ionizing radiation
10Clostridium Botulinum
- Destroyed by
- boiling gt120 degrees for gt20 min
- Botulinum toxin
- Very powerful
- 0.5 nanograms (lethal)
- Heat sensitive
- 80 degrees for 30 min
11Clostridium Botulinum
- Signs and Symptoms
- 12-48 hrs (14 days)
- N/V/D
- abdominal distention
- constipation (as disease progresses)
- Neurologic disturbances
- dysarthria, dysphagia, dry mouth
12Clostridium
- With disease progression
- descending paralysis
- respiratory weakness
- respiratory failure
- oculobulbar symptoms
13Clostridium Botulinum
- Treatment
- stabilization of airway
- history
- upper and lower GI decontamination
- trivalent antitoxin
- (ABE)
- watch for hypersensitivity
- call CDC
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17BotulismDifferential Diagnoses
- Neuromuscular disorders
- Stroke syndrome
- Myasthenia gravis
- Guillain-Barre syndrome (Miller-Fisher variant)
- Tick paralysis
- Atropine poisoning
- Paralytic shellfish/puffer fish poisoning
- Diagnosis based on clinical presentation with
subsequent laboratory confirmation -
18Botulism Treatment/Prophylaxis
- Ventilatory assistance and supportive care
- Botulinum antitoxin
- Trivalent equine product against types A,B, and E
available from CDC - Most effective if given early
- Antibiotics for wound botulism
- Penicillin
- Recovery may be prolonged with supportive care
necessary - Vaccine investigational
- not available
19Laboratory Capacity for Botulinum Toxin Testing
20Arnon SS et al, JAMA 20012851059-70
21Staphylococcus aureus
- Enterotoxins
- found
- protein rich foods
- ham, poultry, fish, milk and other dairy
- improper food handling
22Staphylococcus
- Mechanism
- entrotoxin acts as a superantigen
- stimulates intense cytokine production
- toxic shock like syndrome
- Signs and Symptoms
- 2-6 hrs
- abdominal pain
- N/V/D
23Staphylococcus
- Treatment
- mild
- self limiting
- death is rare
- elderly
- debilitated
24Ciguatera
- Most common reported fish poisoning
- Hawaii and Florida report 90 of all cases
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28Ciguatoxic Effects on the Sodium Channel
Nerve Cell
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33CIGUATERAOnset of Symptoms
Am J Trop Med 281067, 1979
34Symptom Course of Chronic Ciguatera
35CIGUATERA POISONINGDays of Bed-rest Required
N 591
Number of Days of Bed-rest
Am J Trop Med Hyg 281067-1073, 1979
36Marine Freshwater Toxin Diseases Clinical
Epidemiology
- Ciguatera ?Clinical Costs
- 2470/case in Canada
- (Todd 1990)
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38Ciguatera
- Heat stable
- Odorless
- Acid stable
- Tasteless
- Mechanism
- free algae dinoflagellates (ciguatoxin)
- dinoflagellates eaten by small fish
39Ciguatera
- Diagnosis
- ELISA for ciguatoxin
- high pressure liquid chromatography (HPLC)
- test fish
- dipstick immuno assay
40Ciguatera
- Treatment
- Mannitol 1g/kg IV over 45 minutes
- activated charcoal
- electrolyte repletion
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43SCROMBOIDMahimahi Flush
- This poisoning is entirely preventable with
adequate refrigeration soon after it is caught. - Bacteria found under the fishs scales are
converted from histadine to histamine.
Morganella morganli
Escherichia Coli
Kiebsiella pneumonia - Cooking the fish will not destroy the histamine
- Poisoning was once attributed to the toxin
Saurine
44SCROMBOID POISONINGSymptoms
- The onset of symptoms is usually within minutes
of the ingestion - Headache
- Flush
- Diarrhea
- Diaphoresis
- Abdominal Cramps
- Pruritis Urticaria
45SCROMBOID POISONINGLaboratory Treatment
- Histamine levels in the fish correlate with
toxicity
0.1 mg/100mg Non-toxic 1.0
mg/100 mg Toxic - Intravenous Diphenhydramine
- Intravenous Cimetidine
- Rehydration
- Once treated, symptoms do not reappear
46Japanese Restaurant Syndrome
- From eating raw fish
- mackerel
- cod
- flounder
- Round worms
- eustronsylids
47Japanese Restaurant Syndrome
- Prevention
- freezing (-4 degrees F x 60 hours)
- cooking (140 degrees F x 5 min)
- Signs and Symptoms
- Stomach
- 1-12hrs
- N/V
- severe abdominal cramping (like gastric ulcer)
48Japanese Restaurant Syndrome
- Signs and Symptoms (cont)
- lower intestinal
- abdominal cramping
- localized abdominal pain
- mimics an acute appendicitis
49Japanese Restaurant Syndrome
- Diagnosis
- without adequate history difficult to diagnose
- endoscopy
- see pink or red larvae
- pathologic examination
- Treatment
- Riclosamide
- Praziquantel
50Chinese Restaurant Syndrome
- Monosodium glutamate
- l-sodium glutamate (MSG)
- Found
- chines restaurants
- flavor enhancer
- sausages
- caned soups
51Chinese Restaurant Syndrome
- Signs and Symptoms
- 10-20 min
- burning
- facial pressure
- headache
- flushing (decreased bp)
- shudder attacks
- seizure like (young children)
52Chinese Restaurant Syndrome
- Treatment
- oxygen
- beta 2 inhalers
- IV fluids