?????? (Foodborne Illness)

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?????? (Foodborne Illness)

• 200204038 ????
• ???

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??

• ??????? ??
• ??????? ?? ?? ? ??
• ??????? ??
• ???? ??? ??? ?
• Shigellosis
• ??
• ????
• ??
• ???
• ??
• ??

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What is foodborne disease? 

• Consuming contaminated foods or beverages
• Microbes
• pathogens
• poisonous chemicals
• other harmful substances
• More than 250 different foodborne diseases
• variety of bacteria, viruses, and parasites

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?? ??(in New York State, 2000 2005)
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How many cases of foodborne disease are there
in the United States?

• 76 million Americans get sick
• more than 300,000 are hospitalized
• 5,000 people die from foodborne illnesses

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Prevention

• Cook
• Separate
• Chill
• Clean
• Report

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Foodborne diseases 

• Campylobacter
• Salmonella
• E. coli O157H7
• Calicivirus, or Norwalk-like virus
• Shigella
• Hepatitis A
• the parasites Giardia lamblia and Cryptosporidia
• Staphylococcus aureus
• Clostridium botulinum

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Shigellosis

• Shigella? ?? acute infectious colitis , ??
  bacillary dysentery ? ??
• Shigella slender, G(-) bacilli(??????? E.coli ?
  ?? ??)

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Shigellosis

• 4 species
• S. dysenteriae(???? ? type)
• S. flexneri(???? ? type)
• S. boydii
• S. sonnei(???? ? type, ???? 90 ??)
• ???? ??? ???? ???, ?? ? ? ??? ? ??
• ?? ??? ??, ????? ???? ? ?? ?? or ????? ??

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Shigella Infections
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???? Shigellosis

• ???? ???? ??
• ??? ?(200????)??? ?? ??(?? ?? ???? ?? ??)
• ?? ??? ?? ?? ?? ???? ??? ?? ??
• Fecal-oral route ?? ?? ??? ?? ????, ?? ???
  ??/?/??? ???? ???(???? ?? ?? ???? ??)

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???? Shigellosis

• ?? ?? ??? ?? ??? resistant(low pH? ? ??) ?? ???
  ??
• Colnic epithelial cells invasion ???? ??, cell to
  cell spread
• ???? ???? ??? ?? ??? recto sigmoid ??? proximal?
  ??
• Shiga toxin ?? S. dysenteriae type 1?? ??

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?? Shigellosis

• ??? 13?
• ? ?????
• ¼? ??
• ¼? transient fever
• ¼? fever self-limited watery diarrhea
• ¼? fever bloody diarrhea ? dysentery? ????
  watery diarrhea ??

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?? Shigellosis

• 1. dysentery ?(??? ??)
• frequent(1030?)
• small-volume stools (??? ?? ? ?? ? ??)
  abdominal pain
• tenesmus (?? ????? rectal prolapse? ?? ??)
• Severe dysentery ?? S. dysenteriae type 1 or S.
  flexneri? ?? ??

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?? Shigellosis

• ???
• hemorrhagic mucosa
• mucous discharge
• focal ulcerations
• ???? ??? distal colon? ???, proximal? ??? ?? ??
• ?? ?? colonic toxic dilatation (toxic megacolon)
  perforation ??
• ? 1? ?????

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?? Shigellosis

• 2. cholera ?
• -???? ??
• -???? ?? ??
• 3. diarrhea?
• ??? ??? ?? ?? (enterotoxin? ??)
• ?? S. sonnei or S. boydii? ??

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??? Shigellosis

• Dehydration ??? ? ??? ??
• Bacteremia
• HUS (hemolytic uremic syndrome) ?? S.dysenteriae
  type 1? ?? Shigellosis? 1? ??(???)? ??
• Seizures, reactive arthritis ?? S. flexneri? ??
  ??, HLA-B27()????? Reiters syndrome? ?? ??
• ??? ??, ???, ??, ??? ?? ?? ??

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Diagnosis Shigellosis

• Bloody diarrhea? ??? ?? ??? ???? ?
• Fever non-bloody diarrhea? ?? ? ??S. sonnei
• ??? stool or rectal swab?? ? ?? (?? ???? ??? ??)
• 3? ???? ???? ? (??? 67)

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Diagnosis Shigellosis

• MacConkeyHektoen enteric or xylose-lysine-deoxych
  olate ?? ????? ??? ??
• Shiga-family toxins ??(EIA)?? ?? ?? ?? ??
• Serologic tests

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??? Shigellosis

• Mildmoderate dehydration ?oral rehydration
  solutions
• S. sonnei ?? self-limited ? ??? ?? ?? ??
• ?? ??? dysentery ?? severe case??? ??? ?? ??
• Fluoroquinolones ?? srtain? ?? ???
• ?? ?? ?? ? pivamdinocillin, azithromycin,
  ceftriaxone, cefixime

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??? Shigellosis

• Nalidixic acid ????? ?? S.dysenteriae type 1 ???
  ?
• Sulfonamides, streptomycin, chloramphenicol, TC,
  ampicillin, bactrim ???? ??
• Amoxicillin? ?? ??
• ???? ??? ?? ?? ?? (?? ?? ? ????)
• Antimotillity agents ????? ??, ??? dysenteric
  phase??? ??

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Listeriosis

• L.monocytogenes nonsporulating G() rod
• Intracellular pathogen cell-mediated immunity ??
  ???? ?? ??
• ??? ?????? GI flora? ???? ????? ?
• Gasric acidity ??, abnormal GI funtion ????? ??
• ??? ?? (370?)
• Food-borne transmission ??? ??, ????

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Listeriosis

• Risk group
• ???
• ???
• ??
• ???? ?? ???
• ??? NSW ??? ???? ???? ?? 2030? (??????? ??? ??)

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Listeriosis
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?? Listeriosis

• ??? Listeriosis
• ?? ?? ?? ??? ? ??.
• ???? ??? 3rd trimester ? ???
• ??? Listeriosis
• Early-onset disease (7? ??) infected
  amniotic fluid? aspiration?? ?? ?sepsis,
  ????, skin lesions, granulomatous infantisepticum
• Late-onset disease meningitis

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?? Listeriosis

• ??? ?? ?? Listeriosis
• ?? ?????, ???? ??
• ???? ????? ??, solid or hematologic malignancy,
  DM, ???, AIDS
• Sepsis
• CNS infection
• -Meningitis, meningoencephalitis, cerebritis,
  abscess
• Endocarditis
• GI illness
• Focal infections

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Diagnosis Listeriosis

• ??
• Serologic assays
• Listeriolysin O? ?? Ab

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??? Listeriosis

• Ampicillin or penicillin IV AG
• Penicillin allergy??? bactrim
• Chloramphenicol, RFP penicillin? ??? antagonize
• Cepha?? ?? ??
• ???? ??? ?? ???? ???? ?? ?? ???? ??? ??? ? ??

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?? Listeriosis

• ?? ??
• Widely disseminated disease
• granulomatosis infantisepticum
• Early-onset disease
• ?????

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Campylobacteriosis

• Campylobacter motile, curved G(-) rods (vibrio
  -like)
• Microaerophilic ??? (510) ??, ??? ???? ?? ??.
• 4?? ?, ??, ???? ??? ?? ??(pasteurization?? ?? ??
  ??)

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Campylobacteriosis

• ??? ??? ???? ??? ??? ??? ?? ?? ??
• ?? ??? ??? ??, ??? ???? ??? ???? ?? ??
• ??? ??? ?? (fecal to oral)
• ?? ???? ????
• ?????? Salmonella, Shigella?? ? ?? ????
  ???(campylobacter (45), salmonella (30),
  shigella (17), E.coli O157H7 (5))

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Campylobacteriosis

• Diarrhea disease Campylobacter jejuni(8090)
• Extra intestinal infection C. coli,
  C.upsaliensis, C.lari, C.fetus

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?? Campylobacteriosis

• Campylobacter enteritis
• -?? Campylobacter related species? ?? enteric
  disease? ?? ??? ??
• -??? 27?
• -?? ?? fever,??, myalgia, malaise (?? ?? 1248??
  ?)
• -??? ?? ??? ?? (??,??? ??),??, ??
• -?? self limited(1020? 1? ?? ??, ????? 510??
  ??)

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?? Campylobacteriosis

• C.fetus infections
• -diarrhea illness C.jejuni ? ??
• -prolonged relapsing systemic illness (fever,
  chills, myalgia)
• -fulminant C. fetus infections vascular sites ??
  (endocarditis, mycotic aneurysm, septic
  thrombophlebitis ? ?? ??)
• -?? ? ?? fetal death ?? ??

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??? Campylobacteriosis

• Bacteremia C.fetus? ????? ???.
• Local suppurative complications ???, ???, ???
• Distant Cx ???, ????, ???, ???, cellulitis,
  septic abortion(?? ??)
• ??, ??? ???, HUS(hemolytic uremic syndrome)
• Reactive arthritis other rheumatologic Cx ??
  HLA-B27()(??? ???) ????
• Guillain-Barre syndrome

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Diagnosis Campylobacteriosis

• WBC counts inflammation severity ??
• Stools ??? WBC ?? RBC??
• Stool grams stain ???? vibrioid morphology
• Stool dark-field or phase-contrast darting
  motility ? ??
• ?? ?? ?? ??

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??? Campylobacteriosis

• ??? ??? ??? ??? ??
• ??? ?? high fever, bloody diarrhea severe
  diarrhea, 1? ?? ??, ????
• EM, Cyplofloxacin, TC, furazolidone
• Anti-motility agent ? ?? ?? ?? ??? ??? ??
• ????? ?? GM, imipenem, chloramphenicol

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?? Campylobacteriosis

• ?? ???? ??? ?? ??? ???
• ?? ?? ?????? ??? ??? ??.

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