Introduction
Food poisoning is a spectrum of disorders arising from:
- Infections acquired by eating contaminated food
- Clinical problems that result from eating food contaminated with toxins
- Clinical sequelae from inherently poisonous animals, plants or mushrooms
Clinical forms:
- Staphylococcal food poisoning:
- Food is contaminated by S. aureus when prepared unhygienically by individuals who are carriers
- Subsequent growth of S. aureus in the food and enterotoxin production occurs if the food is not cooked at temperatures sufficient to kill the bacteria, or is not refrigerated
- Food-borne botulism
- Non-typhoidal Salmonellosis
- Shigellosis
- E. coli food poisoning
- Campylobacter food poisoning
- Listeria monocytogenes food poisoning
- Yersinia enterocolitica food poisoning
- Norwalk virus food poisoning
- Hepatitis A virus food poisoning
- Giardiasis
- Helminthic parasitic food poisoning
Clinical features
Staphylococcal food poisoning:
- Nausea
- Diarrhoea 2 – 6 hours after eating food contaminated by enterotoxin
Food-borne botulism:
- Incubation period is 18 36 hours, but depending on toxin dose, can extend from a few hours to several days
- Symmetric descending paralysis
- Diplopia
- Dysarthria/dysphagia
- Nausea, vomiting and abdominal pain may precede or follow the onset of paralysis
Non-typhoidal Salmonellosis:
- Nausea
- Diarrhoea
- Vomiting
- Abdominal cramps
- Fever
- Headache
- Myalgia
Shigellosis:
- Fever
- Self-limiting watery diarrhoea
- Bloody diarrhoea
- Dysentry
- Frequent passage, 10 – 30 times/day of small volume stools containing blood, mucus and pus
- Abdominal cramps
- Tenesmus
Campylobacter food poisoning:
- A prodrome with fever, headache, myalgia and/or malaise
- 12-48 hours later: Diarrhoea and abdominal pain
E. coli food poisoning:
- Watery diarrhoea accompanied by cramps
L. monocytogenes food poisoning:
- Common source of outbreaks of acute gastritis
- Not a major cause of sporadic diarrhoea
Norwalk virus food poisoning:
- Abrupt onset of nausea and abdominal cramps followed by vomiting and/or diarrhoea
Hepatitis A virus food poisoning:
- May cause large outbreaks of diarrhoea and vomiting from contaminated food, water, milk and shellfish
- Intrafamily and intra-institutional spread is common
Diagnosis
- Essentially clinical laboratory confirmation of the specific microbe(s) involved
Differential diagnoses
- Other causes of acute onset diarrhoea, nausea, abdominal cramps and vomiting with or without systemic manifestations
Complications
- Fluid and electrolyte derangements
- Others (By no means limited to the stated organisms)
Shigellosis:
- Dehydration
- Rectal prolapse
- Protein-losing enteropathy
- Malnutrition
- Haemolytic-uraemic syndrome
- Toxic megacolon
- Perforation
Campylobacter food poisoning:
- Bacteraemia
- Cholecystitis
- Pancreatitis
- Cystitis
- Meningitis
- Endocarditis
- Arthritis
- Peritonitis
- Cellulitis
- Septic abortion
Treatment objectives
- Restore fluid and electrolyte balance
- Neutralize toxin
- Eradicate microbe
Non-drug measures
- Gastric lavage in food-borne botulism
Drug treatment
- Appropriate fluid and electrolyte
replacement - Trivalent (types A, B, and E) equine anti-toxin should be administered as soon as possible after specimens are obtained for laboratory analysis for food-borne botulism
- Emetics in food-borne botulism
- Administer appropriate medicines
Shigellosis
- Oral Rehydration Therapy
Plus:
Amoxicillin
- Adult: 50-100 mg/kg/day orally
every 8 hours; up to 2 g/day - Child up to 10 years: 125 mg every 8 hours, doubled in severe infections
Or:
Trimethoprim/sulfamethoxazole (cotrimoxazole)
- Adult: 960 mg orally every 12 hours for 5 days
- Child:
- weeks to 5 months: 120 mg orally;
- 6 months -5 years: 240 mg;
- 6-12 years: 480 mg given every 12 hours for 5 days
Or:
Ceftriaxone:
- Adult: 1 g intravenously slowly
- Child: 50 mg/kg/day intravenously for 5 days
Campylobacter food poisoning
- Fluid and electrolyte replacement
Plus:
Erythromycin
- Adult: 250 mg orally every 6 hours for 5 – 7 days
- Child: 30-50 mg/kg orally every 6 hours for 5 -7 days
E. coli food poisoning
Ciprofloxacin
- Adult: 500-750 mg orally every 12 hours
Or:
- 200 – 400 mg 12 hourly by intravenous infection over 30-60 minutes
- Child and adolescent: not recommended
L. monocyogenes food poisoning
- Amoxicillin Plus Gentamicin
- Treat specific complications as appropriate e.g.
- Antibiotic-unresponsive toxic
megacolon: colectomy - Haemolytic-uraemic syndrome: dialysis
- Malnutrition from protein-losing enteropathy: nutritional support; optimal nutritional management
- Antibiotic-unresponsive toxic
Prevention
- Appropriate environmental and personal hygiene
- Hand washing with soap and water
- Decontamination of water supplies
- Use of sanitary latrines or toilets
- Identify and treat chronic carriers among food handlers
- Hygienic preparation and storage of food
- Ensure that food is cooked at temperatures sufficient to kill bacteria
- Refrigerate food whenever possible
- Encourage measures to reduce the burden of malnutrition (with its attendant predisposition to severe infections)
- Encourage exclusive breastfeeding
- Administer a pentavalent vaccine (A, B, C, D, and E) for persons at high of botulism
- Report new cases to public health authorities