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Food Poisoning

Food Poisoning. Richard S. Weisman, Pharm.D. Director, Florida Poison Center – Miami Research Associate Professor of Pediatrics University of Miami, School of Medicine. Overview. Salmonella Clostridium Staphylococcus Ciguatera Scombroid Japanese Restaurant Syndrome

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Food Poisoning

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  1. Food Poisoning Richard S. Weisman, Pharm.D. Director, Florida Poison Center – Miami Research Associate Professor of Pediatrics University of Miami, School of Medicine

  2. Overview • Salmonella • Clostridium • Staphylococcus • Ciguatera • Scombroid • Japanese Restaurant Syndrome • Chinese Restaurant Syndrome

  3. Salmonella enteritidis • Outbrakes associated with grade A eggs • Preparation of Poultry • Sources • Chocolate mousse • Ceasar salad • Chicken • Gram - rod • Killed by high temperatures

  4. Salmonella • Signs and symptoms • 5-72 hours • low grade fever • abdominal pain • diarrhea • chills

  5. Salmonella • Diagnosis • patient history • stool culture • Microscopic examination • leukocytes • occult blood

  6. Salmonella • 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

  7. BOTULISM

  8. Clostridium botulinum • Four different types • food borne • infant • wound • undetermined • Resistant • heating, freezing, ionizing radiation

  9. Clostridium Botulinum • Destroyed by • boiling >120 degrees for >20 min • Botulinum toxin • Very powerful • 0.5 nanograms (lethal) • Heat sensitive • 80 degrees for 30 min

  10. Clostridium Botulinum • Signs and Symptoms • 12-48 hrs (14 days) • N/V/D • abdominal distention • constipation (as disease progresses) • Neurologic disturbances • dysarthria, dysphagia, dry mouth

  11. Clostridium • With disease progression • descending paralysis • respiratory weakness • respiratory failure • oculobulbar symptoms

  12. Clostridium Botulinum • Treatment • stabilization of airway • history • upper and lower GI decontamination • trivalent antitoxin • (ABE) • watch for hypersensitivity • call CDC

  13. Botulism:Differential 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

  14. Botulism: 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

  15. Laboratory Capacity for Botulinum Toxin Testing

  16. Arnon SS et al, JAMA 2001:285:1059-70

  17. Staphylococcus aureus • Enterotoxins • found • protein rich foods • ham, poultry, fish, milk and other dairy • improper food handling

  18. Staphylococcus • 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

  19. Staphylococcus • Treatment • mild • self limiting • death is rare • elderly • debilitated

  20. Ciguatera • Most common reported fish poisoning • Hawaii and Florida report 90% of all cases

  21. Ciguatoxic Effects on the Sodium Channel NerveCell

  22. CIGUATERAOnset of Symptoms Am J Trop Med 28:1067, 1979

  23. Symptom Course of Chronic Ciguatera

  24. CIGUATERA POISONINGDays of Bed-rest Required N= 591 Number of Days of Bed-rest Am J Trop Med Hyg 28:1067-1073, 1979

  25. Marine & Freshwater Toxin Diseases : Clinical Epidemiology Ciguatera: ?Clinical Costs $2470/case in Canada (Todd 1990)

  26. Ciguatera • Heat stable • Odorless • Acid stable • Tasteless • Mechanism • free algae dinoflagellates (ciguatoxin) • dinoflagellates eaten by small fish

  27. Ciguatera • Diagnosis • ELISA for ciguatoxin • high pressure liquid chromatography (HPLC) • test fish • dipstick immuno assay

  28. Ciguatera • Treatment • Mannitol 1g/kg IV over 45 minutes • activated charcoal • electrolyte repletion

  29. SCROMBOID“Mahimahi Flush” • This poisoning is entirely preventable with adequate refrigeration soon after it is caught. • Bacteria found under the fish’s scales are converted from histadine to histamine. Morganella morganli Escherichia Coli Kiebsiella pneumonia • Cookingthe fish will not destroy the histamine • Poisoning was once attributed to the toxin Saurine

  30. SCROMBOID POISONINGSymptoms • The onset of symptoms is usually within minutes of the ingestion • Headache • Flush • Diarrhea • Diaphoresis • Abdominal Cramps • Pruritis &Urticaria

  31. SCROMBOID 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

  32. Japanese Restaurant Syndrome • From eating raw fish • mackerel • cod • flounder • Round worms • eustronsylids

  33. Japanese 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)

  34. Japanese Restaurant Syndrome • Signs and Symptoms (con’t) • lower intestinal • abdominal cramping • localized abdominal pain • mimics an acute appendicitis

  35. Japanese Restaurant Syndrome • Diagnosis • without adequate history difficult to diagnose • endoscopy • see pink or red larvae • pathologic examination • Treatment • Riclosamide • Praziquantel

  36. Chinese Restaurant Syndrome • Monosodium glutamate • l-sodium glutamate (MSG) • Found • chines restaurants • flavor enhancer • sausages • caned soups

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