Typhoid and Food poisoning NBR

Typhoid fever and Food poisoning: 

Typhoid fever and Food poisoning Dr. N. Bayapa Reddy MD Asst. Professor Dept. of Community Medicine Chennai Medical College Hospital & Research Centre Trichy , Tamilnadu 9/30/2011 Dr N B R Com.Med CMCH&RC

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Typhoid fever Salmonella Typhoid fever is the results of systemic infection mainly by salmonella Typhi found only in man 9/30/2011 Dr N B R Com.Med CMCH&RC

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Typhoid fever , also known as "enteric fever" is a collective term that refers to typhoid and paratyphoid. it is a common in worldwide. Transmitted by the ingestion of contaminated food or water with Salmonella Typhi. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. 9/30/2011 Dr N B R Com.Med CMCH&RC

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Coliform bacilli (enteric rods) Motile gram-negative facultative anaerobes Non-lactose fermenting Resistant to bile salts H 2 S producing The organism is motile due to its peritrichous flagella. General Characteristics of Salmonella 9/30/2011 Dr N B R Com.Med CMCH&RC

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This is a highly adapted, human-specific pathogen occurring more frequently in underdeveloped regions of the world where overcrowding and poor sanitation are prevalent. According to the best global estimates, there are at least 21 million new cases of typhoid fever each year, with 6,00,000 deaths (Ivanoff, 2004). Between 1 - 5% of patients with acute typhoid infection have been reported to become chronic carriers of the infection, depending on age , sex and treatment regimen. Furthermore this chronic carrier state has also been implicated in causation of carcinoma of the gall bladder . Epidemiology : 9/30/2011 Dr N B R Com.Med CMCH&RC

Antigenic structure of Salmonella: 

Antigenic structure of Salmonella Two sets of antigens present Somatic or 0 Antigens contain long chain polysaccharides ( LPS ) comprises of heat stable polysaccharide commonly. Flagellar or H Antigens are strongly immunogenic and induces rapid antibody formation. High titers following infection or immunization 9/30/2011 Dr N B R Com.Med CMCH&RC

Agent factors: 

Agent factors S. typhi and para typhi A & B Man is the only Reservoir of Infection Cases Carriers (convalescence, Incubatory and chronic) Source of infection Primary Feces and urine of cases and carriers Secondary contaminated water, food, fingers & flies 9/30/2011 Dr N B R Com.Med CMCH&RC

Host factors : 

Host factors Age – 5-19 years Sex – Males > Females Carriers Females > Males Immunity – all age groups are susceptible. Second attack may occur Environment:- July- Sept IP – 10 to 14 days Mainly by faecal - oral, urine-oral route 9/30/2011 Dr N B R Com.Med CMCH&RC

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Clinical Fetures of Salmonella Prodromal stage: malaise, headache, cough, sore throat abdominal pain and constipation fever ascends like step ladder pattern After 7- 10 days fever reaches plateau and looks toxic with pea soup diarrhoea, Nausea, vomiting, cramps, myalgia and headache. Spleenomegaly abdominal distention and tenderness Relative bradycardia, dicrotic pulse. Rose spots commonly appear in the second week 9/30/2011 Dr N B R Com.Med CMCH&RC

Diagnosis: 

Diagnosis Blood culture is usually positive in only half the cases. . Bone-marrow culture increases the diagnostic yield to about 80% of cases Stool culture is not usually positive during the acute phase of the disease WIDAL Test land Mark In Diagnosis: WIDAL Test land Mark In the Diagnosis typhoid fever. Widal test is an old serologic assay for detecting IgM and IgG antibodies to the O and H antigens of Salmonella . The test is unreliable, but is widely used in developing countries because of its low cost. Newer serologic assays are somewhat more sensitive and specific than the Widal test, but are infrequently available IDL Tubex test with in few mints can detect IgM09 Typhidot -3hrs IgM and IgG against 50 KD antigen 9/30/2011 Dr N B R Com.Med CMCH&RC

Control of typhoid fever: 

Control of typhoid fever Control of reservoir- cases and carriers Improve the sanitation Immunization 9/30/2011 Dr N B R Com.Med CMCH&RC

Control of reservoir: 

Control of reservoir Cases – Early diagnosis Notification Isolation – atleast three bacteriologically negative stools and urine Treatment Disinfection Follow up Carriers- identification Treatment Surgery Surveillance Health education 9/30/2011 Dr N B R Com.Med CMCH&RC

Immunization: 

Immunization It is not 100% protection but it decrease both incidence and seriousness of the infection Those living in endemic areas Household contacts Groups at risk such as school children and hospital staff Travelers proceeding to endemic areas Those attending melas and yatras 9/30/2011 Dr N B R Com.Med CMCH&RC

Vaccines: 

Vaccines Vi polysaccharide vaccine Sub unit vaccine Vi capsular polysaccharide from the Ty2 S. typhy No use for less than 2yrs old children Single dose SC or IM 25micrograms of Antigen Revaccination required once in every three years 9/30/2011 Dr N B R Com.Med CMCH&RC

Vaccines con..: 

Vaccines con.. Ty21a Vaccine Live attenuated Ty2 strain of S. typhi Oral administration Two forms Capsular used above 5 years age and liquid form used above 2 years Three doses – 1, 3, and 5 th days immunity develops after 7 days of last dose revaccination required once in every three years Can administer HIV positive, asymptomatic individuals (T cell count CD4 >200/mm3) 9/30/2011 Dr N B R Com.Med CMCH&RC

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WHAT IS FOOD POISONING: 

WHAT IS FOOD POISONING Food poisoning comes from eating foods that contain germs like bacteria, virus, protozoon's and toxins. Food borne illness usually arises from improper handling, preparation, or food storage. Good hygiene practices before, during, and after food preparation can reduce the chances of contracting an illness. 9/30/2011 Dr N B R Com.Med CMCH&RC

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Pathogenesis: 

Pathogenesis Microbes attach to the cells lining the intestinal walls, and begin to multiply there. Some microbes produce a toxin that is absorbed into the bloodstream some can directly invade the deeper body tissues. The infectious dose :- is the amount of agent that must be consumed to give rise to symptoms. 9/30/2011 Dr N B R Com.Med CMCH&RC

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SYMPTOMS: 

Nausea Abdominal pain Vomiting Cramps Diarrhea Gastroenteritis Fever, headache or fatigue In most cases the body is able to permanently recover after a short period of acute discomfort and illness. SYMPTOMS 9/30/2011 Dr N B R Com.Med CMCH&RC

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Nausea Diarrhoea Fever 9/30/2011 Dr N B R Com.Med CMCH&RC

BACTERIAL CAUSES: 

BACTERIAL CAUSES Salmonella Staphylococcal food poisoning E. Coli Botulism Cl.perfringes B.cereus 9/30/2011 Dr N B R Com.Med CMCH&RC

SALMONELLA: 

SALMONELLA Salmonella is a bacterial infection that can be passed on to humans domestic animals, including poultry. An increase in communal feeding Wide distribution of prepared foods Widespread use of detergents it will interfering with sewage treatment Agent: S typhimurium , S. cholera- suis , S. enteritidis Salmonella can escape from the intestine and go into the blood and travel to other organs. It may become a chronic infection in some people IP 12-24hrs 9/30/2011 Dr N B R Com.Med CMCH&RC

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Virulence attributable to: Invasiveness Intracellular survival & multiplication Endotoxin Exotoxins: Effects in host have not been identified Several Salmonella serotypes produce enterotoxins similar to both the heat-labile (LT) and heat-stable enterotoxins (ST), but their effect has not been identified A distinct cytotoxin is also produced and may be involved in invasion and cell destruction Pathogenesis of Salmonella 9/30/2011 Dr N B R Com.Med CMCH&RC

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Clinical Progression of Salmonella Enteritis Lamina propria = thin membrane between epithelium & basement layer Hyperplasia = abnormal increase in # of normal cells Hypertrophy = abnormal increase in normal tissue/organ size Prostaglandins = potent mediators of diverse set of physiologic processes 9/30/2011 Dr N B R Com.Med CMCH&RC

SHIGELLA: 

SHIGELLA Shigella is a bacteria generally transmitted through feces. It causes dysentery, an infection of the intestines causing severe bloody diarrhea. The disease generally occurs in tropical or temperate climates, especially under conditions of crowding, where personal hygiene is poor. 9/30/2011 Dr N B R Com.Med CMCH&RC

E. Coli: 

E. Coli E. coli is a growing cause of food borne illness. Most E. coli O157:H7 infections have been associated with eating undercooked, contaminated ground beef . Drinking unpasteurized milk and swimming in or drinking sewage-contaminated water can also cause infection. Bacteria from stools of infected people can be passed to others if less than adequate hygiene or hand-washing habits are present. 9/30/2011 Dr N B R Com.Med CMCH&RC

BOTULISM: 

BOTULISM The bacterium Clostridium botulinum is responsible for causing the rare but serious illness. Grows in improperly canned low-acid foods and produces botulinum , a powerful paralytic toxin with IP 12 to 36hrs Three main types of botulism are foodborne , wound, and infant botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism, which is very rare, is caused by a toxin produced from a wound infected with C. botulinum . Infant botulism is caused by consuming the spores of botulinum bacteria, which grow in a child's intestines. 9/30/2011 Dr N B R Com.Med CMCH&RC

Cont…: 

Cont… Additional Symptoms include: Blurred vision Double vision Droopy eyelids Slowed or slurred speech Difficulty swallowing Dry mouth Muscle weakness Constipation 9/30/2011 Dr N B R Com.Med CMCH&RC

EXOTOXINS: 

EXOTOXINS Clostridium perfringens - ingetion meat, meat dishess and poultry- IP 6- 24 hrs Mainly diarrhoea and abdominal pain some times fever Nausea and vomiting are rare Bacillus cereus- spore baring motile and gram – ve bacilli Two forms Emetic form- 1-6hrs predominantly upper GI symptoms Diarrheal form 12-24 hrs predominantly lower GI symptoms Staphylococcus aureus produces a toxin that causes intense vomiting with IP 1-6hrs Salads, milk and milk products 9/30/2011 Dr N B R Com.Med CMCH&RC

MYCOTOXINS AND ALIMENTARY MYCOTOXICOSES : 

MYCOTOXINS AND ALIMENTARY MYCOTOXICOSES The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins through food consumption. Mycotoxins have prominently affected on human and animal health. 9/30/2011 Dr N B R Com.Med CMCH&RC

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Aflatoxins - originated from Aspergillus parasiticus and Aspergillus flavus . The pronounced forms of Aflatoxins are those of B1, B2, G1, and G2, Aflatoxin B1 predominantly targets the liver, which will result in necrosis, cirrhosis, and carcinoma. Altertoxins - originated from Alternaria spp. Some research has shown that the toxins can be easily cross-contaminated between grain commodities and animal food, suggesting that manufacturing and storage is a critical practice. 9/30/2011 Dr N B R Com.Med CMCH&RC

SYMPTOMS: 

SYMPTOMS Consequences of oral intake of, or dermal exposure to, the toxins will result in Neutropenia Aplastic anemia Thrombocytopenia Skin irritation 9/30/2011 Dr N B R Com.Med CMCH&RC

VIRUSES: 

VIRUSES Viral infections make up perhaps one third of cases of food poisoning. Food borne viral infection are usually of intermediate (1–3 days) incubation period, causing illnesses which are self-limited in otherwise healthy individuals, and are similar to the bacterial forms described above. 9/30/2011 Dr N B R Com.Med CMCH&RC

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Rotavirus Enterovirus Hepatitis A prolonged (2–6 week) incubation period Hepatitis E It has ability to spread beyond the stomach and intestines, into the liver. induces jaundice, and rarely leads to chronic liver dysfunction. 9/30/2011 Dr N B R Com.Med CMCH&RC

PARASITES: 

PARASITES Most foodborne parasites are zoonoses Platyhelminthes Diphyllobothrium sp. (raw, infected fish) Taenia saginata (beef that is under cooked) Taenia solium (pigs are intermediate hosts) Fasciola hepatica (from infected liver) 9/30/2011 Dr N B R Com.Med CMCH&RC

PROTOZOA: 

PROTOZOA Cyclospora cayetanensis (uncooked or cross-contaminated food) Entamoeba histolytica Giardia lamblia Sarcocystis hominis Sarcocystis suihominis Toxoplasma gondii 9/30/2011 Dr N B R Com.Med CMCH&RC

NEMATODE: 

NEMATODE Ascaris lumbricoides (swallowing of food contaminated with unhatched juveniles). Trichinella spiralis (undercooked pork as the primary vector for the parasite) Trichuris trichiura (food that may have been fecaly contaminated) 9/30/2011 Dr N B R Com.Med CMCH&RC

PREVENTING: 

PREVENTING Proper storage and refrigeration of food help in the prevention of food poisoning Prevention is mainly through the definition of strict rules for food sanitation and role Personal hygiene. Food handling techniques Sanitary improvement Health education 9/30/2011 Dr N B R Com.Med CMCH&RC

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Farm Transportation Slaughterhouse Processing Market Consumer 9/30/2011 Dr N B R Com.Med CMCH&RC

HYGIENIC CONTROL OF MEAT IN MARKET: 

HYGIENIC CONTROL OF MEAT IN MARKET Objective Food purity It is essential that meat offered for sale to the public should not contain any pathogen that cause disease. At the time of sale meat must not be contaminated with other spp. Pathogen e.g. staphylococcus, clostridium, etc. Such foods are injurious to health 9/30/2011 Dr N B R Com.Med CMCH&RC

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Slaughter house construction: 

Slaughter house construction Cemented floor of shop Tile wall Stainless steel/ marble Proper ventilation Refrigerator Water supply Drainage facility Restriction of other animals to enter in to the premisis 9/30/2011 Dr N B R Com.Med CMCH&RC

DAILY FOOD HANDLING: 

DAILY FOOD HANDLING The equipment and arrangement of an establishment is an important factor in getting the products of good hygienic quality Personal hygiene Fly control Avoid stray dogs Avoid customer to touch the meat with fingers 9/30/2011 Dr N B R Com.Med CMCH&RC

APPROVAL OF PREMISES: 

APPROVAL OF PREMISES Meat and meat products should be carried out only in rooms efficiently approved for this purpose Periodic inspection of meat market It should cover proper inspection of meat, equipments used, general sanitation and personal hygiene of meat handlers 9/30/2011 Dr N B R Com.Med CMCH&RC

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9/30/2011 Dr N B R Com.Med CMCH&RC