Food-Borne and Water-Borne Diseases

1. cleveland.com Food-Borne and Water-Borne Diseases By: Melina Rothert Eli Dougherty Randy Hale

2. Food-Borne Diseases • AKA- Food Poisoning • The diseases, if not serious, usually causes gastroenteritis which is inflammation of the stomach and intestinal lining. Side effects are usually nausea, vomiting, and diarrhea. • Food Poisoning can happen 2 ways: • Food-borne infection- bacteria colonize in the GI tract and grow, then either invade host tissues or secrete exotoxins • Food intoxication- bacteria is already in food which create exotoxins that contaminates the food before consumed. Presence of living bacteria is not required. • These toxins are called enterotoxins because they disrupt the functioning of the gastroenteritis tract.

3. Botulism • Bacteria- Clostridium botulinumspores. It is an anaerobic gram-positive rod  • Route of transmission –the common source of disease is home-canned food that hasn’t been heated enough to kill harmful bacteria. The spores then germinate and a toxin is produced during anaerobic vegetative growth. Therefore it is in is a food intoxication. • Populations Effected- the toxin binds to the synapse of motor neurons, preventing the transmission of the chemical acetylcholine (responsible for enabling muscle action, memory and learning) from one neuron to another. Therefore, muscles don’t contract and leads to flaccid paralysis. • Symptoms- blurred vision , difficulty swallowing and speaking, muscle weakness, nausea and vomiting. Occur 12 to 72 hours after.

4. Botulism Cont. • Diagnosis – your doctor will check you for signs of muscle weakness or paralysis, such as drooping eyelids and a weak voice. Your doctor will also ask about the foods you've eaten in the past few days. Analysis of blood, stool or vomit for evidence of the toxin may help confirm, but because these tests may take days, your doctor's clinical examination is the primary means of diagnosis. • Treatments- supportive care and polyvalent antitoxin • Occurrence/Death rate- if untreated , one-third of the patients die of either respiratory or cardiac failure within a few days. Fewer than 100 cases of botulism occur in the US annually.

5. Campylobacter jejuniGastroenteritis • Bacteria- Campylobacter jenjuni. It’s a slender, gram-negative, motile, spiral rod found in intestinal tract of animals. • Route of Transmission- Chicken, turkeys and cattle have shown that as much as 50 to 100% of a flock or herd of these animals secrete C. jenjuni. They are transmitted to humans by contaminated food and water, contact with infected animals, or anal-oral sexual activity. • Populations effected- the bacteria invades the epithelium of the small intestine, causing inflammation, and also secretes an exotoxin • Symptoms- diarrhea, high fever, severe inflammation of the intestine along with ulceration, and bloody stools. It’s also been linked to Guillain-Barre syndrome, where the immune system attacks peripheral nerves, resulting in life threatening paralysis.

6. C. jejuniGastroenteritis Cont. • Diagnosis- labitory diagnosis is by culture in an atmosphere with reduced 02 and added CO2 • Treatments- fluids, electrolyte replacement and erythromycin may be added in severe cases. Recovery usually takes from 5 to 8 days • Occurrence/Death-rate- there is an estimated 2 million cases per year in the US • Prevention- good personal hygiene and food-handling precautions, including pasteurization of milk and thorough cooking and poultry. https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcR1thfoUUr-eG1OAK_45rTjqht2YKzRvptqSBt6mzbFbPofN5yJ https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcQPaBQtvjPWEhmB6sgeeBvKG3BlRvhCtivJwTW8iQGLHTyTT3We

7. Cholera • Bacteria- Vibrio cholera. Gram-negative, comma-shaped bacterium • Route of Transmission- ingesting food or water contaminated by fecal material from infect individuals • Populations Effected-The bacteria adhere to the intestinal mucosa of small intestine then secrete a toxin known as choleragen. • Symptoms- profuse watery diarrhea, vomiting, and leg cramps. Which then result in rapid loss of body fluid leading to dehydration and shock. Death can result in hours if dehydration is left untreated https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcQQG5TsMWwhP9jfnFOYZN8uw6u_Crvk4VXyeDCinkexcYFLkQer

8. Cholera Cont. • Diagnosis- confirmed through culture of a stool specimen or rectal swab. • Treatment- oral rehydration therapy with NaCl plus glucose. Antibiotics may also be given • Occurrence/Death rate- has caused several pandemics in various areas of the world Asia, Middle East, and Africa. Rare in the US. Mortality rate is often 50% without treatment, less than 1% with treatment • Prevention- proper sanitation, especially of water supplies. https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSYADTcvkGfa6JMt4rHmYx9yar4TD997YwN4aq5IxKn5TOy3Dd9cQ

9. E. coli Gastroenteritis • Bacteria- Escherichia coli. Gram-negative, rod shaped bacteria • Route of Transmission- through contaminated meat and water that hasn’t been properly been prepared • Populations Effected- the bacteria inhabits the colon of humans and other warm blooded animals. Usually nonpathogenic members of the normal intestinal mechanisms. • Symptoms- Usually none because it can be nonpathogenic but based on what strain E. coli you have of the 6, it can vary, though all of the 6 causes diarrhea . • Diagnosis- laboratory diagnosis is by isolation of the specific type of E. coli from feces and indentify by using DNA probes, determination of virulence factors and the polymerase chain reaction. • Treatments- fluid and electrolytes plus doxycycline and trimethoprim-selfamethoxazole. • Occurrence/Death rate-73,000 cases each year and 60 deaths of those cases • Prevention- avoiding contaminated food and water

10. Six Strains of Diarrheagenic E. coli • Enterotoxin E. coli- releases 2 enterotoxins that bind to the surface of intestinal epithelial cells that then cause hypersecretion of the electrolytes and water in the intestinal lumen • Enteroinvasive E. coli- cause diarrhea by penetrating and multiplying within the intestinal epithelial cells • Enteropathogenic E. coli- the bacteria create lesions in the brush border of the epithelial cells that cause subsequent diarrhea • Enterohemorrhagic E. coli- the bacteria carry a toxin that also produce lesions. Causing hemorrhagic colitis with severe abdominal pain and cramps followed by bloody diarrhea. Can also lead to kidney failure • Enteroaggregative E. coli- form clumps of bacteria on top of epithelial cells. • Diffusely adhering E. coli- adhere over the entire surface of the epithelial cells https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcSbePiuj8-9u0heoIMRSL2-oyIAg2AfdaiCw7YCcedkQdy2HCm4

11. Salmonellosis • Bacteria- Salmonella enterica. Gram-negative rods • Route of Transmission- the initial source of the bacteria is in the intestinal tracts of birds and other animals. Humans acquire the bacteria from contaminated water or foods such as beef products, poultry, eggs or egg products. Was linked to typhoid that has cause several epidemics. • Populations Effected- when the bacteria multiply and invade the intestinal mucosa, where they produce an enterotoxin and a cytotoxin that destroys epithelial cells. • Symptoms- abdominal pains, cramps, diarrhea, nausea, vomiting, and fever; usually last for 2 to 5 days but can persist for several weeks.

12. Salmonellosis Cont. • Diagnosis-Blood culture, complete blood count with differential, Febrile/cold agglutinins (test for specific antibodies), Stool culture for salmonella • Treatment- stay constantly hydrated • Occurrence/Death rate- estimated 1.4 million cases occur annually in the US. Of these about 45,000 are culture-confirmed and reported to CDC. https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQdEGzLbpI_7Za6OTgAmiNs1ceSRQUFDri5XBgSPunf7-0vrFW9zw

13. Shigellosis • Bacteria- Shigellasonnei. Gram-negative, rod shaped, non- motile bacteria. • Route of Transmission- transmitted through a fecal-oral route; primarily by food, fingers, feces, and flies. It is a particular problem in day-care centers and crowded custodial institutions • Populations Effected- the bacteria multiply within the villus cells of the colonic epithelium and generally don’t spread beyond it. • Symptoms- watery stool that often contains blood, mucus and pus. In severe cases the colon can become ulcerated. In infants and children, it may become fatal.

14. Shigellosis Cont. • Diagnosis-Dehydration with fast heart rate and low blood pressure, abdominal tenderness, elevated white blood cell count, stool culture, white blood cells in stool • Treatment- fluid and electrolyte replacement, antibiotics are needed in mild cases but can shorten symptoms and reduce transmission to family members • Occurrence/Death rate- about 20,000 to 25,000 cases a year are reported in the US, and around 600,000 deaths a year worldwide. • Prevention- good personal hygiene and maintenance of a clean water supply https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcR6qYdBGy_32VwMRr-LVSBrj2nXBcYXcJMy4PPaD-Ul-rsG62PCBA

15. Staphylococcal Food Poisoning • Bacteria- Staphylococcal aureus. Gram-positive, round bacteria. • Route of Transmission- ingestion of improperly stored or cooked food. Foods like: ham, processed meats, chicken salad, pastries, ice cream, and hollandaise sauce. • Populations Effected- in inhabits the intestines and produces a toxin that causes illness. • Symptoms- severe abdominal pain, cramps, diarrhea, explosive vomiting and nausea. Symptoms are rapid but last for a shorter while. https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcQz12ToN2iufZvY_kPLoUqnLk0eug9v32GzS-DhMqaVeu5D6oR3AQ

16. Staphylococcal Food Poisoning Cont. • Diagnosis-obtaining a culture from the area of suspected infection. Suspect diagnosis is based on patient symptoms and the healthcare provider’s evaluation. • Treatment- just letting it run its course but constantly keeping hydrated. The toxins usually resolves without medication • Occurrence/Death rate- very rare do people die from it • Prevention- hand washing during food preparation and the use of safe cooking and dining practices.

17. Food-Borne Prevention • Keep food at safe temperatures • - Do not leave cooked food at room temperature for more than 2 hours • - Refrigerate cooked and perishable food • - Keep food hot when serving • - Do not store food too long even in a refrigerator • - Do not thaw foods out at room temperature • Wash with water • - Wash fruits vegetable, especially if eaten raw • - Do not use food beyond expiration date • Stay Clean • - Wash hand after going to the bathroom • - Wash and sanitize all surfaces and equipment used for food preparation • - Protect kitchen and food from insects, pests, and other animals • - Wash hands before and after handling food • Separate raw and cooked foods • - Separate raw meats from cooked ones • - Clean equipment used on raw food before using them on anything else • - Store food in containers to avoid contact between raw and prepared foods • Cook thoroughly • - Cook food thoroughly especially meat, poultry, eggs and seafood • - Bring foods like stews to boiling to make sure that they have reached 70°C. For meat and poultry, make sure that juices are clear, not pink. Ideally use a thermometer • - Reheat cooked foods thoroughly

18. References • Botulism • http://www.bt.cdc.gov/agent/botulism/clinicians/diagnosis.asp • http://emedicine.medscape.com/article/213311-overview • physio-pedia.com (image) • Cholera • http://www.cdc.gov/cholera/diagnosis.html • Shigellosis • http://health.nytimes.com/health/guides/disease/shigella-enteritis/overview.html • Staphylococcal • http://www.health.state.mn.us/divs/idepc/diseases/staph/treat.html • Prevention • http://www.who.int/foodsafety/publications/consumer/flyer_keys_en.pdf