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INFECTIONS OF LEISURE

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INFECTIONS OF LEISURE. At the Shore. (insert picture of a beach). Puffer Fish Poisoning. Rare in U.S., common in Japan which is known as fugu-fugu Tetrodotoxin , heat stable, non-protein Causes total paralysis including respiratory paralysis 60\% dies within the first 24 hours.

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Presentation Transcript
at the shore
At the Shore
  • (insert picture of a beach)
puffer fish poisoning
Puffer Fish Poisoning
  • Rare in U.S., common in Japan which is known as fugu-fugu
  • Tetrodotoxin, heat stable, non-protein
    • Causes total paralysis including respiratory paralysis
    • 60% dies within the first 24 hours.
slide11
Diagnosis based on clinical history.
  • Treatment
    • Remove unabsorbed toxins
    • Airway support
    • Volume expansion with IV fluids
    • Atropine for bradycardia
ciguatera food poisoning
Ciguatera Food Poisoning
  • The most commonly reported food borne illness in U.S.
  • Most common toxins include ciguatoxin and maitotoxin
    • Lipid soluble
    • Colorless
    • Odorless
    • Heat stable
slide14
Incubation period from 2 – 30 hours

Symptoms

  • Filipinos & Chinese are more severely affected, Hawaiians the least
  • Gastrointestinal
    • Diarrhea
    • Nausea & vomiting
    • Abdominal pain
slide15
Symptoms
    • Neurological
      • Vertigo
      • Weakness
      • Motor paralysis
      • Blurred vision
      • Coma
      • Temperature reversal
slide16
Diagnosis on clinical grounds
    • electrolyte imbalance
    • Elevated serum ammonia
  • Treatment is primarily symptomatic
    • Remove toxin through emesis or gastric lavage with activated charcoal
    • Intravenous mannitol
    • Acetamenophen for myalgia
slide17
Prevention
    • Avoid ingesting fish weighing more than 5 pounds
    • Beware of fish caught during red tides
scombroid fish poisoning
Scombroid-Fish Poisoning
  • Definition:
    • Acute clinical syndrome characterized by histamine toxicity due to ingestion of spoiled fish.
    • Half of the outbreaks reported to CDC were due fish served in restaurants & cafeterias.

BONITO

ALBACORE

slide20
Histidinehistamine due to spoilage
    • Marine bacteria cause spoilage, e.g., M. morganii, K. pneumoniae, E. coli, clostridia, achromobacter, plesiomonas, enterobacter, serratia, & hafnia – common bacteria on fish surface
    • Histamine is heat stable and freezing stable
slide21
Symptoms appear 30 minutes – 4 hours after ingestion of sharp, peppery, & bitter tasting fish.
    • Flushing & hot sensation of skin
    • Dizziness & headache
    • Burning sensation of the mouth & throat
    • Shortness of breath & palpitations
    • Skin rash
slide24
Diagnosis on clinical grounds
  • Treatment is supportive and symptomatic
    • Epinephrine
    • Oxygen
    • Corticosteroids
    • Aminophylline
    • IV cemetidine
vibrio vulnificus
Vibriovulnificus
  • Found in the pacific and Atlantic coasts
  • Most invasive and rapidly lethal human pathogen
  • Major Syndromes
    • Primary septicemia after ingestion of raw oysters by individuals with liver disease
    • Most vulnerable are individuals who have liver disease, especially alcoholic cirrhosis
vibrio vulnificus26
VIBRIO VULNIFICUS
  • The most invasive and rapidly lethal human pathogen
  • Septicemia after of raw oysters
    • Portal of entry is gastrointestinal tract
    • Incubation period 16 hours
    • DIC & septic shock
  • 2nd major syndrome is wound infections
    • Occurs in first 36 hours on trunk & extremities
    • Majority of cases from alcohol abuse
treatment
Treatment
  • Prompt institution of ciprofloxacin, combination of ceptazidime & doxycycline
mycobacterium marinum
MYCOBACTERIUM MARINUM
  • Pathogen of salt and freshwater fish
  • Isolated from swimming pools or aquariums, dead or diseased fish.
  • Causes cutaneous lesions, osteomyelitis, arthritis, sclero-keratitis
slide30
Diagnosis: history & culture
  • Treatment: minocycline, clarithromycin & doxycycline
freshwater lakes hot tubs
Freshwater: Lakes & Hot Tubs
  • Pseudomonas Dermatitis/Folliculitis
    • Swimming pools and spas
    • Synthetic sponges
slide44
Swimmer’s ear
    • Painful & pruritic auditory canal
    • Recurrent in swimmers
    • Mild infections respond to 2% acetic acid or eardrops containing topical steroids.
slide45
Aeromonas in fish tanks, swimming pools, tap water, and brackish water.
    • Implicated in gastroenteritis, wounds, & soft tissue infections
    • Symptoms are fever, pain, edema & foul fish odor
    • Treatment by broad spectrum cephalosporins, aztreonam & aminoglycosides
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