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Food poisoning and Prevention. 食物中毒及其预防. 食物中毒的概述 我国食品安全现状 食源性疾病 食物中毒的 概念     发生原因     流行病学特点     分类 发病机理     调查与处理 . 教学安排 主要内容. 病原 发生原因 流行病学特点 发病机制 临床表现 诊断与预防. 细菌性食物中毒 沙门菌   副溶血弧菌 葡萄球菌 肉毒梭菌. 化学性食物中毒   亚硝酸盐、农药 有毒动植物食物中毒   鱼类、贝类、毒蕈 真菌及其毒素食物中毒   镰刀菌、节菱孢霉.

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Food poisoning and Prevention

食物中毒及其预防

Food poisioning


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食物中毒的概述我国食品安全现状食源性疾病食物中毒的概念    发生原因    流行病学特点    分类发病机理    调查与处理 

教学安排

主要内容

病原

发生原因

流行病学特点

发病机制

临床表现

诊断与预防

细菌性食物中毒

沙门菌  副溶血弧菌葡萄球菌肉毒梭菌

化学性食物中毒

  亚硝酸盐、农药

有毒动植物食物中毒

  鱼类、贝类、毒蕈

真菌及其毒素食物中毒

  镰刀菌、节菱孢霉

Food poisioning


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食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

Food-borne illness:

disease acquired from eating or drinking contaminated food or water. This term can include any type of illness that you can get from eating food that is contaminated. It can include illness from bacteria, viruses, parasites, chemicals, allergies or naturally occurring poisons such as some mushrooms.

Two major categories: INTOXICATIONS and INFECTIONS.

The former is the result of ingesting toxins produced by microbes that have grown on the food prior to it being eaten.

The latter is the result of the food serving as a fomite that carries an infectious pathogen deep into the juicy recesses of a body where it is able to gain a foothold.

Food poisioning


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Food poisioning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。


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Contents食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 源于传统的食物中毒,

  • 经食物而感染的肠道传染病、

  • 食源性寄生虫病,

  • 由食物中有毒、有害污染物所引起的中毒性疾病;

  • 慢性退行性疾病(心脑血管疾病、肿瘤、糖尿病等),

  • 食源性变态反应性疾病,

  • 食物中某些污染物所致的慢性中毒性疾病等

Food poisioning


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Food Safety食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。食品安全

  • 食品合格率

  • 面粉,大米

  • 蔬菜、水果

  • 鸡,猪肉

  • 酸奶

我国每年食物中毒人数:20~40万

Data From

USA/CDC

Food poisioning


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acidophilus milk---食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。酸奶

  • 北京抽查酸奶合格率为55.2%

    • 1. 产品微生物超标

    • 2. 防腐剂超标

    • 3. 亚硝酸盐、硝酸盐超标

    • 4. 乱用商标,误导消费者

    • 5. 蛋白质、脂肪含量参差不齐

Food poisioning


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国内外食品安全事件食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

1. 1987年12月至1988年2月上海甲型肝炎

暴发性流行事件30万市民染上肝炎

2. 1996年6月27日至7月21日,云南曲靖地区会泽县发生食用散装白酒甲醇严重超标的特大食物中毒事件,192人中毒,35人死亡,6人致残。

3. 1997年6月底至7月上旬,云南思茅地区发生群众自行采食蘑菇中毒事件,共有255人中毒,死亡73人。  

4. 1996年5月下旬,日本几十所中学和幼儿院相继发生6起集体大肠杆菌O157中毒事件,中毒超过万人,死亡11人,波及44个府县.

5. 1998年2月,山西省朔州、忻州、大同等地区连续发生的多起重大的假酒中毒事件,有200多人中毒,夺去了27人生命.

6. 1999年1月,广东省46名学生的食物中毒;同年6月,某省一医院接受了34人中毒事件,中毒原因都是食用带有甲胺磷农药残留的“蔬菜”.

Food poisioning


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7. 食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。最早发生并流行于英国的牛海绵状脑病(疯牛病),自1987年至1999年期间证实的病牛就达17余万头,英国为此损失300亿美元。

8. 1999年5月在比利时“二恶英污染食品”事件,造成的直接损失达3.55亿欧元,如果加上与此关联的食品工业,损失已超过上百亿欧元。

9. 1999年年底,美国李斯特菌食物中毒事件。美国密歇根州14人死亡,在另外22个州也有97人因此患病,6名妇女流产。

10. 2000年底至2001年初,法国发生李斯特氏菌污染食品事件,有6人死亡。

11. 2000年6月,日本雪印牌牛奶14 500多人患有腹泻、呕吐疾病,180人住院治疗,使占牛奶市场总量14%的雪印牌牛奶进行产品回收,全国21家分厂停业整顿。

12. 2001年1月,浙江省杭州市60多人到医院就诊,症状为心慌、心跳加快、手颤、头晕、头痛等,原因是食用了含有“瘦肉精”(即盐酸克伦特罗)的猪肉。

Food poisioning


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Food poisioning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。


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浙江省白砂糖中添加食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。“吊

   白块”中毒

重庆市“毛发水”酱油

广东劣质大米中毒

江西市场河豚鱼中毒

内蒙古死因不明原因羊

肉中毒

天津输液瓶灌装酱油

江西病死肉加工食品

四川非法食品非法宣传

重庆市非法加工伪劣食品

广西“吊白块”粉丝重大食物

中毒

2001卫生部公布

食品卫生大案 (4 – 7 月)

Food poisioning


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1994食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。年卫生部:《食物中毒诊断标准及技术处理总则》(B14938-94)

Food Poisoning

  食物中毒是指摄入含有生物性、化学性有毒有害物质的食物或把有毒有害当作食物食物摄入后出现的急性或亚急性疾病。

Food poisoning refers to an acute illness caused by ingestion of food contaminated by bacteria, bacterial toxins, viruses, natural poisons, or harmful chemical substances.

It is characterized by a short incubation period (1 wk or less). The symptoms, varying in degree and combination, include abdominal pain, vomiting, diarrhea, headache, and prostration; more serious cases can result in life-threatening neurologic, hepatic, and renal syndromes leading to permanent disability or death.

Food poisioning


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Kernel in the definition食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • Normal amount 正常数量

  • The status can be eaten 可食状态

  • Toxic food 有毒食品

  • Acute poisoning 急性中毒

  • No-infection 非传染性

Food poisioning


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The source of the toxic food食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 1. The contamination of bacteria and toxin

    • 食品受到某些细菌和毒素的污染

  • 2.Mixture of poisoning chemical substance

    • 有毒化学物的混入

  • 3.Toxic itself in nature

    • 食品本身有毒

  • 4.Inappropriate storage

    • 储存方式不当

  • 5.Misuse.

    • 误食

Food poisioning


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Distinguished Diagnosis食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 1. Engorgement 暴饮暴食

  • 2. Hyper metamorphosis 变态反应

  • 3. Infectious disease, verminosis 人蓄共患

    传染病,寄生虫病

  • 4. Diarrhea, enteritis 痢疾、伤寒、肠炎

  • 5. Placing toxin 人为投毒

Food poisioning


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Characteristic of Food Poisoning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 1. 暴发性

  • 2. 症状基本相似

  • 3. 集体发病,人与人之间不传染

  • 4. 与食物有关

  • 5. 采取措施后控制快,无流行病余波

Food poisioning


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Classification of food poisoning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 1. 细菌性食物中毒

  • 2. 有毒动植物食物中毒

  • 3. 有毒化学物质食物中毒

  • 4. 真菌毒素和霉变食品中毒

Food poisioning


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Epidemic Characteristic食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

  • 食物中毒发病的原因分布特点:

    微生物、化学性食物中毒

  • 食物中毒的食品种类分布特点

    动物性、植物性

  • 食物中毒发病的季节性、地区性分布特点

Food poisioning


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Food poisioning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。


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Food poisioning食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。


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1998食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。~2000年北京市食物中毒致病原因分类

Food poisioning


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化学性食物中毒有增加的趋势食源性疾病通过摄食进入人体内的各种致病因子引起的、通常具有感染性质或中毒性质的一类疾病。

据卫生部全国重大食物中毒情况通报:

  • 1999年化学性食物中毒的人数占中毒总人数的29%,

  • 2000年化学性食物中毒的人数上升到占中毒总人数的

    35%;

  • 2001年第二季度化学性食物中毒发生的起数和中毒人数

       居首位。造成中毒的有毒物质主要是农药(包括灭鼠

       药)、亚硝酸盐、违法掺入食品中的非食品原料等。

Food poisioning


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  • 近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有10起以上;此类因在畜禽养殖过程中滥用各种兽药和饲料添加剂,造成畜禽产品中残留高浓度的兽药导致人的急性中毒是近年来化学性食物中毒的新特点。

  • 随着种植业和养殖业的发展,越来越多的化学物质可能被应用到传统的种植业和养殖业中,成为化学性食物中毒的新隐患。

Food poisioning


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有毒动植物食物中毒近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有

  • 90%以上是集体供餐单位发生的扁豆中毒,而扁豆中毒完全可以在烹调过程中通过延长加热时间破坏扁豆中的毒素来避免中毒的发生

Food poisioning


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造成食物中毒的责任单位近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有

  • 以饮食服务单位和集体食堂为主,但由送餐企业导致的以中小学生为主的食物中毒近年来有增加的趋势。

Food poisoning tends to occur at picnics, school cafeterias, and large social functions. These are situations where food may be left unrefrigerated too long or food preparation techniques are not clean. Food poisoning often occurs from undercooked meats or dairy products (like mayonnaise mixed in cole slaw or potato salad) that have sat out too long.

Food poisioning


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食物中毒漏报问题近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有

  • 据WHO有关专家估计,发展中国家报告的食物中毒仅占实际发生的食物中毒的5%或更低。

Food poisioning


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Bacterial food poisoning近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有

细菌性食物中毒

Epidemiological Characteristic

  • 发病季节性明显

  • 有些还具有一定地区性

  • 中毒食品主要为动物性食品

  • 发病率高,病死率因病原而异

Food poisioning


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3近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有.Pathogen---发生原因:

  • 牲畜屠宰销售受致病菌污染

  • 食物贮藏不当致病菌繁殖,产生毒素

  • 食物灭菌不彻底、

  • 生熟交叉污染或

  • 从业人员带菌污染

Food poisioning


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Mechanism of poisoning近几年以散发为主未报告的因食用猪肝所致兽药盐酸克伦特罗(瘦肉精)食物中毒累计已有

- organisms multiply within and invade the gut; incubation period of several days;E. coli , Salmonellosis, Campylobacter(弧菌), Shigella(志贺氏菌), Yersinia rarities(耶尔森氏菌)

Infectious type(感染型)

致病菌 肠道  继续繁殖并侵袭肠粘膜及粘膜下层

 吞噬细胞吞噬或杀灭     肠粘膜炎性反应

 病原菌解体  内毒素

             体温调节中枢  体温升高

Food poisioning


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- release pre-formed toxin causing rapid onset of symptoms; usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

toxin type

(毒素型)

致病菌  污染食物并大量繁殖  

       产生肠毒素吸收入血呕吐中枢呕吐

      腺/鸟苷酸环化酶

ATP,GTP

cAMP,cGMP

Cl-分泌亢进

细胞分泌功能改变腹泻

Na+、H2O吸收抑制

Food poisioning


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intermediate-type usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.(混合型)

- pre-formed toxin released once organism has multiplied within the gut; 12 hour incubation period:

V. parahemolyticus, (副溶血弧菌)等

     侵袭肠粘膜

致病菌         急性胃肠道症状

     产生肠毒素

Food poisioning


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Salmonella usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.沙门菌食物中毒

  • G-杆菌,周生鞭毛,

  • O抗原:67种(A、B、C1、C2、C3、D、E1、

    E4、F 9类)

  • 2300个以上的血清型,我国超过161种

  • 鼠伤寒,猪霍乱,肠炎沙门菌

  • 菌毛引起侵入性腹泻

1.病原菌(pathogeny)

Food poisioning


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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2 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus..流行病特点

1) 引起中毒的食物:畜禽肉、蛋类、奶及其制品

2) 食物中沙门菌的来源:畜禽肉类、蛋类及其制品,奶  

类及其制品,熟制品

原发性感染

肉 生前感染全身感染

   类继发性感染

宰后污染:局部感染

3) 发病季节分布

4) 发病率:活菌量、菌型、个体易感性

Food poisioning


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mechanism of poisoning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.infection: main toxin: minor

abbreviation

肠粘膜炎性反应:充血、WBC浸润、水肿、渗出等

Sal. 侵袭肠及粘膜粘膜下层淋巴细胞吞噬

吞噬细胞激暂时性菌血病Sal.在吞噬细

活杀死Sal. 和全身性感染胞中继续繁殖

病原菌解激活WBC趋化因子 肠粘膜局部炎症

体,释放

内毒素致热源体温调节中枢体温升高

Food poisioning


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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4. Clinical manifestation usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

急性胃肠炎型

  • 以急性胃肠炎型为主,并伴发烧:

  • 潜伏期短,,数小时,长2~3天,一般12~24小时

  • 主要症状:

    • 1. 前驱症状:头晕,头痛,恶心,食欲不振

    • 2. 先呕吐,后腹痛

    • 3. 大便颜色:黄色,或绿色,水样便,并带脓血黏液

    • 4. 发烧:38~400C

    • 5. 病程:3~5天

    • 6. 重症病人:死亡率1%

类霍乱型

类伤寒型

类感冒型

Food poisioning


5 diagnosis l.jpg
5. Diagnosis usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • Clinic Diagnosis

    • 临床表现,流行病学特点

    • 发病季节

    • 膳食内容

    • 集体发病

    • 临床症状

  • Pathogenic Diagnosis

Food poisioning


Pathogenic diagnosis l.jpg
Pathogenic Diagnosis usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • 1. 细菌学检查----分离培养病原菌

  • 2. 血清学检查----分型鉴定

    • 血清凝集试验:

      • 1:20~40 正常

      • 1:100 可疑

      • 1:200 阳性

      • 7~15天两次

Food poisioning


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


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6. Preventive usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus. measurement

  • Prevent Contamination

  • Control Growth and Reproduce

  • Killing Pathogen Completely

Food poisioning


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Prevent Contamination usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • 加强动物的饲养管理

  • 动物检疫

  • 宰杀--------销售整个过程

  • 防交叉感染

Food poisioning


Control growth and reproduce l.jpg
Control Growth and Reproduce usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • Be careful for your food

    • Storage temperature

    • Storage time

Killing Pathogen

Center temperature 中心温度

80℃× 12 min: for Sal.

Food poisioning


Who golden rules for safe food preparation l.jpg
WHO Golden Rules for Safe Food Preparation usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • Choose foods processed for safety

  • Cook food thoroughly

  • Eat cooked foods immediately

  • Stored cooked foods thoroughly

  • Reheat cooked foods

WHO

Food poisioning


V parahaemolyticus l.jpg
V. Parahaemolyticus usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.副溶血性弧菌

Food poisioning


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Pathogen usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

  • 1. 嗜盐菌: halophilic, or salt-requiring organism

  • 2. 最适温度:30~37,繁殖快,一世代时间:10分钟

  • 3. 对酸敏感的:sensitive to acid

  • 4. 神奈川现象:Kanagawa hemolysin

    • Research has found that some strains of V. Parahaemolyticus associated with gastroenteritis produce a b-hemolysis of human erythrocytes, a reaction known as the Kanagawa phenomenon.

  • 5. 血清型:与致病性无关,流行病调查有意义

    • 菌体抗原:O抗原

    • 夹膜抗原:K抗原

    • 鞭毛抗原:H抗原

  • Food poisioning


    Slide51 l.jpg

    Creating leaks in a cell's usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.membrane is another way of killing cells. Bacteria use hemolysin to put holes in our membranes.

    Food poisioning


    Epidemiological characteristic52 l.jpg
    Epidemiological Characteristic usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • 1. Distribution:a worldwide distribution in estuarine and

      coastal environments

      • 近海海湾,近海淡水,富含有机物(中国、日本多见)

  • 2. Season:warmer months(7~9月)

    • Incidences correlate with water temperature. It attaches to plankton, which is eaten by the fish, later eaten by people.

  • 3. Susceptibility:

  • 4. Poisoning food:marine product including many species of

    fish, shellfish, and crustaceans(crabs, shrimp, and

    lobsters). (检出率与季节有关)

    • 墨鱼:93%,蟹:79.8%,

    • 带鱼:41.2%,大黄鱼:27.3%

  • Food poisioning


    Slide53 l.jpg

    V usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.. parahaemolyticus has been implicated in numerous outbreaks of seafood-borne gastroenteritis in the United States. Crab, oyster, shrimp, and lobster were implicated in 14 outbreaks, which may have resulted from the consumption of raw or insufficiently heated seafood or properly cooked seafood contaminated after cooking.

    Food poisioning


    Mechanism l.jpg
    Mechanism--- usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.发病机理

    • 感染型中毒:活菌侵袭肠粘膜

                       肠道

    • 毒素型中毒:耐热性溶血毒素

                      中毒症状

    混合型

    Food poisioning


    Clinical manifestation l.jpg
    Clinical Manifestation usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • 1. 潜伏期短

      • Usually these symptoms occur within 24 hours of ingestion. Illness is usually self-limited and lasts 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems.

    • 2. 腹痛(阵发性)、腹泻、呕吐

      • Intense abdominal pain, vomiting, and diarrhea.  In most cases, the stool was watery, but there were some cases of bloody stool. 

      • Coldness of extremities, increased pulse, and constriction of blood vessels were also reported.

      • Less commonly, this organism can cause an infection in the skin when an open wound is exposed to warm seawater.

    • 3. 预后

    Food poisioning


    Background l.jpg

    details of a case on usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.V. Parahemolyticus

    Background

    • 1998年8月1日,我市某酒店职工加餐,8∶00左右从某熟食店购得17只盐水鸭,其中3只由冷盘间厨师领去制作冷盘供应顾客;其余14只存放于厨房生配案板上作职工加餐用。约9∶00开始由一帮厨切好装盘,仍放置在厨房内,从10∶30~11∶30职工分别食用。自8月2日凌晨1∶00~上午9∶00陆续有50名职工发病住院治疗,主要症状为腹痛、腹泻、呕吐,3日大多痊愈出院。采集1日午餐职工用餐所使用的刀板刮取物,帮厨所用抹布及2例病人大便,均检出副溶血性弧菌;采集冷盘间冰箱剩余盐水鸭,未检出副溶血性弧菌。当日食用冷盘间制作的盐水鸭的顾客未发现异常。

    Food poisioning


    Analysis l.jpg
    Analysis usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

       加工场所条件及人员 经

     调查得知,该帮厨平时负责宰

     杀海鲜,当日所用刀、板、抹布均为日常宰杀海鲜用,未作消毒。时值盛夏,气温在30℃以上,厨房无降温设施,温度更高,适宜细菌生长繁殖,食用间隔期(盐水鸭自购回到食用)在2h以上,存放容器均为切配生菜所用容器;而供应顾客的冷盘在一专室制作,有降温及冷藏设施,工具容器均专用,并由专人操作。

    Food poisioning


    Causation l.jpg
    Causation usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    •   从调查结果可以看出,

       这是一起典型的由于生熟

       不分,导致副溶血性弧菌污染其它食物而引起的食物中毒。这与酒店内部管理不善,操作者卫生知识缺乏有直接关系;而所有的环境条件又正好适宜于副溶血性弧菌的生长繁殖,最终导致了这次中毒的发生。

    Food poisioning


    Reflection l.jpg
    Reflection usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    1. 副溶血性弧菌广泛分布在夏季的沿岸海水中,鱼贝类海鲜受污染的可能性很高,配制时应特别注意通过烹调用具和手等污染其它食品的可能。

      根据本菌在10℃以下不发育,而在25℃以上增殖速度为金黄色葡萄球菌和沙门氏菌等的2倍的特点,烹调后的食品应尽快吃完,减少污染繁殖的机会。

    Food poisioning


    Slide60 l.jpg

    • 2. usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.加强对酒店管理人员及厨师的卫生知识培训,提高他们的卫生意识,特别要强化厨师生熟分开的意识,对直接入口熟卤菜的加工制作真正做到“五专”。

    • 3. 在细菌性食物中毒高发的夏秋季,卫生监督部门要加大监督力度,提高监督水平,将食品加工过程中存在的卫生问题作为监督的重点。并广泛做好宣传,提高群众自我保护意识,防止细菌性食物中毒的发生。

    The symptoms common to all patients were most people become infected by eating raw or undercooked shellfish, particularly oysters.

    Food poisioning


    Staphylococcus aureus l.jpg
    Staphylococcus aureus usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.葡萄球菌肠毒素食物中毒

    Food poisioning


    Slide62 l.jpg

    Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


    1 pathogeny l.jpg
    1 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus..Pathogeny

    • 种属:微球菌科(Micrococcaceae)、G+球菌

    • 分类:A、B、C1、C2、C3、D、E、F(8 serum type).

      Type A: most common, and poison.

      凝固酶致病力

    • 习性:适温37℃,较耐热,兼性厌氧,耐盐,对营养条件要求不高,

      最常见的化脓性球菌之一,自然界分存广泛.

    • 肠毒素(enterotoxin)

          结构:蛋白质类毒素,分子量26000~30000

          毒性:1µg/kg.bw即可引起食物中毒

          耐热:100℃下可耐受30min,破坏食物中的肠毒素100 ℃, 2小时.

          抗酶解:人体蛋白酶不能消化分解

    Food poisioning


    2 epidemiological characteristic l.jpg
    2 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus..Epidemiological Characteristic

    1)发病季节:

    2)引起中毒的食品:奶及奶制品最为常见(营养

    丰富,水分充足)

    3)食物中葡萄球菌的来源:

    • 葡萄球菌广葡萄球菌存在于空气、土壤、水中

    • 患化脓性皮肤病,急性上呼吸道炎症和口腔疾患的病人,鼻腔带菌率为83.3%,

    • 健康人为20~30%

    • 人类带菌是污染食品的主要原因

    Food poisioning


    S aureus in human l.jpg
    S. Aureus usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.in human

    • S. aureus is one of the major causes of hospital-acquired infection. One study ranked it fourth in a listing of the “Pathogens Most Frequently Isolated From Hospitalized Patients When All Anatomic Sites Are Considered” .

    • Approximately 40% of the general population and 50 – 90% of health care practitioners harbor an S. aureus colony in their anterior nasal passage.

    • Infection becomes a problem when bacteria migrate from their normal habitat, especially in individuals already suffering from a compromised immunologic response.

    Food poisioning


    Slide66 l.jpg
    4 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.)葡萄球菌的产毒条件

    • 食物的成分和性质(含淀粉和水丰富的食品)

    • 污染程度(106 ~109/ g)

    • 适宜的温度(25~30 ℃,5~10h)

    • 足够的潜伏期

    Food poisioning


    Slide67 l.jpg

    米粉也是常见的中毒食品 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    •   切粉的生产工艺(不含现做现卖的切粉)大米→水冼3次,浸泡2~3小时→磨浆→蒸煮→风冷→刷食用油→切条→装筐

    •   榨粉的生产工艺(不含现榨现卖的生榨粉)大米→水冼、浸泡→磨浆→蒸煮成块状→压榨成圆条状→煮熟→水漂(冷)→装箱

    Food poisioning


    3 poisoning mechanism l.jpg
    3. Poisoning Mechanism usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • The toxins most relevant to disease causing symptoms in humans are the superantigens and -toxins.

    • The -toxins oligomerize to form pores in the host cellular membrane, allowing cellular contents to leak into the extracellular matrix.

    • The superantigens, consisting of enterotoxins and the toxic shock syndrome toxin, are responsible for S. aureus-related food poisoning and toxic shock syndrome, respectively.

    Food poisioning


    Slide69 l.jpg

    Food poisioning usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.


    Slide70 l.jpg

    S. aureus usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus. produces two types of superantigens, enterotoxins and toxic shock syndrome toxin.

    Toxic schock syndrome toxin causes 75 % of toxic shock syndrome cases reported. Superantigens stimulate T-cells nonspecifically, causing the release of large amounts of cytokines. The cytockines are responsible for the toxic chock syndrome symptoms.

    Food poisioning


    Food poisoning mechanism l.jpg
    Food poisoning mechanism usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    Enterotoxins:Typical Toxic type food poisoning

         小肠粘膜adenylate cyclase:ATP→ cAMP↑

    肠毒素

     小肠粘膜guanylate cyclase:GTP→ cGMP↑

                       细胞分泌功能改变   

    Na+、H2O的吸收抑制与Cl-分泌亢进

    Na+、Cl-、H2O在肠腔潴留     腹泻

    吸收入血到达中枢神经系统刺激呕吐中枢呕吐

    Food poisioning


    Clinical manifestation72 l.jpg
    Clinical Manifestation usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • 潜伏期短:2~4小时

    • 恶心,反复呕吐,上腹部腹泻

    • 体温正常或低烧

    • 儿童对肠毒素比成人敏感,发病率高,病情重

    • 预后一般良好

    Food poisioning


    Slide73 l.jpg

    • S. aureus usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.most commonly causes a localized skin infection, although it can also infect the eye, nose, throat, urethra, vagina, and gastrointestinal tract.

    • In addition,S. aureus can cause more serious ailments when it enters the bloodstream, such as pneumonia, osteomyelitis, arthritism endocarditis, myocarditis, brain abscesses and meningitis

    Food poisioning


    Diagnosis l.jpg
    Diagnosis usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    流行病学特点

    临床表现

    Therapy

    对症处理,一般不需抗生素

    Food poisioning


    Slide75 l.jpg
    实验室诊断 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • 以毒素鉴定为主(双向琼脂扩散法和动物试验法)

      • 提取中毒食品中的肠毒素,确定型别

      • 分离中毒食品、患者呕吐物或粪便中的葡萄球菌及其肠毒素与型别

      • 不同患者呕吐物中检出葡萄球菌及同一型别肠毒素

    • 判定原则:符合实验室诊断三项之一者,即可判定

    Food poisioning


    Prevention l.jpg
    Prevention: usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.防止污染与肠毒素的产生

    1. 避免人对食品的污染

    2. 避免患乳房炎的奶牛对奶的污染

    3. 奶极其制品从生产至销售全过程的严格管理

    4. 低温冷藏

    Food poisioning


    Clostridium botulinum l.jpg
    Clostridium botulinum usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.肉毒梭菌食物中毒

    Food poisioning


    1 pathogeny78 l.jpg
    1 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus..Pathogeny

    芽孢杆菌科(Bacillaceae)、G+粗短杆菌,可形成芽孢,按其外毒素(exotoxin)抗原性可分为A、B、Cα、Cβ、D、E、F、G 8个血清型

    专性厌氧,适温30~37℃,15~55℃与pH4.5~9.0下繁殖并可产生毒素。

    芽孢可耐湿热100℃5h或干热180℃5~min或高压蒸汽121℃30min,对营养条件要求不高,自然界分存广泛,在土壤中半永久性生长。

    Food poisioning


    Botulinum toxin l.jpg

    神经毒,毒性为 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.KCN的10000倍

    对人致死剂量:10-6µg/kg.bw

    Botulinum toxin

    形成于胞浆,菌体死亡自溶

       释放毒素复合体

    小肠 胰蛋白酶

       神经毒素解离    吸收入血botulism

    75~85℃,5~15min

    100 ℃,1min

    热不稳定

    胃酸及酶不能消化分解

    Each neurotoxin consists of a 2 chain polypeptide linked by a disulfide bond as demonstrated in this picture. The larger polypeptide, called the heavy chain, is identical for all 7 toxin types. The smaller polypeptide, called the light chain, varies for each toxin subtype.

    Food poisioning


    Botulinum toxin structure schematic diagram l.jpg
    Botulinum toxin structure (schematic diagram) usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    Food poisioning


    2 epidemiological characteristic81 l.jpg
    2. usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.Epidemiological Characteristic

    • 分布:广泛分布于大自然

      • 借其芽孢长期生存

      • 借尘土可以污染蔬菜,粮食和各类食品

      • 借昆虫,家畜,鸟类等传播到各地

    • 季节性:3~5月

    • 中毒食品:因饮食习惯、膳食组成、制作工艺而异

      • 中国:家庭自制发酵食品

      • 欧美国家:火腿,腊肠

      • 日本:鱼制品

    日本寿司

    Food poisioning


    Slide82 l.jpg
    食品被污染及中毒发生的原因 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

    • 肉毒梭菌污染食品

    • 温度大量繁殖

    • 渗透压形成毒素

    • 厌氧

      未彻底消毒

    Food poisioning


    2 epidemiological characteristic83 l.jpg
    2 usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus..Epidemiological Characteristic

    • 发病以家庭或个体出现,很少暴发

    • 地区性明显,与饮食习惯有关

    • 病死率高12.5%~ 76.2%

    Food poisioning


    3 poisoning mechanism84 l.jpg
    3. Poisoning Mechanism usually short duration, afebrile: Staphylococcus aureus, Bacillus cereus.

      作用于外周神经-肌肉接头处、植物神经末梢及颅脑神经核

      通过H键与胆碱能神经突触前膜上的毒素受体--神经节苷结合,降低Ca2+亲和力,影响突触小泡的泡溢作用,从而阻止胆碱能神经末梢释放乙酰胆碱

    Food poisioning


    Slide85 l.jpg

    The impulses from the nervous system travel down the nerve and cause a chemical messenger, acetylcholine, to be released from synaptic vesicles stored with the nerve endings.

    Within the nerve ending itself, there are a series of proteins that are necessary to allow the synaptic vesicles to bind with the nerve endings to allow release of the acetylcholine. These proteins include SNAP-25, VAMP, and syntaxin. Botulinum toxin type A and E cut SNAP-25. Botulinum toxin B,D, F, and G cut VAMP. Botulinum toxin C1 cut syntaxin and SNAP-25.

    Food poisioning


    Slide86 l.jpg

    The first stage of toxicity comprises the recognition and binding of the carbonyl group at the end of the heavy chain (marked on as a black spot on the figure above) to a receptor or acceptor of a neuron.

    The next stage involves the transfer of the toxin to within the neuron through a pathway generally known as Receptor Mediated Endocytosis (RME). The net result is the formation of a toxin containing vesicle within the neuron.

    Food poisioning


    Slide87 l.jpg

    Cleavage of the disulphide bond then leads to the release of the light chain part of the molecule into the cytoplasm.

    This movement of the light chain leads to the third and final stage of toxicity, as it crosses to the cytoplasm it demonstrates enzyme like properties and catalyses specific reactions that consequently leads to the prevention of neurotransmitter release.

    In the nerve terminal botulinum toxin type A cuts the protein SNAP-25 and botulinum toxin type B cuts VAMP. The nerve terminal is no longer able to release acetylcholine.

    Food poisioning


    Slide88 l.jpg

    Food poisioning release of the light chain part of the molecule into the cytoplasm.


    Slide89 l.jpg

    Food poisioning release of the light chain part of the molecule into the cytoplasm.


    Slide90 l.jpg

    Food poisioning release of the light chain part of the molecule into the cytoplasm.


    Clinical manifestation91 l.jpg
    Clinical Manifestation release of the light chain part of the molecule into the cytoplasm.

    • 潜伏期短,病情重,神经毒性

    • 前驱症状:乏力、头痛、头晕、走路不稳等

    • 神经症状:

    • 眼部:视力模糊

    • 延髓麻痹:吞咽困难

    • 分泌障碍

    • 肌肉(呼吸肌)麻痹

    • 体温正常或偏低

    Food poisioning


    Slide92 l.jpg
    诊断 release of the light chain part of the molecule into the cytoplasm.

    • 流行病学特征

    • 中毒表现

    • 可疑食品毒素分析

    • 抗肉毒毒素血清实验

    治疗

    多价抗肉毒毒素血清及支持疗法

    Food poisioning


    Slide93 l.jpg
    预防措施 release of the light chain part of the molecule into the cytoplasm.

    • 定期对发酵豆制品进行监测

    • 指导群众安全制酱

    • 食品生产加工全过程卫生管理

    • 肉制品不宜堆集,以防厌氧环境

    • 消灭毒素80 ℃ 30分钟

    • 100 ℃ 10~20分钟

    • 防止婴儿中毒

    Food poisioning


    Slide94 l.jpg
    有毒动植物食物中毒 release of the light chain part of the molecule into the cytoplasm.

    • 河豚鱼中毒

      Puffer fish poisoning

    • 鱼类组胺中毒

      Fish histamine poisoning

    • 麻痹性贝类中毒

      Paralytic shellfish poisoning

    • 毒蕈中毒

      Noxious mushroom poisoning

    Food poisioning


    Puffer fish poisoning l.jpg
    Puffer fish poisoning release of the light chain part of the molecule into the cytoplasm. 河豚鱼中毒

    The puffer fish lives in shallow coastal waters, coral reefs and tidal lagoons in the western and central Pacific Ocean. The puffer fish has rounded fins and eyes that protude from its head. The puffer fish gets its food by using its puffer-like beak like teeth. The pufferfish protects itself by puffing itself up by taking gulps of water or air to fill its stomach. This makes the spine on its body which normally lies flat against its skin puff up.

    Food poisioning


    Toxin tetrodotoxin l.jpg

    potent and rapid acting, lethal marine neurotoxin release of the light chain part of the molecule into the cytoplasm.

    Toxin: tetrodotoxin

    • 性质:无色针状结晶,微溶于水,性质稳定,为毒性极强的非蛋白类毒素,100℃7小时或200℃以上10分钟才可破坏。

    The molecule consist of a positively charged Guanidinium group (resonance stabilized cation, which consists of three Nitrogen atoms, is outlined in blue) and a Pyrimidine ring (shown in red) with additional fused ring systems (five additional ring systems, certainly help stabilize the TTX-sodium channel binding complex at the aqueous interface). 

    Food poisioning


    Slide97 l.jpg
    河豚鱼毒素毒力 release of the light chain part of the molecule into the cytoplasm. 毒性为氰化钾的1000倍

    • The LD50 for rats is 8 µg/kg by injection or 30 µg/kg if ingested. The toxicity for humans is also extremely high for inhaled toxin with the LD50 of about 150 µg/man (i.e., 2 µg/kg). Ingested TTX requires much higher doses (30 µg/kg) because stomach acid destroys the toxin.

    • TTX is a slightly water soluble and heat stable, but it is sensitive to strong acids and alkalis. The toxin can enter the body by ingestion, injection, inhalation and through abraded skin.

    Food poisioning


    Slide98 l.jpg
    毒素分布及毒性大小 release of the light chain part of the molecule into the cytoplasm. :

    • 卵巢、肝、脾、肾等脏器及皮肤、血液、眼球等部位。

    • 死鱼肉或有些品种的鲜鱼肉,螺类,也含有毒素。

    • 毒性大小:卵巢、肝脏最毒

    • 肾、血液次之

    • 鱼体以皮肤最毒,肌肉次之

    • 毒性与季节有关,春季最毒

    Food poisioning


    Poisoning mechanism l.jpg
    Poisoning Mechanism release of the light chain part of the molecule into the cytoplasm.

    TTX is an especially potent neurotoxin, specifically blocking voltage-gated sodium channels on the nerve membranes surface. The TTX-Na Channel binding site is extremely tight (Kd = 10-10 nM).

    • 口腔与胃肠道粘膜吸收

    • 作用于神经系统

    • 阻断神经肌肉间的传导

    • 使神经末梢和中枢神经麻痹。

    •      感觉神经运动神经麻痹

    •      外周血管扩张,使血压急剧下降,

    • 呼吸中枢和血管运动中枢麻痹而致死。

    Food poisioning


    Physiological properties of ttx l.jpg
    Physiological Properties of TTX release of the light chain part of the molecule into the cytoplasm.

    TTX mimics the hydrated sodium cation, enters the mouth of the Na+-Channel peptide complex, binds to a peptide glutamate side group, among others, and then further tightens it hold when the peptide changes confirmation in the second half of the binding event. Following complex conformational changes, TTX is further electrostatically attached to the opening of the Na+ gate channel.

    With the bulk of the TTX molecule denying sodium the opportunity to enter the channel, sodium movement is effectively shut down, and the action potential along the nerve membrane ceases. 

    A single milligram or less of TTX - an amount that can be placed on the head of a pin, is enough to kill an adult.

    Food poisioning


    Clinical manifestation101 l.jpg
    Clinical Manifestation release of the light chain part of the molecule into the cytoplasm.

    The first symptom: a slight numbness of the lips and tongue, appearing between 20 min. to 3 hours after ingestion.

    The next symptom: increasing paraesthesia in the face and extremities, sensations of lightness or floating. Headache, epigastric pain, nausea, diarrhea, and/or vomiting may occur. Occasionally, some reeling or difficulty in walking may occur.

    The third stage: increasing paralysis. Many victims are unable to move; even sitting may be difficult. There is increasing dyspnea, affected speech, and hypotension. Convulsions, mental impairment, and cardiac arrhythmia may occur. Death usually occurs within 4 to 6 hours, with a known range of about 20 minutes to 8 hours.

    The victim, although completely paralyzed, may be conscious and in some cases completely lucid until shortly before death.

    Food poisioning


    Emergency treatment l.jpg
    Emergency treatment release of the light chain part of the molecule into the cytoplasm.

    • 催吐:1% CuSO4

    • 洗胃:1/2000~4000KMnO4或1 ~3%NaHCO3

    • 导泻:50% MgSO4 50ml

    • 对症治疗:

      早期解毒:L-半胱氨酸盐酸盐静脉滴注

      呼吸困难:洛贝宁、尼可刹米注射

      肌肉麻痹:士的宁、番木鳖碱

      保肝解毒:高渗葡萄糖输液

    Food poisioning


    Preventive measures l.jpg
    Preventive measures release of the light chain part of the molecule into the cytoplasm.

    • 禁止食用新鲜河豚鱼

    • 河豚鱼鱼干经鉴定后食用

    • 新鲜河豚鱼统一收购→去头、皮、内脏→鱼干

    • 开展宣传教育,改变饮食习惯

    • 避免误食中毒

    Food poisioning


    Slide104 l.jpg

    常见的河豚鱼 release of the light chain part of the molecule into the cytoplasm.

    Food poisioning


    Slide105 l.jpg

    河豚鱼集中处理 release of the light chain part of the molecule into the cytoplasm.

    家庭自制河豚鱼要不得

    中毒后立即接受治疗

    严防河豚鱼混入市场

    Food poisioning


    Paralytic shellfish poisoning l.jpg
    麻痹性贝类中毒 release of the light chain part of the molecule into the cytoplasm. Paralytic shellfish poisoning

    Food poisioning


    Poisoning mechanism107 l.jpg
    Poisoning Mechanism release of the light chain part of the molecule into the cytoplasm.

    有毒藻类(膝沟藻等,海水富营养化和赤潮时大量繁殖)   

    贝类摄入(毒素呈结合状态,对贝类无毒)

    人类摄入(毒素解离,呈现毒作用)

    Character of toxin:saxitoxin

    白色、耐热、易溶于水、易吸收

    小分子非蛋白类毒素

    Food poisioning


    Fish histamine poisoning l.jpg
    鱼类组胺中毒 release of the light chain part of the molecule into the cytoplasm. Fish histamine poisoning

    Food poisioning


    Poisoning mechanism109 l.jpg
    Poisoning Mechanism release of the light chain part of the molecule into the cytoplasm.

    foods such as fishery products, particularly tuna, rich in histidine

    certain bacteria growth: spoilage

    decarboxylase enzymes on histidine and other amino acids in food

    foods contain high levels of histamine and possibly other vasoactive amines and compounds

    However, any food that contains the appropriate amino acids and is subjected to certain bacterial contamination and growth may lead to scombroid poisoning when ingested.

    Food poisioning


    Clinical manifestation110 l.jpg
    Clinical Manifestation release of the light chain part of the molecule into the cytoplasm.

    Initial symptoms may include a tingling or burning sensation in the mouth, a rash on the upper body and a drop in blood pressure.

    Frequently, headaches and itching of the skin are encountered.

    The symptoms may progress to nausea, vomiting, and diarrhea and may require hospitalization, particularly in the case of elderly or impaired patients.

    Food poisioning


    Noxious mushroom poisoning l.jpg
    毒蕈中毒 release of the light chain part of the molecule into the cytoplasm. Noxious mushroom poisoning

    Food poisioning


    2 epidemiological characteristic112 l.jpg
    2 release of the light chain part of the molecule into the cytoplasm. .Epidemiological Characteristic

    • 1)季节性:5~10月

    • 2)地区性

    • 3)零星发生

    • 4)临床表现多样

    • 5)死亡率高

    胃肠毒素型

    神经、精神型

    溶血型

    肝肾损害型

    过敏皮炎型

    Food poisioning


    Slide113 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 1)胃肠毒型:

    毒蕈:黑伞属和乳菇属某些蕈种

    毒素:类树脂物质

    机理:刺激胃肠道

    症状:剧烈腹泻,水样便,阵发性腹痛

    治疗:对症治疗

    Food poisioning


    Russula emetica l.jpg
    毒红菇 release of the light chain part of the molecule into the cytoplasm. Russula emetica

    胃肠毒型

    毒 蕈

    红菇 (无毒)Russula lepida

    窝边黄乳菇

    Lactarius scrobiculats

    Food poisioning


    Slide115 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 2)神经、精神型

    • 毒素:

      毒蝇碱(muscarin):毒蝇伞、丝盖伞属等

       蜡子树酸(ibotenic acid)类:毒伞属

       光盖伞素(psilocybin)类:裸盖菇属、花褶伞属

       幻觉原(hallucinogens):桔黄裸伞蕈

    • 症状:副交感神经兴奋症状

      流涎、流泪、大量出汗、瞳孔缩小、脉缓等, 并可伴有胃肠道症状。

      重症患者精神错乱,胡言乱语,幻视、幻听、狂笑、手舞足蹈

    • 治疗:阿托品

    Food poisioning


    Slide116 l.jpg

    桔黄裸伞:幻觉原 release of the light chain part of the molecule into the cytoplasm.

    Gymnopilus spectabilis

    花褶伞:光盖伞素Panaeolus retirugis

    神经、精神毒型

    毒 蕈

    毒蝇伞:毒蝇碱

    Amanita muscaria

    Food poisioning


    Slide117 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 3)溶血型

    • 毒蕈:鹿花蕈

    • 毒素:鹿花蕈素(gyromitrin)

          甲基联胺类化合物

          溶于热水,具挥发性

    • 机理:溶血毒素

    • 症状:以恶心、呕吐、腹泻等胃肠道症状为主,溶

      血性黄疸、肝脾肿大、血红蛋白尿等

    • 治疗:肾上腺皮脂激素

    鹿花菌:鹿花蕈素Gyromitra esculenta

    Food poisioning


    Slide118 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 4)脏器损害型

    • 毒蕈:毒伞属、褐磷小伞属、秋生盔孢伞

    • 毒素:毒肽类(phallotoxins)与毒伞肽类

      (amanitoxins),为细胞原浆类剧毒物质,

      对人致死剂量为0.1mg/kg.bw.

    • 病程发展:一般可分为6 期

    • 治疗:二巯基丙磺酸钠

    Food poisioning


    Slide119 l.jpg
    脏器损害型中毒病情发展 release of the light chain part of the molecule into the cytoplasm.

    ①潜伏期:10~24 h

    ②胃肠炎期:恶心、呕吐、腹痛、水样便

    ③假愈期:症状缓解或仅有轻微乏力,不思饮食

    ④脏器损害期:肝、肾、心、脑等脏器损害

    ⑤精神症状期:烦燥不安、倦怠思睡,继而惊劂、

    昏迷,甚至死亡

    ⑥恢复期:2~3 W

    Food poisioning


    Amanita phalloids l.jpg

    秋生盔孢伞 release of the light chain part of the molecule into the cytoplasm. :毒伞肽类

    Galerina autamnalis

    毒伞 :毒伞肽类Amanita phalloids

    褐磷小伞:毒伞十肽Lepiota helveola

    脏器损害型

    毒 蕈

    Food poisioning


    Slide121 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 5)光过敏皮炎型

    毒蕈:胶陀螺(猪嘴蘑)

    症状:皮肤裸露部分如颜面肿胀、疼痛

    Food poisioning


    Slide122 l.jpg
    毒蕈中毒的预防 release of the light chain part of the molecule into the cytoplasm.

    鉴别:分类学鉴定

       动物试验

    不要采食不认识或可疑的蘑菇

    Food poisioning


    Kidney bean poisoning l.jpg
    kidney bean poisoning release of the light chain part of the molecule into the cytoplasm.

    • 四季豆因地区不同又称为豆角、莱豆、梅豆角、芸扁豆等,四季豆中含有一种叫皂素的生物碱,这种物质对消化道粘膜有较强的刺激性,会引起胃肠道局部充血、肿胀及出血性炎症。此外,皂素还能破坏红细胞,引起溶血症状。

    • 皂素主要在四季豆的外皮内,只要加热至100C以上,使四季豆皮彻底煮熟,就能破坏其毒性。

    Food poisioning


    Slide124 l.jpg

    Clinical Manifestation release of the light chain part of the molecule into the cytoplasm.

    • 四季豆中毒的潜伏期为数十分钟至数小时。中毒症状主要为胄肠炎表现,如恶心、呕吐、腹痛、腹污、排无脓血的水样便。呕吐少则数次,多者可过10余次。多数中毒者有四肢麻木,胃烧灼感、心慌和背疼等感觉。此外还有头晕、失痛、胸闷、出冷汗和畏寒等神经系统症状。四季豆中毒的病程较短,一般在1~2天内,甚至数小时内就可恢夏健康

    Food poisioning


    Treatment l.jpg
    Treatment release of the light chain part of the molecule into the cytoplasm.

    • 1.轻症中毒者,只须静卧休息,少量多次地饮服糖开水或浓茶水,必要时可服镇静剂如安定、利眠宁等。2.中毒严重者,若呕吐不止,造成脱水,或有溶血表现,应及时送医院治疗。3.民间方用甘草、绿豆适量煎汤当茶饮,有一定的解毒作用。

    Food poisioning


    Slide126 l.jpg
    黄花菜中毒 release of the light chain part of the molecule into the cytoplasm. 类秋水仙素碱

    Food poisioning


    Slide127 l.jpg
    白果中毒 release of the light chain part of the molecule into the cytoplasm. 银杏酸、银杏碱

    Food poisioning


    Slide128 l.jpg
    化学性食物中毒 release of the light chain part of the molecule into the cytoplasm.

    Food poisioning


    Nitrite poisoning l.jpg

    食物亚硝酸盐的来源 release of the light chain part of the molecule into the cytoplasm. :

    误食(食盐)

    蔬菜长期存储

    暴腌菜

    苦井水

    腌肉制品过量添加

    亚硝酸盐食物中毒: nitrite poisoning

    中毒机理:强氧化剂

    亚铁血红蛋白  高铁血红蛋白

    组织缺氧  失去输氧功能 

    临床表现:青紫症

    潜伏期:1~3h(甚至10min)

    口唇、舌尖、指尖青紫

    结膜、面部及全身青紫

    头痛、头晕、无力、呼吸急促

    恶心、呕吐、昏迷、死亡

    Food poisioning


    Treatment130 l.jpg
    Treatment release of the light chain part of the molecule into the cytoplasm.

    轻症:无需治疗; 

    重症:洗胃、灌肠+特效治疗

    特效治疗:1%美蓝(20ml 25~50%葡萄糖液稀释)小剂

         量(1~2ml/kg.bw.)缓注(高剂量维C协同)

     辅酶(还)   美蓝(氧)   亚铁血红蛋白

     辅酶(氧)   美蓝(还)   高铁血红蛋白

    Food poisioning


    Arsenic poisoning l.jpg

    中毒机理 release of the light chain part of the molecule into the cytoplasm. :原浆毒(As3+)

     直接腐蚀消化道

     抑制巯基酶

     麻痹血管运动中枢

     直接作用于毛细血管

    砷中毒:arsenic poisoning

    原因:

    • 误食

    • 滥用杀虫剂

    • 容器污染

    临床表现:

     消化道症状

     干渴、烧灼感、流涎、口中金属味

     恶心、吐(→血)、泻(→血)

     衰竭、脱水、体温↓、虚脱、昏迷

     肝肾损害、神经精神病症→死亡

    治疗:

     排毒:催吐、洗胃

     解毒:氢氧化铁、二巯基丙磺酸钠、二巯基丙醇

    Food poisioning


    Slide132 l.jpg
    有机磷农药中毒 release of the light chain part of the molecule into the cytoplasm.

    中毒机理:抑制CHE

    急救治疗:

    排毒:催吐、洗胃(苏打水)

     特效解毒:阿托品(抗胆碱)

    CHE复能剂:氯磷定、解磷定 

    性质:

     脂溶性:经皮吸收

     挥发性:呼吸道进入

     稳定性:耐酸、碱液中分解

    临床表现:

     轻度:头痛、恶心、呕吐、多汗(CHE↓:30~50%)

     中度:肌颤、呼吸困难、瞳孔↓、血压↑(CHE↓:50~70%)

     重度:瞳孔↓、肺水肿、抽搐、昏迷、呼吸衰竭、(CHE↓:70%以上)

    注:敌百虫在碱液中转化为毒性更强的敌敌畏

    Food poisioning


    Slide133 l.jpg
    release of the light chain part of the molecule into the cytoplasm. 瘦肉精”中毒

      中文名:瘦肉精、盐酸克伦特罗,又名氨哮素、克喘素、氨心妥、氨双氯喘通、氨双氯醇胺等

      英文名:Clenbuterol; Spiropent; Planipart; NAB365;4-Amino-3,5-dichloro-alpha-(((1,1-dimethylethyl)amino)methyl) benzenemethanol

      分子式:C12H18Cl2N2O

      理化特性:白色或类白色结晶粉末,

    无臭、味苦,熔点161℃,溶于水、乙醇,

    微溶于丙酮,不溶于乙醚

    Food poisioning


    Slide134 l.jpg
    瘦肉精的药理作用 release of the light chain part of the molecule into the cytoplasm.

      瘦肉精是一种β2-受体激动剂,具有强而持久的松驰支气管平滑肌的作用,原本用于治疗人和家畜的支气管哮喘及家畜的保胎药。

    80年代初,美国一家公司意外发现,将其适量添加在饲料中,可明显促进动物生长和蛋白质合成,加速脂肪的转化和分解,提高瘦肉率,因此被称为瘦肉精。90年代初国外曾用于饲料添加剂,后因人的不良反应而被禁用。

      小鼠静脉LD50:27.6 mg/kg

    Food poisioning


    Slide135 l.jpg
    使用过 release of the light chain part of the molecule into the cytoplasm. "瘦肉精"的生猪和猪肉

    饲喂瘦肉精比较严重的生猪,在宰前症状:

    • 皮毛光亮

    • 呼吸怠促

    • 后臀部外形异常饱满并又突出

    • 明显的瘫软症状,四肢严重颤抖或卧地不起

    • 猪肉肉色较深、肉质鲜艳,后臀肌肉饱满突

      出,脂肪非常薄

    Food poisioning


    Slide136 l.jpg
    临床表现 release of the light chain part of the molecule into the cytoplasm.

      生猪停药一周后再屠杀,“瘦肉精”的残留会减少许多,但猪的瘦肉率也会随之锐减。“瘦肉精”残留以眼睛、毛发最高,肝、肺、肾和骨髓等次之。

      人在用量过大或无病用药则可能出现肌肉震颤、心慌、战粟、头痛、恶心、呕吐等症状,特别是对高血压、心脏病、甲亢、前列腺肥大等病病患者危险更大。

      虽然克伦特罗残留的毒作用为轻度,但美国FDA研究表明,应用拟交感神经药者或对前药过敏者,对克伦特罗的反应要比正常健康个体更为严重。职业性吸入克伦特罗对心血管的影响,可能要比经食品摄食的危害性更大。

    Food poisioning


    Slide137 l.jpg
    急救治疗 release of the light chain part of the molecule into the cytoplasm.

      洗胃、输液,促使毒物排出。

      在心电图监测及电解质测定下,使用保护心脏药物如1,6-二磷酸果糖(FDP)及β1-受体阻滞剂倍他乐克。

    预防方法

      加强执法宣传,禁止在饲料中掺入瘦肉精。

      加强对上市猪肉的检验。

      消费者购买猪肉时要拣带些肥膘(1-2cm)的肉,颜色不要太鲜红,猪内脏因瘦肉精残留量多不宜食用。

    Food poisioning


    Investigation on food poisoning l.jpg
    Investigation on food poisoning release of the light chain part of the molecule into the cytoplasm.

    调查的目的

    • 及时掌握中毒发生情况,找出中毒食品、

      致病因子及导致中毒的途径

    • 为病人的急救治疗提供依据

    • 查明中毒原因,采取控制措施防止蔓延

    • 积累资料,分析其特点、规律,以制定

      有效的预防措施

    Food poisioning


    Slide139 l.jpg
    调查内容与步骤: release of the light chain part of the molecule into the cytoplasm. 调查前的准备

    • 人员准备:

    • 物质准备:

      采样用品:

      法律文书:

      取证工具:

      食物中毒快速检测箱

      常见食物中毒的特效解毒药

    • 交通工具准备:

    Food poisioning


    Slide140 l.jpg
    调查内容与步骤:现场调查 release of the light chain part of the molecule into the cytoplasm.

    • 了解发病情况和参与抢救病人

    • 中毒患者临床表现与进餐史调查

      《食物中毒患者临床表现调查表》

      《食物中毒患者进餐情况调查表》

    • 可疑中毒食物调查

    • 从业人员健康状况调查

    Food poisioning


    Slide141 l.jpg
    调查内容与步骤: release of the light chain part of the molecule into the cytoplasm. 现场采样检验

    • 食物采集:尽量采集剩余可疑食物

    • 可疑食物制售环节的涂抹采样

    • 患者呕吐物、大便的采集

    • 血、尿样的采集

    • 从业人员带菌检查的样品采集

    Food poisioning


    Disposal of food poisoning l.jpg
    Disposal of food poisoning release of the light chain part of the molecule into the cytoplasm.

    • 现场处理

      a. 控制措施

      b. 追回、销毁导致中毒的食物

      c. 中毒场所处理

      微生物引起:氯制剂(有效氯150~300mg/L)

      浸泡擦拭或1~2%碱水煮沸消毒

      化学性:碱液彻底清洗

      d. 对急救治疗方案进行必要的纠正与补充

    • 行政处罚

    Food poisioning


    Slide143 l.jpg

    Food poisioning release of the light chain part of the molecule into the cytoplasm.


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