| Generalities |
| Agents |
Several agents:
1) Bacteria:
-Bacillus Cereus Bacillus cereus, toxin producing, spore forming
-Brucella
-Botulism Clostridium botulinum, spor forming, toxin producer
-Campylobacter jejuni and Campylobacter coli
-Cholera
-Clostridium perfringes Clostridium perfringes, spore-forming, toxin producing
-Escherichia coli
-Listeria monocytogenes
-Salmonella typhi
-Non-typhoid Salmonella
-Shigellosis: Shigella dysenteriae, S. flexneri, S. boydii, S. sonnei
-Staplyococcus aureus, toxin producing
-Vibrio parahaemolyticus
-Vibrio vulnificus
-Yersinia enterocolitica
…
2) Virus:
-Adenovirus, coronavirus, rotavirus, parvovirus, calicivirus, astrovirus…
-Poliovirus and enterovirus
-Viral hepatitis A
-Viral hepatitis E
3) Parasites and mycosa
-Intestinal nematode: trichinella spiralis
-Toxoplasma gondii: family Sarcocystidae
-Giardia intestinalis
-Entamoeba histolytica
4) Natural toxins
-Scomboid fish poisoning: following the consumption of fish of the family Scombroidea or Scomberesocidae (tuna, mackerel, skipjack, bonito) containing high levels of free histamine. This occur when the fish undergoes bacterial decomposition after capture.
-Paralytic shellfish poisoning: caused by the presence of saxitoxins and gonyautoxins in the shellfish (Alexandrium sp., and other dinoflagelates)
-Tetrodotoxin poisoning: caused by the tetrodotoxin, non-protein neurotoxin concentrated in the skin and viscera of puffer fish, porcupine fish, ocean sunfish…
-Mushroom toxins
-Plant toxins
…
5)Chemicals
-Pesticides (Organophosphates, antimony)
-Toxic metals (cadmium, copper, lead, mercury, tin)
-Polychlorinated biphenyls
-Fluoride
-Zinc
-Nitrites (food preservatives)
-Sodium hydroxide
-Monosodium glutamate
…
The information below will present the information related to Bacillus cereus, Clostridium botulinum, Clostridium perfringes, Staplyococcus aureus, Vibrio parahaemolyticus, Vibrio vulnificus, Yersinia enterocolitica, Adenovirus, Norovirus, Trichinella spiralis, Toxoplasma gondii, Tetrodotoxin poisoning, Histamine poisoning / scombroid, Paralytic shellfish.
The other agents were exposed in previous sections: Brucella, Campylobacter jejuni, Campylobacter coli, Cholera, Escherichia coli, Listeria monocytogenes, Salmonella, Shigella, Coronavirus, viral hepatitis A, viral hepatitis E, Rotavirus, poliovirus, Entamoeba histolytica, Giardia intestinalis, |
| Incubation |
The incubation varies with the agent.
| Agent |
Incubation |
| Bacteria |
|
| Bacillus cereus |
24-36 hours |
| Clostridium botulinum |
12-36 hours (several hours to 8 days) |
| Clostridium perfringes |
8-24 hours |
| Staplyococcus aureus |
2-6 hours |
| Vibrio parahaemolyticus |
9-25 hours, up to 3 days |
| Vibrio vulnificus |
12 hours – 3 days |
| Yersinia enterocolitica |
24-36 hours |
| |
|
| Virus |
|
| Adenovirus |
1-10 days |
| Norovirus |
12-48 hours |
| |
|
| Parasites |
|
| Trichinella spiralis |
8-15 days (5-45 days) |
| Toxoplasma gondii |
5-23 days |
| |
|
| Chemical |
|
| Tetrodotoxin poisoning |
< 1 hour |
| Histamine poisoning |
Minutes to few hours |
| Paralytic shellfish |
Less than 1 hour |
| Organophosphates |
Within minutes to hours |
|
| Period of communicability |
The period of communicability varies with the agent.
| Agent |
Period of communicability |
| Bacteria |
|
| Bacillus Cereus |
No person to person transmission |
| Clostridium botulinum |
No person to person transmission |
| Clostridium perfringes |
No person to person transmission |
| Staplyococcus aureus |
No person to person transmission |
| Vibrio parahaemolyticus |
Usually no person to person transmission |
| Vibrio vulnificus |
No person to person transmission |
| Yersinia enterocolitica |
Bacteria excreted in feces for 2-3 weeks |
| |
|
| Virus |
|
| Norovirus |
As long as the virus is excreted, in particular during the acute phase |
| Adenovirus |
| |
|
| Parasites |
|
| Trichinella spiralis |
No person-to-person transmission |
| Toxoplasma gondii |
No person to person transmission |
| |
|
| Chemical |
|
| Tetrodotoxin poisoning |
No person to person transmission |
| Histamine poisoning |
No person to person transmission |
| Paralytic shellfish |
No person to person transmission |
| Organophosphates |
No person to person transmission |
|
| Reservoir |
The reservoir vary with the agent
| Agent |
Reservoir |
| Bacteria |
|
| Bacillus Cereus |
Widely distributed in nature (soil) |
| Clostridium botulinum |
Soil, marine, freshwater sediments, intestinal tracts of fishes, animals, birds, and insects |
| Clostridium perfringes |
Soil, sewage, dust, feces of animals and humans, animal-origin feedstuffs |
| Staplyococcus aureus |
Humans (skin, nose, throat) |
| Vibrio parahaemolyticus |
Coastal seawater, and estuarine brackish waters, marine fish and shellfish |
| Vibrio vulnificus |
Coastal and estuarine waters |
| Yersinia enterocolitica |
Animals |
| |
|
| Virus |
|
| Adenovirus |
Humans |
| Norovirus (Norwalk-like virus) |
Humans |
| |
|
| Parasites |
|
| Trichinella spiralis |
Swine, dogs, cats, horses, bears |
| Toxoplasma gondii |
Cats and other felines.
Intermediate hosts: sheep, goats, rodents, pigs, cattle, and birds. |
| |
|
| Chemical |
|
| Tetrodotoxin poisoning |
Puffer fish, porcupine fish, ocean sunfish |
| Histamine poisoning |
Fish of the family Scombroidea or Scomberesocidae (tuna, mackerel, skipjack, bonito) |
| Paralytic shellfish |
Shellfish (Alexandrium sp., and other dinoflagelates) |
| Organophosphates |
-Accidental: Food sprayed with insecticides containing organophosphates
-Intentional poisoning |
|
| Modes of transmission |
The modes of transmission are mainly by consumption of contaminated food or toxic food.
| Agent |
Modes of transmission |
| Bacteria |
|
| Bacillus Cereus |
Consumption of contaminated food (usually stored at ambient temperature after cooking) as: fried rice, spices, dried foods, milk, dairy products, vegetable dishes, sauces… |
| Clostridium botulinum |
Ingestion of toxin pre-formed in food stored in anaerobic conditions as: vegetables, condiments, fish, meat… Honey may transmit the bacteria |
| Clostridium perfringes |
Ingestion of contaminated food inadequately cooled as meat and poultry. |
| Staplyococcus aureus |
Consumption of food containing the toxin, and contaminated by food handlers as ham, chicken, egg salads, creams, ice creams, cheese… |
| Vibrio parahaemolyticus |
Consumption of raw or undercooked fish or fishery products , or foods subject to cross-contamination from raw fish. |
| Vibrio vulnificus |
Consumption of seafood, and raw oysters. |
| Yersinia enterocolitica |
Consumption of contaminated food: pork products, milk products… |
| |
|
| Virus |
|
| Adenovirus |
- Person-to-person transmission: fecal oral route
- Ingestion of contaminated food: by food handler or harvested from contaminated water (seafood and vegetables)
- Ingestion of contaminated water or drinks |
| Norovirus (Norwalk-like virus) |
| |
|
| Parasites |
|
| Trichinella spiralis |
Consumption of raw or undercooked infected animal.
|
| Toxoplasma gondii |
Ingestion of occysts:
-by playing/ handling with cats
- by consumption of raw / undercooked meat
- by consumption of food/water contaminated by feline feces |
| |
|
| Chemical |
|
| Tetrodotoxin poisoning |
Ingestion of puffer fish, porcupine fish, ocean sunfish |
| Histamine poisoning |
Ingestion of shellfish |
| Paralytic shellfish |
Ingestion of fish of the family Scombroidea or Scomberesocidae |
| Organophosphates |
Consumption of food sprayed with organophosphates |
|
| Clinical |
The clinical presentation includes gastro-intestinal symptoms, neurological symptoms, respiratory illness, or general symptoms…
| Agent |
Clinical presentation |
| Bacteria |
|
| Bacillus Cereus |
Gastro-enteritis |
| Clostridium botulinum |
Paralytic manifestations: ocular disturbance, dry mouth, difficulty in swallowing and speaking, limb paralysis, respiratory paralysis |
| Clostridium perfringes |
Gastro-enteritis |
| Staplyococcus aureus |
Upper gastro-intestinal tract symptoms, with no fever. |
| Vibrio parahaemolyticus |
Gastroenteritis. |
| Vibrio vulnificus |
-Gastroenteritis with blood stools.
-Complications: septicaemia in persons with chronic liver diseases, or immune-suppression. |
| Yersinia enterocolitica |
Gastroenteritis |
| |
|
| Virus |
|
| Adenovirus |
Fever, vomiting, watery non-inflammatory diarrhoea |
| Norovirus (Norwalk-like virus) |
Watery diarrhea, vomiting, nausea |
| |
|
| Parasites |
|
| Trichinella spiralis |
-Symptoms depend on the number of larvae ingested and location.
-May include facial oedema and hypereosinophilia |
| Toxoplasma gondii |
-Acute lympho-adenopathy.
-May be asymptomatic
-Complications during pregnancy: abortion, congenital chorioretinitis, congenital brain damage.
-Complications in immune-compromised persons: cerebritis, chorioretinitis, pneumonia, myocarditis… |
| |
|
| Chemical |
|
| Tetrodotoxin poisoning |
-Neurological manifestations: paresthaesias, ataxia, paralysis, death
-Case fatality: 60% |
| Histamine poisoning |
Tingling and burning sensations around the mouth, facial flushing, sweating, nausea, vomiting, headache, palpitations, dizziness, and rash |
| Paralytic shellfish |
Neurological manifestations: paresthaesias of the mouth and extremities with gastro-intestinal symptoms. |
| Organophosphates |
Cholinergic syndrome: excess respiratory and oral secretions, diarrhea and vomiting, diaphoresis, convulsions, altered mental status, miosis, bradycardia, and generalized weakness that can progress to paralysis, respiratory arrest and death |
|
| Worldwide |
- Most of the agents are found worldwide.
-Tedrodotoxin poisoning is usually known in Japan; in the past years, cases were also observed in the Middle East.
|
| Lebanon |
Investigated food poisoning episodes in the past 10 years isolated the following agents:
Escherichia coli, non-typhoid Salmonella, Shigella, Staplyococcus aureus, Trichinella spiralis,
tetrodotoxin poisoning, and Organophosphates.
|
| Control objective |
Control |
