Food-Water Borne Dses

7/29/2019 Food-Water Borne Dses

1/26

Food-borne and Water-borne

Diseases


2/26

Definition

Food-borne illness two or more cases of asimilar illness resulting from the ingestion of a

common food Water-borne illness an illness that occurs afterconsumption or use of water intended fordrinking or as illness associated with recreational

water such as swimming pools, whirlpools, hottubs, spas, water parks, and naturally occurringfresh and marine surface waters


3/26

Epidemiology - Food-borne

List of most common bacterial food-borneillness, listed in order of occurrence

1) Campylobacter2) Salmonella

3) Shigella

4) E. Coli


4/26

Epidemiology - Food-borne

List of most common viral food-borne illness1) Norwalk virus

2) Astroviruses

3) Rotaviruses

4) Enteric adenoviruses


5/26

Physical Examination

Determine hydration statusPresence of blood in the stoolExclude other diarrheal illness


6/26

Diagnostic Tests

Blood cultures suspect bateremia Gram stain - identifies campylobacter with

66-99% sensitivity Fecal leukocytes - if positive = higher

culture yield

Ova and parasites - done in the ER


7/26

Diagnostic Tests

Stool cultures only if pt1) febrile

2) bloody diarrhea

3) severe abdominal pain

4) clinically severe or persistent

5) significant historical risk factors for

food-borne illness


8/26

Treatment

Most episodes are self-limiting and fluidreplacement with supportive care is all that isneeded.

If determined that a severe case of bacterialinfectious diarrhea has occurred then antibioticof choice is either:

Ciprofloxacin 500mg PO BID x3-5 days

Ciprofloxacin 1 gm PO x 1 dose

Bactrim DS PO BID x 3-5 days


9/26

Bacillus anthracis

Incubation period2d-weeks Signs and symptoms nausea, vomiting,

bloody diarrhea, abdominal pain Duration weeks Food Sourcecontaminated meat

Lab testingblood Treatmentpenicillin, ciprofloxacin


10/26

Bacillus cereus

Enterotoxin Incubation period1-6h

Signs and symptomssudden fever, nausea,vomiting, may have diarrhea

Duration 24h

Food Sourcerice, meat Lab testing none Treatmentsupportive only


11/26

Bacillus cereus

Diarrheal toxin Incubation period - 10-16h

Signs and symptoms - watery diarrhea,nausea, cramps

Duration - 24-28h

Food Source meat, stew, gravy, vanilla sauce Lab testing none Treatmentsupportive only


12/26

Brucella spp.

Incubation period7-21d Signs and symptoms fever, chills, headache,

myalgias, arthralgias, bloody diarrhea Duration weeks Food Source raw milk, goat cheese, meats

Lab testingblood, serology Treatmentrifampin and doxycycline


13/26

Clostridium botulinum

Adults, children Incubation period12-72h Signs and symptoms vomiting, diarrhea, diplopia,

dysphagia, descending muscle weakness Duration variable, can end in death Food Sourceimproperly canned foods, fermented

fish, garlic, herb-infused oils, baked potato in foil, foodskept in a warm oven for hours

Lab testingstool, serum, and food assayed for toxinat CDC or state labs Treatmentbotulinum antitoxin


14/26

Clostridium botulinum

Infants Incubation period3-30d

Signs and symptomslethargy, poorfeeding, hypotonia Duration variable Food Sourcehoney, home-canned foods

Lab testingstool, serum, and food assayedfor toxin at CDC or state lab

Treatmentbotulinum immune globulin


15/26

Campylobacter

Incubation period2-5d Signs and symptomsbloody or watery

diarrhea, cramps, fever Duration 2-10d Food SourcePoultry, milk, water

Lab testingspecial stool culture Treatmenterythromycin or ciprofloxacin-antibiotic for severe cases only


16/26

Clostridium perfringens

Incubation period8-16h Signs and symptoms watery diarrhea, nausea,

cramps Duration 24-48h Food Source meat, poultry, gravy, dried or

precooked foods

Lab testingquantitative culture of stool Treatmentsupportive only


17/26

Enterohemorrhagic E. coli

Incubation period1-8d Signs and symptomsbloody diarrhea,

abdominal pain, vomiting

Duration 5-10d Food Source undercooked meat,

unpasteurized dairy products, milk, raw fruit and

vegetables, salami, contaminated water, saladdressing, yogurt, acidic foods

Lab testingspecific stool culture Treatmentsupportive only


18/26

Enterotoxigenic E. coli

(travelers diarrhea) Incubation period1-3d Signs and symptomswatery diarrhea,

vomiting, cramps Duration 3-10d Food Sourcefecal contamination of food

Lab testingspecific stool culture Treatmentciprofloxacin-antibiotic forsevere cases only or TMP-SMX


19/26

Listeria monocytogenes

Incubation period9-48h for GI, 2-6 weeks forinvasive disease

Signs and symptoms fever, myalgias, nausea, diarrheain pregnant women, flu-like illness, can lead topremature delivery, elderly orimmunocompromised can have sepsis ormeningitis

Duration variable Food Source soft cheese, unpasteurized milk, deli

meat, and hot dogs Lab testingblood or CSF cultures TreatmentIV ampicillin or TMP-SMX. Antibiotics

for severe cases only


20/26

Salmonella spp.

Incubation period1-3d Signs and symptoms diarrhea, fever, cramps, vomiting,

s. typhi and paratyphi cause chills, myalgia,

headache, with rare diarrhea Duration 4-7d Food Sourceeggs, poultry, unpasteurized milk or

juice, raw fruits and vegetables, street venders, fecalwater contamination

Lab testingstool cultures Treatmentciprofloxacin or TMP-SMX. Antibiotics

for severe cases only

Necessitates typhoid immunization for travelers


21/26

Shigella spp.

Incubation period24-48h Signs and symptomsbloody diarrhea, fever,

cramps

Duration 4-7d Food Sourcefecal food or water

contamination, person-person spread by

fecal-oral contamination Lab testingstool cultures TreatmentTMP-SMX if susceptible


22/26

S. Aureus

Incubation period1-6h Signs and symptomssudden severe

nausea, vomiting, diarrhea Duration 24-48h Food Sourceunrefrigerated meats,

potato and egg salad, cream pastries Lab testing none Treatment supportive only


23/26

Vibrio cholerae

Incubation period24-72h Signs and symptomssevere watery

diarrhea and vomiting

Duration 3-7d death from dehydration Food Sourcecontaminated water, fish,

shellfish, street vendors

Lab testingspecific stool cultures Treatmentciprofloxacin in adults, TMP-SMX in children


24/26

Vibrio vulnificus

Incubation period1-7d Signs and symptoms vomiting, diarrhea, abdominal

pain, sepsis, wound infections, liver disease, and

elderly can have skin bullae Duration 2-8d death can result Food Sourceraw shellfish, open wound exposure

to seawater

Lab testingspecific wound or blood cultures Treatmentdoxycycline or ceftazidime


25/26

Yersinia spp.

Incubation period24-48h Signs and symptomsmimics appendicitis,

can have a rash

Duration 1-3 weeks Food Source undercooked pork, unpasteurized

milk, contaminated water Lab testingspecific stool or blood cultures

Treatmentciprofloxacin, doxycycline,ceftriaxone, or gentamycin. Antibiotics forsevere cases only


26/26

Chronic sequelae

Occurs in 2-3% of pts Seronegative reactive arthritis &

salmonella, shigella & campylobacter GBS & campylobacter HUS & E. coli 0157:H7

Documents

Food-Water Borne Dses