Milk Borne Diseases-II

Milk Borne Diseases-IIMilk Borne Diseases-II

Mansur-ud-Din AhmadMansur-ud-Din Ahmad

OutlineOutline

E. coliE. coli Vibrio choleraeVibrio cholerae Fungal intoxicationsFungal intoxications Milk-borne toxi-infectionsMilk-borne toxi-infections Clostridium perfringens Clostridium perfringens and and B. cereusB. cereus Uncertain organismUncertain organism Emerging pathogens (Listeria, Emerging pathogens (Listeria,

Campylobacter, YersiniaCampylobacter, Yersinia

E. coliE. coli poisoning poisoning

Enteritis in infants Enteritis in infants Travellers’ diarrhoea & food Travellers’ diarrhoea & food

poisoning in adultspoisoning in adults By invasion or by enterotoxins, By invasion or by enterotoxins,

heat labile (LT) & heat stable (ST)heat labile (LT) & heat stable (ST)

Cont…Cont…

Contaminated Milk & milk products (ice-Contaminated Milk & milk products (ice-cream, kulfi, dried milks, cheese) with cream, kulfi, dried milks, cheese) with toxigenic strains of toxigenic strains of E. coliE. coli

Minimum of 10 Minimum of 10 5-5-10 10 77 cells/g produce cells/g produce LT-inactivated at 65°C for 30 min LT-inactivated at 65°C for 30 min ST- resist that temp.ST- resist that temp. LT & ST toxinsLT & ST toxins--cause food poisoningcause food poisoning Children more susceptibleChildren more susceptible Sensitive adultsSensitive adults

SourcesSources

Water supplies contaminated with faecal Water supplies contaminated with faecal mattermatter

Unhygienic practices by the handlersUnhygienic practices by the handlers Infected animals excrete organisms Infected animals excrete organisms

Cont…Cont…

Symptoms- resemble those of choleraSymptoms- resemble those of cholera Massive watery diarrhoea Massive watery diarrhoea ST type-diarrhoea, with or without ST type-diarrhoea, with or without

vomition, Fever in children but not in vomition, Fever in children but not in adultsadults

Incubation period-8-24 hIncubation period-8-24 h

Prevention and controlPrevention and control

The faecal contamination of water The faecal contamination of water supply should be avoided.supply should be avoided.

• Handlers follow hygienic practices.Handlers follow hygienic practices.• Cross contamination from infected Cross contamination from infected

animals should also be avoided.animals should also be avoided.

CholeraCholera ( (Vibrio cholerae)Vibrio cholerae)

Massive epidemics-unhygienic practicesMassive epidemics-unhygienic practices Mainly a water-borne illness, contaminated Mainly a water-borne illness, contaminated

milk and milk products may also transmit milk and milk products may also transmit Adheres to the epithelial cells lining the Adheres to the epithelial cells lining the

crypts of mucosa in the small intestine-crypts of mucosa in the small intestine-produces enterotoxin-causes loss of fluid produces enterotoxin-causes loss of fluid and electrolytes from the body-dehydrationand electrolytes from the body-dehydration

SourcesSources

i)i) Milk may be infected by soiled hands of a Milk may be infected by soiled hands of a patient or a convalescent carrier.patient or a convalescent carrier.

ii)ii) Use of infected water for dairy purposes.Use of infected water for dairy purposes.

iii)iii) Adulteration of milk with contaminated Adulteration of milk with contaminated water may also be one of the causes.water may also be one of the causes.

SymptomsSymptoms

Mild cases-diarrhoeaMild cases-diarrhoea

Severe cases-diarrhoea, vomiting, rice water Severe cases-diarrhoea, vomiting, rice water stools, abdominal pain, thirst, dehydrationstools, abdominal pain, thirst, dehydration

Short course terminating in death, sometimes Short course terminating in death, sometimes within 12 h within 12 h

Cont…Cont…

Incubation period-Incubation period-3 days (few hours-5 days)3 days (few hours-5 days)

Diagnosis V. cholerae Diagnosis V. cholerae isolated fromisolated from faeces faeces (infected individuals and carriers)(infected individuals and carriers)

Intraperitoneal inoculation of culture in Intraperitoneal inoculation of culture in guinea pigs cause death within 24 hours.guinea pigs cause death within 24 hours.

Susceptibility and immunity-Susceptibility and immunity-resistance varies resistance varies Clinical attacks confer temporary Clinical attacks confer temporary immunity.immunity.

Active immunity for 6-12 months (vaccines) Active immunity for 6-12 months (vaccines)

Prevention and control Prevention and control

Pasteurization of milk and milk products.Pasteurization of milk and milk products.• Sanitary disposal of human excreta.Sanitary disposal of human excreta.• Protection of water by boiling.Protection of water by boiling.• Sanitary preparation and handling of Sanitary preparation and handling of

products.products.• Control or destruction of house flies.Control or destruction of house flies.

Cont…Cont…

vi)vi) Education of public in personal cleanliness.Education of public in personal cleanliness.

vii)vii) Isolation of patients.Isolation of patients.

viii)viii) Disinfection of stools and vomits, soiled articlesDisinfection of stools and vomits, soiled articles

ix)ix) Food left by patients should be burnt.Food left by patients should be burnt.

x)x) Room of patient thoroughly cleaned and disinfectedRoom of patient thoroughly cleaned and disinfected

xi)xi) Carriers should be isolated.Carriers should be isolated.

xii)xii) Use of cholera vaccine in exposed population Use of cholera vaccine in exposed population groups.groups.

Fungal intoxicationsFungal intoxications

Aspergillus, Aspergillus, other molds other molds Penicillium, FusariumPenicillium, Fusarium etc. etc.

a)a) Aflatoxicosis-common Aflatoxicosis-common A. flavusA. flavus & & A. parasiticus A. parasiticus

b)b) Preformed toxin secreted in milk Preformed toxin secreted in milk by the milch animal fed with by the milch animal fed with aflatoxin containing feeds. aflatoxin containing feeds.

Cont…Cont…

Ingested Aspergillus-toxins are Ingested Aspergillus-toxins are metabolised and secreted in milk (M1 metabolised and secreted in milk (M1 & M2)& M2)

B1, B2, B2a aflatoxin B1 is the most B1, B2, B2a aflatoxin B1 is the most abundant and most toxic of the abundant and most toxic of the aflatoxinsaflatoxins

G1, G2 and G2a.G1, G2 and G2a.

Cont…Cont…

Mycotoxins are heat stable, potent, strong Mycotoxins are heat stable, potent, strong toxicity (highly carcinogenic)toxicity (highly carcinogenic)

Raw milk, ice-cream powder, evaporated Raw milk, ice-cream powder, evaporated milk, dried milks and cheese milk, dried milks and cheese

Permissible limit 90 ppm.Permissible limit 90 ppm. Sources are aerial contamination, Soil & Sources are aerial contamination, Soil &

contaminated foods, Poor storage contaminated foods, Poor storage conditionsconditions

AAcute aflatoxicosiscute aflatoxicosis

Symptoms-Symptoms-liver hyperplasia, tissue liver hyperplasia, tissue haemorrhage, anorexia, hepatitis and haemorrhage, anorexia, hepatitis and finally deathfinally death

Prevent contamination of milk and milk Prevent contamination of milk and milk products as well as feed products as well as feed

Proper storage and fungistatic agentsProper storage and fungistatic agents Detoxification of aflatoxins by physical, Detoxification of aflatoxins by physical,

chemical or biological agents (relatively chemical or biological agents (relatively impractical)impractical)

Milk-borne toxi-infectionsMilk-borne toxi-infections

Clostridium perfringens &Clostridium perfringens & B. cereusB. cereus By ingestion of contaminated milk or milk By ingestion of contaminated milk or milk

productsproducts Canned products favorable for toxi-Canned products favorable for toxi-

infection by Clostridiuminfection by Clostridium Five distinct types of Clostridial toxins, A, Five distinct types of Clostridial toxins, A,

B, C, D, and E. Two of the enterotoxins are B, C, D, and E. Two of the enterotoxins are lethal and emetic.lethal and emetic.

Sources of organism Sources of organism

Commonly found in soil and faeces Commonly found in soil and faeces Water supplies contaminated with sewage Water supplies contaminated with sewage

Disease in humanDisease in human

Gastroenteritis-due to the production of Gastroenteritis-due to the production of exotoxin/enterotoxins resistant to intestinal exotoxin/enterotoxins resistant to intestinal juicesjuices

Children more susceptible lethal dose 2,000 Children more susceptible lethal dose 2,000 mice/mg mice/mg

Symptoms.Symptoms. Diarrhoea, vomiting, nausea, Diarrhoea, vomiting, nausea, abdominal painabdominal pain

Cont…Cont…

Incubation period- Incubation period- 8-22 h, not very fatal8-22 h, not very fatal


i)i) Proper heat treatment of milk.Proper heat treatment of milk.

ii)ii) Milk should not be stored under conditions Milk should not be stored under conditions suitable for the spores to vegetate suitable for the spores to vegetate

iii)iii) Rapid cooling after pasteurization and Rapid cooling after pasteurization and storage below 15°Cstorage below 15°C

iv)iv) Environment hygiene should be observed. Environment hygiene should be observed.

Bacillus cereusBacillus cereus poisoning poisoning

Present in all raw milk & pasteurized milk, Present in all raw milk & pasteurized milk, cream, cakes, pastry, processed cheese etc.cream, cakes, pastry, processed cheese etc.

Sources Sources

i)i) B. cereus B. cereus from mastitis animalsfrom mastitis animals

ii)ii) Animal’s teat, skin, milking cansAnimal’s teat, skin, milking cans

iii)iii) Soil Soil

ToxinsToxins

Three types of toxinsThree types of toxins Haemolysin Haemolysin • Lecithinase (phospholipase C)Lecithinase (phospholipase C)• EnterotoxinEnterotoxinEnterotoxin responsible for food poisoningEnterotoxin responsible for food poisoningLecithinase and haemolysin play role in the Lecithinase and haemolysin play role in the

pathogenesispathogenesis

Types of poisoningTypes of poisoning

Two typesTwo types

diarrhoeal typediarrhoeal type

vomiting typevomiting type

Symptoms-Symptoms-are nausea, diarrhoea, are nausea, diarrhoea, abdominal painabdominal pain

Incubation period-Incubation period-one day or less (6-12 h)one day or less (6-12 h)


i)i) Prompt cooling of milk/milk products Prompt cooling of milk/milk products

ii)ii) Environment hygiene be maintained Environment hygiene be maintained aerial contamination should be aerial contamination should be avoided.avoided.

iii)iii) General hygiene conditions should be General hygiene conditions should be maintained during production and maintained during production and marketingmarketing

Uncertain pathogenesisUncertain pathogenesis

ProteusProteus infection:infection: Proteus vulagrisProteus vulagris rarely rarely Proteus mirabilis Proteus mirabilis may cause summer may cause summer diarrhoea diarrhoea

Organism easily destroyed by heat-proper Organism easily destroyed by heat-proper pasteurization, proper sanitizingpasteurization, proper sanitizing

Aeromonas Aeromonas infectioninfection

Associated with animals that live in water. Associated with animals that live in water. Aeromonas hydrophilia -enAeromonas hydrophilia -enterotoxigenic, terotoxigenic, exact role in food poisoning through milk exact role in food poisoning through milk and milk products is not knownand milk products is not known

• Appropriate hygienic practices during Appropriate hygienic practices during production and processing of milk production and processing of milk

CitrobacterCitrobacter infectioninfection

RRarely associated with gastroenteritis through arely associated with gastroenteritis through ingestion of contaminated ingestion of contaminated

A few strains produce enterotoxinsA few strains produce enterotoxins

KlebsiellaKlebsiella infection-infection- milk-borne illnesses rare milk-borne illnesses rare

K. pneumoniae K. pneumoniae produce heat stable and heat produce heat stable and heat labile toxins-comparable to labile toxins-comparable to E. coliE. coli. .

PseudomonasPseudomonas infectioninfection

PseudomonasPseudomonas encountered in milk are encountered in milk are Ps. Ps. Putrefaciens, Ps. Fluorescens, Ps. fragi, Ps. Putrefaciens, Ps. Fluorescens, Ps. fragi, Ps. viscosa viscosa and and Ps. aeruginosa. Ps. aeruginosa. Of these, Of these, Ps. Ps. aeruginosa aeruginosa appears to play an important role appears to play an important role in food poisoning through milk and milk in food poisoning through milk and milk productsproducts

Sources of the causative organism Sources of the causative organism

Water supply is the initial source of this Water supply is the initial source of this organism.organism.

i)i) Improperly cleaned utensils, equipments, Improperly cleaned utensils, equipments, pipelines, milk cans, churns, holding cans, pipelines, milk cans, churns, holding cans, valves, milking machines, etc. constitute the valves, milking machines, etc. constitute the other sources.other sources.

ii)ii) Udder teats and cowshed environment may Udder teats and cowshed environment may also be the potential sources.also be the potential sources.

Cont…Cont…

Disease in relation to human beings and animalsDisease in relation to human beings and animals

Human beings. Human beings. In human beings,In human beings, Ps. aeruginosa Ps. aeruginosa can produce urinary tract infections, eye can produce urinary tract infections, eye infections, ear infections, septicaemia, abscess, infections, ear infections, septicaemia, abscess, meningitis and enteritis. The gastrointestinal meningitis and enteritis. The gastrointestinal distrubances dur to enterotoxin produced by distrubances dur to enterotoxin produced by Ps. aeruginosa Ps. aeruginosa have also been recorded.have also been recorded.

Cont…Cont…

Ps. aeruginosa Ps. aeruginosa can cause mastitis, necrotizing enteritis, can cause mastitis, necrotizing enteritis, abortion, vaginitis and endometritus in cattleabortion, vaginitis and endometritus in cattle


i)i) Proper heat treatment of milk.Proper heat treatment of milk.

ii)ii) Hygienic conditions during production and Hygienic conditions during production and processing.processing.

iii)iii) Microbicidal treatment of dairy water supply.Microbicidal treatment of dairy water supply.

iv)iv) Proper cleaning and sanitization of dairy utensils Proper cleaning and sanitization of dairy utensils and equipments. and equipments.

Emerging pathogensEmerging pathogens

Listeriosis- Listeriosis- Listera monocytogenes Listera monocytogenes in in milk & milk productsmilk & milk products

Increase in number of outbreaks of Increase in number of outbreaks of listeriosislisteriosis

L. Monocytogenes L. Monocytogenes cause mastitis cause mastitis Gram-positive, non-sporulating Gram-positive, non-sporulating

rods, grow at 1° to 45°Cproduce rods, grow at 1° to 45°Cproduce haemolysin (aplha, beta)haemolysin (aplha, beta)

Source of organismSource of organism

i)i) Infected animals in milk through infected Infected animals in milk through infected uddersudders

ii)ii) Handlers may introduce the organism Handlers may introduce the organism iii)iii) Unhygienic practices during production Unhygienic practices during production

and processing of milk and processing of milk iv)iv) Faecal contamination of milk and waterFaecal contamination of milk and waterv)v) Contaminated refrigerators Contaminated refrigerators vi)vi) Survive some of the processing conditions Survive some of the processing conditions

((ingestion by leucocytes in milk give ingestion by leucocytes in milk give protection against heat treatment)protection against heat treatment)

LListeriosisisteriosis in man in man

LListeriosis lethal in man, acute meningitis with isteriosis lethal in man, acute meningitis with or without septicaemia. or without septicaemia.

Sudden onset with fever, nausea, headache, Sudden onset with fever, nausea, headache, vomiting, followed by delirium, coma, vomiting, followed by delirium, coma, collapse and shock resulting in death if not collapse and shock resulting in death if not treated promptly and properly.treated promptly and properly.


i)i) Strict hygiene practices should be followed Strict hygiene practices should be followed during production and processing of milk.during production and processing of milk.

ii)ii) The human carriers should not be allowed to The human carriers should not be allowed to handle milk and milk products.handle milk and milk products.

iii)iii) Culling of the infected animals.Culling of the infected animals.

iv)iv) Proper heat treatment of milk.Proper heat treatment of milk.

v)v) Proper storage conditions.Proper storage conditions.

Campylobacter jejuniCampylobacter jejuni

RRelatively new bacterium elatively new bacterium

Variety of warm-blooded animals infected with Variety of warm-blooded animals infected with Campylobacter jejuni.Campylobacter jejuni.

Sources of the causative organism Sources of the causative organism

i)i) The organism has been isolated from The organism has been isolated from intestinal tracts and faecal matter of man, intestinal tracts and faecal matter of man, goat, sheep,goat, sheep,

ii)ii) Polluted water contaminated with Polluted water contaminated with C. jejuniC. jejuni

iii)iii) Infected personnel and animals. Infected personnel and animals.

Diseases in man and animals Diseases in man and animals

C. jejuni C. jejuni common cause of acute gastro-enteritis common cause of acute gastro-enteritis

Also implicated in mastitis in milch animalsAlso implicated in mastitis in milch animals

Symptoms.Symptoms. Severe abdominal pain and diarrhea. Severe abdominal pain and diarrhea.


i)i) Milk be properly pasteurized and heat Milk be properly pasteurized and heat treated.treated.

ii)ii) Water supplies be adequately treated Water supplies be adequately treated chlorinationchlorination

iii)iii) Good hygiene by dairy personnelGood hygiene by dairy personnel

iv)iv) Persons suffering not be allowed to handle Persons suffering not be allowed to handle milk and milk products milk and milk products

Yersinia enterocoliticaYersinia enterocolitica

Yersiniosis-incidences of illness through raw Yersiniosis-incidences of illness through raw and pasteurized milk and pasteurized milk

Water or streams often contain this organismWater or streams often contain this organism Faecal contaminationFaecal contamination Infected animalsInfected animals Contaminated raw materialsContaminated raw materials

Disease in man Disease in man

Acute syndrome with appendicitisAcute syndrome with appendicitis Y. enterocolitica Y. enterocolitica produces several disease produces several disease

syndromes in human beings on ingestion of syndromes in human beings on ingestion of contaminated milkcontaminated milk

Abdominal pain and feverAbdominal pain and fever Vomiting and diarrhoeaVomiting and diarrhoea Enterotoxin production andinvasiveness of the Enterotoxin production andinvasiveness of the

organism. organism.


i)i) Avoiding faecal contamination.Avoiding faecal contamination.

ii)ii) Following hygienic practices.Following hygienic practices.

iii)iii) Avoiding handling by infected personnelAvoiding handling by infected personnel

Vibrio parahaemolyticus Vibrio parahaemolyticus

Gastro-enteritis in human beingsGastro-enteritis in human beingsSymptoms-Symptoms-Diarrhoea & gastroenteritis. Diarrhoea & gastroenteritis.

Abdominal cramps, nausea, vomiting, Abdominal cramps, nausea, vomiting, headache, chills and fever. In severe cases, headache, chills and fever. In severe cases, death may also occur.death may also occur.

Incubation period. Incubation period. This varies from 12-24 h. This varies from 12-24 h. The symptoms persist from few hours to The symptoms persist from few hours to 10 days with the usual duration of 2-3 10 days with the usual duration of 2-3 days.days.


Contamination of water should be avoided.Contamination of water should be avoided.

Application of good sanitary practices Application of good sanitary practices

Personnel hygiene help in preventing the cross-Personnel hygiene help in preventing the cross-contamination.contamination.

Other milk-borne diseasesOther milk-borne diseases

TuberculosisTuberculosis (TB): Milk-borne tuberculosis (TB): Milk-borne tuberculosis directly or indirectly related to the directly or indirectly related to the consumption of raw milk from infected dairy consumption of raw milk from infected dairy herdsherds

Bovine type causes non- pulmonary type TBBovine type causes non- pulmonary type TB

Avian type cause both types of tuberculosisAvian type cause both types of tuberculosis

Cont…Cont…

SpeciesSpecies HostHost

M. tuberculosisM. tuberculosis ManMan

M. bovisM. bovis Cattle and Cattle and manman

M. aviumM. avium Birds and swine; rarely Birds and swine; rarely manman

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Milk Borne Diseases-II