Food Poisoning is Common

Food Poisoning is Common

Food poisoning, also called foodborne illness, is illness caused by eating contaminated food. ... Food poisoning symptoms, which can start within hours of eating contaminated food, often include nausea, vomiting or diarrhea. Most often, food poisoning is mild and resolves without treatment.

Foodborne illness is any illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that

contaminate food, as well as chemical or natural toxins such as poisonous mushrooms and various species of beans that have not been

boiled for at least 10 minutes.

Symptoms vary depending on the cause, and are described below in this article. A few broad generalizations can be made, e.g.: The

incubation period ranges from hours to days, depending on the cause and on how much was consumed. The incubation period tends to

cause sufferers to not associate the symptoms with the item consumed, and so to cause sufferers to attribute the symptoms to

gastroenteritis for example. Symptoms often include vomiting, fever, and aches, and may include diarrhea. Bouts of vomiting can be

repeated with an extended delay in between, because even if infected food was eliminated from the stomach in the first bout, microbes

can pass through the stomach into the intestine via cells lining the intestinal walls and begin to multiply. Some types of microbes stay

in the intestine, some produce a toxin that is absorbed into the bloodstream, and some can directly invade deeper body tissues.

Causes.

Foodborne illness usually arises from improper handling, preparation, or food storage. Good hygiene practices before, during, and

after food preparation can reduce the chances of contracting an illness. There is a consensus in the public health community that

regular handwashing is one of the most effective defenses against the spread of foodborne illness. The action of monitoring food to

ensure that it will not cause foodborne illness is known as food safety. Foodborne disease can also be caused by a large variety of

toxins that affect the environment.

Furthermore, foodborne illness can be caused by pesticides or medicines in food and natural toxic substances such as poisonous

mushrooms or reef fish.

Bacteria

Bacteria are a common cause of foodborne illness. In the United Kingdom during 2000, the individual bacteria involved were the

following: Campylobacter jejuni 77.3%, Salmonella 20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.56%. In the

past, bacterial infections were thought to be more prevalent because few places had the capability to test for norovirus and no active

surveillance was being done for this particular agent. Toxins from bacterial infections are delayed because the bacteria need time to

multiply. As a result, symptoms associated with intoxication are usually not seen until 12–72 hours or more after eating contaminated

food. However, in some cases, such as Staphylococcal food poisoning, the onset of illness can be as soon as 30 minutes after ingesting

contaminated food.

Most common bacterial foodborne pathogens are:

Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome and periodontitis

Clostridium perfringens, the "cafeteria germ"

Salmonella spp. – its S. typhimurium infection is caused by consumption of eggs or poultry that are not adequately cooked or by other

interactive humananimal pathogens

Escherichia coli O157:H7 enterohemorrhagic which can cause hemolyticuremic syndrome

Other common bacterial foodborne pathogens are:

Bacillus cereus

Escherichia coli, other virulence properties, such as enteroinvasive, enteropathogenic, enterotoxigenic, enteroaggregative

Listeria monocytogenes

Shigella spp.

Staphylococcus aureus

Staphylococcal enteritis

Streptococcus

Vibrio cholerae, including O1 and nonO1

Vibrio parahaemolyticus

Vibrio vulnificus

Yersinia enterocolitica and Yersinia pseudotuberculosis

Less common bacterial agents:

Brucella spp.

Corynebacterium ulcerans

Coxiella burnetii or Q fever

Plesiomonas shigelloides

Enterotoxins

In addition to disease caused by direct bacterial infection, some foodborne illnesses are caused by enterotoxins . Enterotoxins can

produce illness even when the microbes that produced them have been killed. Symptom appearance varies with the toxin but may be

rapid in onset, as in the case of enterotoxins of Staphylococcus aureus in which symptoms appear in one to six hours. This causes

intense vomiting including or not including diarrhea, and staphylococcal enterotoxins are the most commonly reported enterotoxins

although cases of poisoning are likely underestimated. It occurs mainly in cooked and processed foods due to competition with other

biota in raw foods, and humans are the main cause of contamination as a substantial percentage of humans are persistent carriers of S.

aureus.

Clostridium botulinum

Clostridium perfringens

Bacillus cereus

The rare but potentially deadly disease botulism occurs when the anaerobic bacterium Clostridium botulinum grows in improperly

canned lowacid foods and produces botulin, a powerful paralytic toxin.

Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some other bacteria, produce the lethal tetrodotoxin,

which is present in the tissues of some living animal species rather than being a product of decomposition.

Emerging foodborne pathogens

Many foodborne illnesses remain poorly understood.

Aeromonas hydrophila, Aeromonas caviae, Aeromonas sobria

Preventing bacterial food poisoning

Prevention is mainly the role of the state, through the definition of strict rules of hygiene and a public services of veterinary surveying

of animal products in the food chain, from farming to the transformation industry and delivery . This regulation includes:

traceability: in a final product, it must be possible to know the origin of the ingredients and where and when it was processed; the

origin of the illness can thus be tracked and solved, and the final products can be removed from the sale if a problem is detected;

enforcement of hygiene procedures such as HACCP and the "cold chain";

power of control and of law enforcement of veterinarians.

In August 2006, the United States Food and Drug Administration approved Phage therapy which involves spraying meat with viruses

that infect bacteria, and thus preventing infection. This has raised concerns, because without mandatory labelling consumers would not

be aware that meat and poultry products have been treated with the spray.

At home, prevention mainly consists of good food safety practices. Many forms of bacterial poisoning can be prevented by cooking it

sufficiently, and either eating it quickly or refrigerating it effectively. preventing crosscontamination, proper storage, and maintaining

cooking temperatures. In general, freezing or refrigerating prevents virtually all bacteria from growing, and heating food sufficiently

kills parasites, viruses, and most bacteria. Bacteria grow most rapidly at the range of temperatures between, called the "danger zone".

Storing food below or above the "danger zone" can effectively limit the production of toxins. For storing leftovers, the food must be

put in shallow containers

for quick cooling and must be refrigerated within two hours. When food is reheated, it must reach an internal temperature of or until

hot or steaming to kill bacteria.

Mycotoxins and alimentary mycotoxicoses

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins through food consumption. Mycotoxins

sometimes have important effects on human and animal health. For example, an outbreak which occurred in the UK in 1960 caused

the death of 100,000 turkeys which had consumed aflatoxincontaminated peanut meal. In the USSR in World War II, 5,000 people

died due to Alimentary Toxic Aleukia . The common foodborne Mycotoxins include:

Aflatoxins – originated from Aspergillus parasiticus and Aspergillus flavus. They are frequently found in tree nuts, peanuts, maize,

sorghum and other oilseeds, including corn and cottonseeds. The pronounced forms of Aflatoxins are those of B1, B2, G1, and G2,

amongst which Aflatoxin B1 predominantly targets the liver, which will result in necrosis, cirrhosis, and carcinoma. In the US, the

acceptable level of total aflatoxins in foods is less than 20 μg/kg, except for Aflatoxin M1 in milk, which should be less than 0.5

μg/kg. The official document can be found at FDA's website.

Altertoxins – are those of Alternariol, Alternariol methyl ether, Altenuene, Altertoxin1, Tenuazonic acid and Radicinin, originated

from Alternaria spp. Some of the toxins can be present in sorghum, ragi, wheat and tomatoes. Some research has shown that the

toxins can be easily crosscontaminated between grain commodities, suggesting that manufacturing and storage of grain commodities

is a critical practice.

Citrinin

Citreoviridin

Cyclopiazonic acid

Cytochalasins

Ergot alkaloids / Ergopeptine alkaloids – Ergotamine

Fumonisins – Crop corn can be easily contaminated by the fungi Fusarium moniliforme, and its Fumonisin B1 will cause

Leukoencephalomalacia in horses, Pulmonary edema syndrome in pigs, liver cancer in rats and Esophageal cancer in humans. For

human and animal health, both the FDA and the EC have regulated the content levels of toxins in food and animal feed.

Fusaric acid

Fusarochromanone

Kojic acid

Lolitrem alkaloids

Moniliformin

3Nitropropionic acid

Nivalenol

Ochratoxins – In Australia, The Limit of Reporting level for Ochratoxin A analyses in 20th Australian Total Diet Survey was 1

µg/kg, whereas the EC restricts the content of OTA to 5 µg/kg in cereal commodities, 3 µg/kg in processed products and 10 µg/kg in

dried vine fruits.

Oosporeine

Patulin – Currently, this toxin has been advisably regulated on fruit products. The EC and the FDA have limited it to under 50 µg/kg

for fruit juice and fruit nectar, while limits of 25 µg/kg for solidcontained fruit products and 10 µg/kg for baby foods were specified

by the EC.

Phomopsins

Sporidesmin A

Sterigmatocystin

Tremorgenic mycotoxins – Five of them have been reported to be associated with molds found in fermented meats. These are

Fumitremorgen B, Paxilline, Penitrem A, Verrucosidin, and Verruculogen.

Trichothecenes – sourced from Cephalosporium, Fusarium, Myrothecium, Stachybotrys and Trichoderma. The toxins are usually

found in molded maize, wheat, corn, peanuts and rice, or animal feed of hay and straw. Four trichothecenes, T2 toxin, HT2 toxin,

diacetoxyscirpenol and deoxynivalenol have been most commonly encountered by humans and animals. The consequences of oral

intake of, or dermal exposure to, the toxins will result in Alimentary toxic aleukia, neutropenia, aplastic anemia, thrombocytopenia

and/or skin irritation. In 1993, the FDA issued a document for the content limits of DON in food and animal feed at an advisory level.

In 2003, US published a patent that is very promising for farmers to produce a trichotheceneresistant crop.

Zearalenone

Viruses

Viral infections make up perhaps one third of cases of food poisoning in developed countries. In the US, more than 50% of cases are

viral and noroviruses are the most common foodborne illness, causing 57% of outbreaks in 2004. Foodborne viral infection are

usually of intermediate incubation period, causing illnesses which are selflimited in otherwise healthy individuals; they are similar to

the bacterial forms described above.

Enterovirus

Hepatitis A is distinguished from other viral causes by its prolonged incubation period and its ability to spread beyond the stomach

and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The

virus has been found to cause infection due to the consumption of freshcut produce which has fecal contamination.

Hepatitis E

Norovirus

Rotavirus

Parasites

Most foodborne parasites are zoonoses.

Platyhelminthes:

Diphyllobothrium sp.

Nanophyetus sp.

Taenia saginata

Taenia solium

Fasciola hepatica

Nematode:

Anisakis sp.

Ascaris lumbricoides

Eustrongylides sp.

Trichinella spiralis

Trichuris trichiura

Protozoa:

Acanthamoeba and other freeliving amoebae

Cryptosporidium parvum

Cyclospora cayetanensis

Entamoeba histolytica

Giardia lamblia

Sarcocystis hominis

Sarcocystis suihominis

Toxoplasma gondii

Natural toxins

Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants in particular may be toxic; animals

which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only

passive defenses such as poisons and distasteful substances, for example capsaicin in chili peppers and pungent sulfur compounds in

garlic and onions. Most animal poisons are not synthesised by the animal, but acquired by eating poisonous plants to which the animal

is immune, or by bacterial action.

Alkaloids

Ciguatera poisoning

Grayanotoxin

Mushroom toxins

Phytohaemagglutinin

Pyrrolizidine alkaloids

Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish

poisoning and ciguatera fish poisoning

Scombrotoxin

Tetrodotoxin

Some plants contain substances which are toxic in large doses, but have therapeutic properties in appropriate dosages.

Foxglove contains cardiac glycosides.

Poisonous hemlock has medicinal uses.

Other pathogenic agents

Prions, resulting in Creutzfeldt–Jakob disease

"Ptomaine poisoning"

In 1883, the Italian professor Salmi, of Bologna, introduced the generic name '' for alkaloids found in decaying animal and vegetable

matter, especially putrescine and cadaverine. The 1892 Merck's Bulletin stated, "We name such products of bacterial origin

ptomaines; and the special alkaloid produced by the comma bacillus is variously named Cadaverine, Putrescine, etc." While The

Lancet stated, "The chemical ferments produced in the system, the...ptomaines which may exercise so disastrous an influence." It is

now known that the "disastrous...influence" is due to the direct action of bacteria and only slightly to the alkaloids. Thus, the use of

the phrase "ptomaine poisoning" is now obsolete.

Tainted potato salad sickening hundreds at a Communist political convention in Massillon, Ohio, and aboard a Washington DC cruise

boat in separate incidents during a single week in 1932 drew national attention to the dangers of socalled "ptomaine poisoning" in the

pages of the American news weekly, Time.

Another newspaper article from 1944 told of more than 150 persons being hospitalized in Chicago with ptomaine poisoning

apparently from rice pudding served by a chain of restaurants.

Mechanism

Incubation period

The delay between consumption of a contaminated food and appearance of the first symptoms of illness is called the incubation

period. This ranges from hours to days, depending on the agent, and on how much was consumed. If symptoms occur within one to

six hours after eating the food, it suggests that it is caused by a bacterial toxin or a chemical rather than live bacteria.

The long incubation period of many foodborne illnesses tends to cause sufferers to attribute their symptoms to gastroenteritis.

During the incubation period, microbes pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and

begin to multiply there. Some types of microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream, and

some can directly invade the deeper body tissues. The symptoms produced depend on the type of microbe.

Infectious dose

The infectious dose is the amount of agent that must be consumed to give rise to symptoms of foodborne illness, and varies according

to the agent and the consumer's age and overall health. Pathogens vary in minimum infectious dose; for example, Shigella sonnei has a

low estimated minimum dose of Staphylococcus aureus has a relatively high estimate.

In the case of Salmonella a relatively large inoculum of 1 million to 1 billion organisms is necessary to produce symptoms in healthy

human volunteers, as Salmonellae are very sensitive to acid. An unusually high stomach pH level greatly reduces the number of

bacteria required to cause symptoms by a factor of between 10 and 100.

Epidemiology

Asymptomatic subclinical infection may help spread these diseases, particularly Staphylococcus aureus, Campylobacter, Salmonella,

Shigella, V. cholerae, and Yersini. with 9.4 million of these caused by 31 known identified pathogens.

127,839 were hospitalized .

3,037 people died .

! !! Cause !! Annual hospitalizations !! Rate

1 Salmonella ~8,000 cases align "center" 13

2 Campylobacter ~3,000 cases align "center" 4.8

3 Parasitesincl. Toxoplasma ~500 cases~400 cases align "center" 0.80.65

4 Listeria ~300 cases align "center" 0.5

5 Hepatitis A ~60 cases align "center" 0.1

Outbreaks

The vast majority of reported cases of foodborne illness occur as individual or sporadic cases. The origin of most sporadic cases is

undetermined. In the United States, where people eat outside the home frequently, 58% of cases originate from commercial food

facilities . An outbreak is defined as occurring when two or more people experience similar illness after consuming food from a

common source.

Often, a combination of events contributes to an outbreak, for example, food might be left at room temperature for many hours,

allowing bacteria to multiply which is compounded by inadequate cooking which results in a failure to kill the dangerously elevated

bacterial levels.

Outbreaks are usually identified when those affected know each other. However, more and more, outbreaks are identified by public

health staff from unexpected increases in laboratory results for certain strains of bacteria. Outbreak detection and investigation in the

United States is primarily handled by local health jurisdictions and is inconsistent from district to district. It is estimated that 1–2% of

outbreaks are detected.

Society and culture

United Kingdom

In postwar Aberdeen a largescale outbreak of typhoid occurred, caused by contaminated corned beef which had been imported from

Argentina. The corned beef was placed in cans and because the cooling plant had failed, cold river water from the Plate estuary was

used to cool the cans. One of the cans had a defect and the meat inside was contaminated. This meat was then sliced using a meat

slicer in a shop in Aberdeen, and a lack of cleaning the machinery led to spreading the contamination to other meats cut in the slicer.

These meats were then eaten by the people of Aberdeen who then became ill.

Serious outbreaks of foodborne illness since the 1970s prompted key changes in UK food safety law. These included the death of 19

patients in the Stanley Royd Hospital outbreak and the bovine spongiform encephalopathy outbreak identified in the 1980s. The death

of 21 people in the 1996 Wishaw outbreak of E. coli O157 was a precursor to the establishment of the Food Standards Agency which,

according to Tony Blair in the 1998 white paper A Force for Change Cm 3830, "would be powerful, open and dedicated to the

interests of consumers".

In May 2015, for the second year running, England’s Food Standards Agency devoted its annual Food Safety Week to – “The Chicken

Challenge”. The focus was on the handling of raw chicken in the home and in catering facilities in a drive to reduce the worryingly

high levels of food poisoning from the campylobacter bacterium. Anne Hardy argues that widespread public education of food

hygiene can be useful, particularly through media and advertisement. She points to the examples set by Scandinavian societies.

United States

In 2001, the Center for Science in the Public Interest petitioned the United States Department of Agriculture to require meat packers

to remove spinal cords before processing cattle carcasses for human consumption, a measure designed to lessen the risk of infection by

variant Creutzfeldt–Jakob disease. The petition was supported by the American Public Health Association, the Consumer Federation of

America, the Government Accountability Project, the National Consumers League, and Safe Tables Our Priority. This was opposed by

the National Cattlemen's Beef Association, the National Renderers Association, the National Meat Association, the Pork Producers

Council, sheep raisers, milk producers, the Turkey Federation, and eight other organizations from the animalderived food industry.

None of the US Department of Health and Human Services targets regarding incidence of foodborne infections were reached in 2007.

Organizations

The World Health Organization Department of Food Safety and Zoonoses provides scientific advice for organizations and the public

on issues concerning the safety of food. Its mission is to lower the burden of foodborne disease, thereby strengthening the health

security and sustainable development of Member States. Foodborne and waterborne diarrhoeal diseases kill an estimated 2.2 million

people annually, most of whom are children. WHO works closely with the Food and Agriculture Organization of the United Nations

to address food safety issues along the entire food production chain—from production to consumption—using new methods of risk

analysis. These methods provide efficient, sciencebased tools to improve food safety, thereby benefiting both public health and

economic development.

International Food Safety Authorities Network

The International Food Safety Authorities Network is a joint program of the WHO and FAO. INFOSAN has been connecting

national authorities from around the globe since 2004, with the goal of preventing the international spread of contaminated food and

foodborne disease and strengthening food safety systems globally. This is done by:

# Promoting the rapid exchange of information during food safety events;

# Sharing information on important food safety issues of global interest;

# Promoting partnership and collaboration between countries; and

# Helping countries strengthen their capacity to manage food safety risks.

Membership to INFOSAN is voluntary, but is restricted to representatives from national and regional government authorities and

requires an official letter of designation. INFOSAN seeks to reflect the multidisciplinary nature of food safety and promote

intersectoral collaboration by requesting the designation of Focal Points in each of the respective national authorities with a stake in

food safety, and a single Emergency Contact Point in the national authority with the responsibility for coordinating national food

safety emergencies; countries choosing to be members of INFOSAN are committed to sharing information between their respective

food safety authorities and other INFOSAN members. The operational definition of a food safety authority includes those authorities

involved in: food policy; risk assessment; food control and management; food inspection services; foodborne disease surveillance and

response; laboratory services for monitoring and surveillance of foods and foodborne diseases; and food safety information, education

and communication across the farmtotable continuum.

Regulatory steps

Food may be contaminated during all stages of food production and retailing. In order to prevent viral contamination, regulatory

authorities in Europe have enacted several measures:

European Commission Regulation No 2073/2005 of November 15, 2005

European Committee for Standardization : Standard method for the detection of norovirus and hepatitis A virus in food products

CODEX Committee on Food Hygiene : Guideline for the application of general principles of food hygiene for the control of viruses

in food

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