food-borne disease: a thanksgiving special · 2018. 11. 1. · food-borne disease: a thanksgiving...

Food-Borne Disease:

A Thanksgiving Special

Thanksgiving 2018

Ted Cieslak MD MPH

University of Nebraska

College of Public Health

Select SLIDE MASTER to Insert Briefing Title Here

1-Nov-18Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address

The Menu

• Appetizers• For the Kids• Salads• Entree

– Turkey

• Sides– Stuffing

– Gravy

– Vegetables

– Cranberries

• Beverages• Desserts• Leftovers



Appetizers (Eggs): Salmonella

• The Salmonellae– S. typhi

– S. paratyphi

– S. enteriditis

• ~2400 serovars

• ~1,000,000 cases/yr in USA• ~5% develop bacteremia

– Neonates

– Persons >50 yo

– Immunosuppressed

– Valvular abnormalities & grafts

• Increasing resistance to antimicrobials

Found only

In humans

Found in

many species



Appetizers (Ahi Poke): Also Salmonella

Top News

Health Department pulls products tied

to salmonella from seaweed farm

http://www.staradvertiser.com/category/breaking-news/



Appetizers (Oysters): Vibrio

• Vibrios– V. cholera

• V. cholera O1 (Ganges Delta)

• V. cholera O139 (New World)

– Halophilic vibrios

• V. vulnificus

• V. parahemolyticus

Increase in Vibrio parahaemolyticus

illnesses associated with consumption of

shellfish from several Atlantic coast harvest

areas, United States, 2013



Appetizers (Chitterlings): Yersinia

• Chittlins’ are pig intestines• Chittlins’ are often served raw• Raw intestines contain feces• Feces is a good source of:

– Protein

– ID Consults

• Pigs are reservoir of Yersinia

• The Yersiniae– Y. pestis (Plague)

– Y. pseudotuberculosis

– Y. enterocolitica



Appetizers (Cheese Tray): Listeria

• For those who don’t care for Listeria:– Salmonella

– Campylobacter

– Brucellosis

• Especially in Texas:– we have a lot of goats

– Quesa fresca is goat cheese

– Quesa fresca is “fresh” (i.e. unpasteurized)



For the Kids (Hot Dogs): More Listeria

• Listeria monocytogenes– Grows at refrigerator temperature (40oF)

– Found in:

• Hot dogs

• Deli meat

• Soft cheeses

• Ice Cream

– High-risk groups:

• Pregnant women

• Neonates

• Elderly

• Immunocompromised



Also for the Kids (Burgers): E. coli O157:H7

• E. coli– Commensals

– ETEC

– EAEC

– EIEC

– EHEC

• Includes O157:H7, O26:H11

• Shiga toxin-producing

• Found in intestines of cattle (& goats)

• Not found in muscle (steaks & roasts pose no risk)

• Causes Hemolytic-Uremic Syndrome



Steak Tartare: Do as I Say…..

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj4wsbisqLTAhWE2YMKHfDcAOEQjRwIBw&url=http://www.sergetheconcierge.com/2012/05/raw-pleasures-beef-sirloin-tartare-with-quail-eggs-from-mansion-on-turtle-creek-cookbook.html&bvm=bv.152180690,d.amc&psig=AFQjCNEPcZm1sxzx7gr3ZZI_lst05ljUxA&ust=1492205925265057



Salads: Hepatitis A

• Additional Salad Bar Items:– Salmonella

– Shigella

– E. coli

– Cyclospora

– Noroviruses

• Extensively-handled foods• Wash it, Boil it, Peel it, or…..• Forget it• Salad items difficult to wash• Boiled salad is unpopular



Job Security for Peds ID Docs

Day Care Centers

Petting Zoos

Salad Bars



Morbidity & Mortality: Implicated Foods

Conclusion– salad is a great way to get sick, but if it’s mortality you’re looking

for, you need to move on to the Main Course…….



Entrée (Turkey): Campylobacter

• For those on a Campylobacter-free diet:– Salmonella

– S. aureus

– C. perfringens

• Most common confirmed agent– ~1,000,000 cases/year in USA

– Although Norovirus is likely far more common



Side Dishes (Stuffing): Bacillus cereus

• Cereus– Latin: ‘waxy’

– Ceres (God of Agriculture)

• Two Toxins– Emetic (ST)

– Diarrheal (LT)

• Fried Rice Syndrome– allow rice to stand out

– this avoids clumping

– fry it the next day



Side Dishes (Gravy): C. perfringens

• Risk factors– Prepared in quantity

– Kept warm (but not hot)

• For long periods of time

• Clostridial Diseases– 1. Soft Tissue (Gangrene)

• C. perfringens

– 2. Enteric

• C. perfringens

• C. difficile

– 3. Neurologic

• C. tetani

• C. botulinum



Vegetables (Green Beans): Botulism

• Aunt Stella cans beans• Aunt Stella doesn’t wash• But she does use good anaerobic technique• Beans sit in cellar for months• Opened at Thanksgiving• Heated thoroughly• Heat kills C. botulinum• Heat doesn’t inactivate toxin• You eat beans• You get Botulism



Cranberries: Cyclospora?



Beverages (Eggnog): More Salmonella

CDC estimates Salmonella causes

about 1.2 million illnesses, 23,000

hospitalizations, and 450 deaths in the

United States every year. Food is the

source for about 1 million of these

illnesses.

•Most persons infected with Salmonella

develop diarrhea, fever, and abdominal

cramps 12 to 72 hours after infection.

The illness usually lasts 4 to 7 days, and

most persons recover without treatment.

•However, in some persons, the

diarrhea may be so severe that the

patient needs to be hospitalized.



On the Other Hand



Dessert (Pumpkin Pie):Bringing it all Together

• Eggs– Salmonella

• Milk– Salmonella

– Campylobacter

– Yersinia

– E coli O157

• Nutmeg– Myristicin

• Cooling– Staph aureus



I Couldn’t Eat Another Bite



Sure You Could!

Leftovers: Staph aureus

• Turkey properly cooked• Everyone enjoys turkey• Turkey sits out all day• Everyone watches Lions lose• Cousin Eddy picks his nose• Cousin Eddy has Staph• Cousin Eddy picks at turkey• Turkey inoculated• You pick at turkey• You get Staph



Leaving the Cooking to Someone Else:

Norovirus



31 Major Foodborne Pathogens

Pathogens

Norovirus

Salmonella

C. perfringens

Campylobacter

S. aureus

Shigella

STEC (non-O157)

all others

Estimated Annual US Cases = 9,388,075



CDC’s Progress Report



Major Food-Borne Illness Syndromes

• Nausea & Vomiting within 1-6 hours– Staphylococcus aureus, Bacillus cereus

• Cramps & Diarrhea within 8-16 hours– Clostridium perfringens, Bacillus cereus

• Fever, Cramps, and Diarrhea within 16-48 hours– Salmonella, Shigella, Campylobacter, E. coli

• Cramps & Watery Diarrhea within 16-72 hours– Vibrio

• Vomiting & Non-Bloody Diarrhea within 24-48 hours– Noroviruses

• Fever & Abdominal Cramps without Diarrhea– Yersinia

• Bloody Diarrhea without Fever– E. coli O157

• Nausea, Vomiting, Diarrhea, and Paralysis– Clostridium botulinum (Botulism), Camplyobacter (Guillain-Barre)

Toxin-mediated:

rapid onset

abrupt onset

absence of fever

Bacterial & Viral:

subacute

often have fever

Special Cases



Miscellaneous Syndromes

• Cramps within an hour– Heavy Metals

• Paraesthesias within an hour– Scombroid, PSP, NSP, Niacin, MSG?

• Paraesthesias within 1-6 hours– Ciguatera, PSP

• Mushroom Poisoning Syndromes– Amanita spp.

• Persistent Diarrhea– Cyclospora

• Systemic Invasive Illness– Listeria, Vibrio vulnificus, Toxoplasma

• Water-borne (rather than food-borne) pathogens– Giardia, Cryptosporidium

I WILL SURVIVE(with apologies to Gloria Gaynor)

I’d listen to the news

And I’d be petrified

Another foodborne outbreak,

I’d be all torn up inside

But then I spent so many nights

Worried about what I just ate

Could I be next?

Did I have poisons on my plate?

31

“Key recommendations”

for food safety

The 2005 USDA Dietary

Guidelines give five

“Key Recommendations”

for food safety.

Source: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm

http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm

Clean hands,

food-contact

surfaces, fruits

and vegetables.

Recommendation 1: CLEAN

Do NOT wash or rinse meat and poultry as

this could spread bacteria to other foods.

Avoid washing raw meat & poultry

Do NOT wash raw meat and

poultry. Washing is not necessary.

Washing increases the danger of

cross-contamination, spreading

bacteria present on the surface of

meat and poultry to ready-to-eat

foods, kitchen utensils, and

counter surfaces.

Recommendation 2: SEPARATE

Separate raw,

cooked, and

ready-to-eat foods

while shopping,

preparing or

storing foods.

Recommendation 3: COOK

Cook foods to a safe

temperature to kill

microorganisms.



Temperature Rules



Turkey

Thermy™ says: A turkey is done when the

temperature in the inner thigh reaches 180 degrees F.

Recommendation 4: CHILL

Chill (refrigerate)

perishable foods

promptly and

defrost foods

properly.

39

DANGER

ZONEBacteria multiply rapidly

between

40 and 140 degrees F.

The TWO-hour rule

Refrigerate perishable foods so

TOTAL time at room temperature

is less than TWO hours or

only ONE hour when temperature

is above 90 degrees F.

Perishable foods include:

• Meat, poultry, fish, eggs, tofu

• Dairy products

• Pasta, rice, cooked vegetables

• Fresh, peeled/cut fruits and

vegetables

The THAW LAW

• Plan ahead to defrost foods.

• The best way to thaw

perishable foods is in the

refrigerator.

Recommendation 5: AVOID...

• Raw (unpasteurized) milk or milk products

• Raw or partially cooked eggs and foods containing raw eggs

• Raw and undercooked meat and poultry

• Unpasteurized juices

• Raw sprouts

Most at risk are infants, young children,

pregnant women, older adults and the

immunocompromised.



Things Could Always Be Worse:Thanksgiving in Congo



Happy Thanksgiving

food-borne disease: a thanksgiving special · 2018. 11. 1. · food-borne disease: a thanksgiving...

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