Foodborne illness (Food poisoning)

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning)[1] is any illness resulting from the consumption of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food,[2] as well as chemical or natural toxins such as poisonous mushrooms.

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 hand-washing 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. For foodborne illness caused by chemicals, see Food contaminants. Foodborne illness can also be caused by pesticides or medicines in food and naturally toxic substances such as poisonous mushrooms or reef fish.

Cause

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%.[3] 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.

Cause-Bacteria

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. Usually the symptoms are seen the day after the food has been ingested and digested completely. However if the intoxication involves preformed toxins as is the case with Staphylococcal food poisoning, the symptoms appear within a few hours.

Symptom onset time

Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome and periodontitis[4] Clostridium perfringens, the "cafeteria germ"[5] Salmonella spp. – its S. typhimurium infection is caused by consumption of eggs or poultry that are not adequately cooked or by other interactive human-animal pathogens[6][7][8] Salmonella Escherichia coli O157:H7 enterohemorrhagic (EHEC) which can cause hemolytic-uremic syndrome

Most common bacterial foodborne pathogens are:

Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome and periodontitis[4] Clostridium perfringens, the "cafeteria germ"[5] Salmonella spp. – its S. typhimurium infection is caused by consumption of eggs or poultry that are not adequately cooked or by other interactive human-animal pathogens[6][7][8] Salmonella Escherichia coli O157:H7 enterohemorrhagic (EHEC) which can cause hemolytic-uremic syndrome

Most common bacterial foodborne pathogens are:

Bacillus cereus Escherichia coli, other virulence properties, such as enteroinvasive (EIEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroaggregative (EAEC or EAgEC) Listeria monocytogenes Shigella spp. Staphylococcus aureus Staphylococcal enteritis Streptococcus Vibrio cholerae, including O1 and non-O1 Vibrio parahaemolyticus Vibrio vulnificus Yersinia enterocolitica and Yersinia pseudotuberculosis

Other common bacterial foodborne pathogens are:

식중독 세균과 바이러스 차이

식중독의 특징

• 잠복기가 짧다. • Ab 형성하지 못한다. • 여름에 많다. • 집단으로 발생한다. • 음식물에서 충분히 증식한 후 감염된다.

Salmonelosis

• S. enteritidis, S. typhimurium, S. newport • I.P : 6~48hr (평균 12~14hr) • Sx : 복통, 설사, 구토, 발열 • 발생시기 : 5~10월 • 원인 : 감염된 동물의 고기, 난류, 우유/보균자/보균동물, 조리용 칼과 주방기구, 새 파충류 등의 애완동물

• 예방 : 생식을 금함, 식품을 차게 보관, 곤충, 쥐의 접근차단, 부정 육류 사용금지

Enteritis Vibrio

• ① Vibrio Parahemolyticus • ② I.P : 4~28hr (평균 10~18hr) • ③ Sx : 심한 상복통, 물과 같은 설사, 오심, 구토, 발열, 오한 -> 2~3일 내에 자연회복

• ④ 발생시기 : 5~11월(7~9월), 온대지방의 연안 해수에 존재

• ⑤ 원인 : 어패류, 바다에서의 창상 감염 • ⑥ 호발연령 : 15세 이상, 남>여(3:1) • ⑦ 예방 : 어패류의 생식시 정수로 세척, 60℃에서 2분간 가열

Staphylococcal FP

• Staphylococcus aureus의 enterotoxin • I.P : 2~6hr (평균 1~3hr) • Sx : 심한 오심, 구토, 복통, 설사, 발열과 오한은 거의 없음

• 3~4시간 지속 -> 2~3일 내에 자연회복 • 발생시기 : 5~11월(7~9월) • 원인 : 수지, 인후부의 화농성 질환자, 가공식품, 오염된 우유(유방염 젖소)

• 예방 : 수지, 인후의 화농성 질환자 조리금지, 음식을 차게 보관

Shigellosis

Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a foodborne illness caused by infection by bacteria of the genus Shigella. Shigellosis rarely occurs in animals other than humans and other primates like monkeys and chimpanzees.[1] The causative organism is frequently found in water polluted with human feces, and is transmitted via the fecal-oral route. The usual mode of transmission is directly person-to-person hand-to-mouth, in the setting of poor hygiene among children.[1]

Shigellosis

• Serogroup A : Shigella dysenteriae most severe infection • Serogroup B : Shigella flexneri common in developing contries • Serogroup C : Shigella boydii not commonly isolated • Serogroup D : Shigella sonei common in developing countries

Shigella flexneri

2. Infection process

3. Epidemiology

• Humans are only reservior • Person to person spread by fecal-oral route

(4Fs : Fingers, Flies, Food, Feces) • Patients ar highest risk : Young child in

daycare centers, nurseries, custodial institutions and male homosexuals

(우리나라에서는 대부분이 단체급식 관련) • Very low ID50 : Higly infectious

4. Clinical disease

• No chronic carriers • Watery diarrhea at first and then bloody or

mucus diarrhea (우리나라에서는 90% 이상이 S.sonnei)

5. Diagnosis

• 대변가검물을 3일 연속 배양 • Methlene blue 염색으로 백혈구 관찰 (Shigella, Salmonella, Campylobacter) • 혈청학적 동정으로 균종을 확정

In addition to disease caused by direct bacterial infection, some foodborne illnesses are caused by a enterotoxins (an exotoxin targeting the intestines). Enterotoxins can produce illness even when the microbes that produced them have been killed. Symptom appearance varies with the toxin but may be rapid on-set, as in the case of enterotoxins of Staphylococcus aureus in which symptoms appear in 1–6 hours.[9] This causes intense vomiting including or not including diarrhea (resulting in staphylococcal enteritis), and staphylococcal enterotoxins (most commonly Staphylococcal Enterotoxin A but also including Staphylococcal Enterotoxin B) are the most commonly reported enterotoxins although cases of poisoning are likely underestimated.[10]

Enterotoxin

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.[10] The CDC has estimated about 240,000 cases per year in the United States.[11]

Enterotoxin

Clostridium botulinum Clostridium perfringens Bacillus cereus The rare but potentially deadly disease botulism occurs when the anaerobic bacterium Clostridium botulinum grows in improperly canned low-acid 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.

Enterotoxin

Proper storage and refrigeration of food help in the prevention of 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 (shops and restaurants).

Preventing bacterial food poisoning[edit]

This regulation includes: traceability: in a final product, it must be possible to know the origin of the ingredients (originating farm, identification of the harvesting or of the animal) and where and when it was processed; the origin of the illness can thus be tracked and solved (and possibly penalized), 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.

Preventing bacterial food poisoning[edit]

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.[12

Preventing bacterial food poisoning[edit]

Phage therapy

Phage therapy is the therapeutic use of bacteriophages to treat pathogenic bacterial infections.[1] Although extensively used and developed mainly in former Soviet Union countries circa 1920, the treatment is not approved in countries other than Russia and Georgia. Phage therapy has many potential applications in human medicine as well as dentistry, veterinary science, and agriculture.[

Phage therapy

Bacteriophages are much more specific than antibiotics, so they can hypothetically be chosen to be indirectly harmless not only to the host organism (human, animal, or plant), but also to other beneficial bacteria, such as gut flora, reducing the chances of opportunistic infections.[3] They would have a high therapeutic index, that is, phage therapy would be expected to give rise to few side effects. Because phages replicate in vivo, a smaller effective dose can be used.

Phage therapy

Safety[edit] Approval of phage therapy for use in humans has not been given in Western countries. Much of the problem is how to prove safety when using a self-replicating entity which has the capability to evolve.[16]

Phage therapy

Potential benefits[edit] Bacteriophage treatment offers a possible alternative to conventional antibiotic treatments for bacterial infection.[24] Bacteriophages are very specific, targeting only one or a few strains of bacteria.[26] The specificity of bacteriophages might reduce the chance that useful bacteria are killed when fighting an infection. Some evidence shows the ability of phages to travel to a required site—including the brain, where the blood brain barrier can be crossed—and multiply in the presence of an appropriate bacterial host, to combat infections such as meningitis.

Phage therapy

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins (The term 'mycotoxin' is usually reserved for the toxic chemical products produced by fungi that readily colonize crops) 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 aflatoxin-contaminated peanut meal.

Mycotoxins and alimentary mycotoxicoses

Altertoxins Citrinin Citreoviridin Cyclopiazonic acid Cytochalasins Ergot alkaloids / Ergopeptine alkaloids Fumonisins –] Fusaric acid Fusarochromanone Kojic acid Lolitrem alkaloids Moniliformin 3-Nitropropionic acid

Mycotoxins and alimentary mycotoxicoses

Nivalenol Ochratoxins Oosporeine Patulin Phomopsins Sporidesmin A Sterigmatocystin Tremorgenic mycotoxins Trichothecenes Zearalenone Zearalenols

쉽시다?

Viruses[edit] 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 (1–3 days) incubation period, causing illnesses which are self-limited in otherwise healthy individuals; they are similar to the bacterial forms described above.

Norovirus Norovirus is a genus of genetically diverse single-stranded RNA, non-enveloped viruses in the Caliciviridae family.[1] The known viruses in the genus are all considered to be the strains of a single species called Norwalk virus. The viruses are transmitted by fecally contaminated food or water; by person-to-person contact;[2] and via aerosolization of the virus and subsequent contamination of surfaces.[3]

Transmission electron micrograph of Norwalk virus. The white bar

= 50 nm

Norovirus Noroviruses are the most common cause of viral gastroenteritis in humans, and affect people of all ages.[4] Norovirus infection is characterized by nausea, forceful vomiting, watery diarrhea, and abdominal pain, and in some cases, loss of taste. General lethargy, weakness, muscle aches, headache, coughs, and low-grade fever may occur. The disease is usually self-limiting, and severe illness is rare. The virus affects around 267 million people and causes over 200,000 deaths each year; these deaths are usually in less developed countries and in the very young, elderly and immuno-suppressed.[5]

Rotavirus is the most common cause of severe diarrhoea among infants and young children.[1] It is a genus of double-stranded RNA virus in the family Reoviridae. Nearly every child in the world has been infected with rotavirus at least once by the age of five.[2] Immunity develops with each infection, so subsequent infections are less severe; adults are rarely affected.[3] There are five species of this virus, referred to as A, B, C, D, and E. Rotavirus A, the most common species, causes more than 90% of infections in humans.

Rotavirus

The virus is transmitted by the faecal-oral route. It infects and damages the cells that line the small intestine and causes gastroenteritis (which is often called "stomach flu" despite having no relation to influenza). Although rotavirus was discovered in 1973[4] and accounts for up to 50% of hospitalisations for severe diarrhoea in infants and children,[5] its importance is still not widely known within the public health community, particularly in developing countries.[6] In addition to its impact on human health, rotavirus also infects animals, and is a pathogen of livestock.[7]

Rotavirus

Protozoa: Acanthamoeba and other free-living amoebae Cryptosporidium parvum Cyclospora cayetanensis Entamoeba histolytica Giardia lamblia Sarcocystis hominis Sarcocystis suihominis Toxoplasma gondii

Parasites[edit] Most foodborne parasites are zoonoses. Platyhelminthes:

Diphyllobothrium sp. Nanophyetus sp. Taenia saginata Taenia solium Fasciola hepatica

See also: Tapeworm and Flatworm Nematode:

Anisakis sp. Ascaris lumbricoides Eustrongylides sp. Trichinella spiralis Trichuris trichiura

Natural toxins[edit] 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.

Natural toxins[edit] Alkaloids Ciguatera poisoning Grayanotoxin (honey intoxication) Mushroom toxins Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling) Pyrrolizidine alkaloids Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning and ciguatera fish poisoning Scombrotoxin Tetrodotoxin (fugu fish poisoning)

Incubation period[edit] 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 (and rarely months or even years, such as in the case of Listeriosis or Creutzfeldt–Jakob disease), depending on the agent, and on how much was consumed. If symptoms occur within 1–6 hours after eating the food, it suggests that it is caused by a bacterial toxin or a chemical rather than live bacteria.

Incubation period[edit] The long incubation period of many foodborne illnesses tends to cause sufferers to attribute their symptoms to stomach flu. 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.[41]

Infectious dose[edit] 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. 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 [1], as Salmonellae are very sensitive to acid. An unusually high stomach pH level (low acidity) greatly reduces the number of bacteria required to cause symptoms by a factor of between 10 and 100.

List of foodborne illness outbreaks by death toll

List of foodborne illness outbreaks by death toll

2011 United States listeriosis outbreak

The 2011 United States listeriosis outbreak was a widespread outbreak of Listeria monocytogenes food poisoning across 28 US states that resulted from contaminated cantaloupes linked to Jensen Farms of Holly, Colorado. As of the final report on December 8, 2011, there were 30 deaths and 146 total confirmed cases since the beginning of the first recorded case on July 31, 2011.[1] It was the worst foodborne illness outbreak in the United States, measured by the number of deaths, since the Centers for Disease Control and Prevention began tracking outbreaks in the 1970s, or tied with the worst, an outbreak of listeria from cheese in 1985, depending on which CDC report is used.[2]

2011 United States listeriosis outbreak

2011 United States listeriosis outbreak

In response to the initial reports by the CDC on the contaminated cantaloupe, Jensen Farms issued a voluntary recall on September 15 of the entire harvest crop of 300,000 cantaloupe that it had distributed to its chain stores. The FDA made the public announcement for the recall after Listeria infection was confirmed by Jensen Farms at its main Colorado branch.[26] Jensen Farms was also forced to temporarily shut down its processing plant while the recall is ongoing.[27] Government officials have been investigating the company's main facility in Colorado to determine if there was "animal or water contamination", but there have been no results from the investigation thus far.[19] Holly, Colorado residents were described as being left "reeling and in fear" because of the disaster for its local producer.[28]

Jensen Farms response

1981 Toxic Oil Syndrome Toxic Oil Syndrome or simply Toxic Syndrome (in Spanish: síndrome del aceite tóxico or síndrome tóxico) was the name given to a disease outbreak in Spain in 1981, which killed over 600 people. Its first appearance was as a lung disease, with unusual features: though the symptoms initially resembled a lung infection, antibiotics were ineffective. The disease appeared to be restricted to certain geographical localities, and several members of a family could be affected, even while their neighbors had no symptoms. Following the acute phase, a range of other chronic symptoms was apparent.

2008 Chinese milk scandal The 2008 Chinese milk scandal was a food safety incident in China, involving milk and infant formula, and other food materials and components, adulterated with melamine. By November 2008, China reported an estimated 300,000 victims,[1] with six infants dying from kidney stones and other kidney damage, and an estimated 54,000 babies being hospitalised.[2][3] The chemical appeared to have been added to milk to cause it to appear to have a higher protein content.

2008 Chinese milk scandal The issue raised concerns about food safety and political corruption in China, and damaged the reputation of China's food exports, with at least 11 countries stopping all imports of Chinese dairy products. A number of criminal prosecutions occurred, with two people being executed, another given a suspended death penalty, three others receiving life imprisonment, two receiving 15-year jail terms,[6] and seven local government officials, as well as the Director of the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) being fired or forced to resign.[7]

2008 Chinese milk scandal A spokesman said the scale of the problem proved it was "clearly not an isolated accident, [but] a large-scale intentional activity to deceive consumers for simple, basic, short-term profits."[8] In 2012, Jiang Weisuo, 44, the man who first alerted authorities to what would become the melamine-tainted milk scandal was murdered in Xi'an city.[11]

2006 North American E. coli O157:H7 outbreaks

In 2006, there were several outbreaks of foodborne illness from spinach and lettuce contaminated by E. coli O157:H7. Spinach The initial outbreak occurred in September 2006 and its probable origin was an Angus cattle ranch that had leased land to spinach grower.[1] At least 205 consumer illnesses and 3 deaths have been attributed to the tainted produce.[2]

Lettuce[edit] Taco Bell[edit] The affected New Jersey counties, as of December 7, 2006. Note that Montgomery and Philadelphia counties in Pennsylvania and Nassau, Suffolk, Clinton, Orange, Oneida, and Otsego counties in New York State were also affected. In December 2006, Taco Bell restaurants in four Northeastern states emerged as a common link among 71 sickened people across five states, 52 of whom were ultimately confirmed by the Centers for Disease Control to have tested positive the same E. coli strain.[3] A total of 33 people in New Jersey, 22 in New York, 13 in Pennsylvania, 2 in Delaware, and 1 in South Carolina fell ill, according to the CDC.[3]

Taco John's[edit] Later in December 2006, Iowa and Minnesota health officials investigated an E. coli outbreak that was traced to foods served at Taco John's restaurants in Cedar Falls, Iowa and Albert Lea and Austin, Minnesota. As of December 13, 2006, the Iowa Department of Health had confirmed that at least 50 Iowans had become ill with E. coli infections after eating at Taco John's. On December 18, 2006, the Minnesota Department of Health reported that 37 probable E. coli cases had been reported in connection with the Taco John's E. coli outbreak, nine people were confirmed ill with E. coli, eight people were hospitalized, and one person had developed hemolytic-uremic syndrome.

Taco John's[edit] The Taco John's E. coli outbreak was traced to contaminated lettuce sold in foods at Taco John's restaurants that were supplied by a Minneapolis lettuce supplier. In response to the Taco John's E. coli outbreak, Taco John's agreed to reimburse ill individuals for medical expenses, and hired a new fresh produce supplier.[10] Taco John's president and CEO Paul Fisherkeller stated in an open letter that their restaurant food was safe to eat in the wake of the E. coli outbreak that closed three of their restaurants in Iowa and Minnesota.

［헤럴드생생뉴스］국내산 배추절임이라고 안심할 수만은 없다. 장출혈성 대장균에 오염된 배추절임으로 7명이 사망한 사건이 일본에서 발생하자, 국내에서도 절임류 김치에 대한 안정성이 제기되고 있다. 김치류로 인한 식중독은 국내에서도 발생한 사례였다. 21일 식품의약안전청에 따르면 지난해와 올해 김치류로 인한 집단식중독이 2건 발생했다. 물론 현재까지 일본 홋카이도 전역으로 퍼졌던 장출혈성 대장균에 오염된 절임류 김치로 인한 식중독 사례는 없었다.

日 배추절임 식중독 사망…국내는? 기사입력 2012-08-21 09:31

작년 이래 집단식중독 2건 보고…환자 약 400명 "장출혈성 대장균엔 오염된 적 없어" (서울=연합뉴스) 하채림 기자 = 일본에서 장출혈성 대장균에 오염된 배추절임을 먹고 7명이 사망한 사건이 터지자 자연스레 절임류와 김치의 오염 가능성에 대해서도 관심이 쏠리고 있다. 21일 식품의약품안전청에 따르면 작년과 올해 김치류가 원인으로 의심 또는 확인된 집단식중독은 모두 2건이다. 지난 4월 인천의 모 중학교에서 환자 41명이 발생한 식중독 사고는 급식에 제공된 배추김치가 원인으로 추정됐으나 인과관계는 입증되지 않았다. 당시 가검물 분석에서 식중독 증세의 원인균은 토양과 하천에 널리 존재하는 식중독균 '클로스트리디움 퍼프린젠스'로 밝혀졌다. 이에 앞서 지난해 5월 경기도 광주시 소재 5개 학교에 걸쳐 환자 345명이 보고된 대형 식중독 사고의 원인은 '노로바이러스'에 오염된 물김치로 확인됐다. 역학조사 결과 채소 세척에 쓰인 물, 물김치, 환자 가검물에서 모두 노로바이러스가 검출됐다. 식약청은 지금까지 국내에서 장출혈성 대장균에 오염된 절임류나 김치류에 의한 식중독 사례는 없는 것으로 파악하고 있다. 지난 2010년 이후 식약청이 실시한 김치류 수거 검사 결과 시중 김치 1천673건(배추김치 1천23건, 기타김치 646건) 중 4건에서 식중독균인 리스테리아균과 클로스트리디움균 각 2건이 나왔지만 병원성 대장균은 아니었다. 식약청 식중독예방관리과의 곽효선 연구관은 "일본에서 식중독 사망자를 낸 배추절임과 달리 발효식품인 김치는 발효 과정에서 독성 균이 대부분 사라진다"며 "김치에서 식중독균이 검출되는 사례가 드물고, 나오더라도 비교적 흔한 클로스트리디움균인 경우가 대부분"이라고 말했다.

밥 먹고 합시다!