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DESCRIPTION
Food poisoning occurs when a person consumes food and/or water containing harmful toxins or microorganisms, usually bacteria. Each year more than 2 million Americans report illnesses that are traced to food they have eaten. The actual number of food poisoning cases is almost certainly well above that number, however, because people often mistake the symptoms of food poisoning for those of intestinal flu.
Types of Food Poisoning
Type Relative
IncidenceSymptoms Time Between Exposure
and Onset of SymptomsBotulism Rare. Double vision; difficulty speaking, breathing, and swallowing; nausea, vomiting, and abdominal pain; diarrhea; muscular weakness. 12-48 hours, but may be as long as 8 days. Campylobacter infection Common. Muscular pain, nausea, vomiting, fever, abdominal cramps. 2-10 days. Clostridium perfringens poisoning Common. Diarrhea, abdominal cramps. 9-15 hours. Giardiasis Common. Nausea, gas, abdominal pain and/or cramping, diarrhea; in severe cases, malabsorption problems and weight loss. 1-3 weeks. Liseriosis Rare. Flu-like symptoms, including fever, chills; can cause spontaneous abortion or stillbirth; can cause severe illness in newborns and immune-depressed people. 2-4 weeks. Norwalk virus infection Common. Nausea, vomiting, diarrhea, headache. 1-2 days. Salmonellosis Common. Nausea, vomiting, diarrhea, abdominal cramps, fever, headache. 6-48 hours. Scombroid poisoning Uncommon. Headache, dizziness, burning throat, hives, nausea, vomiting, abdominal pain. 5 minutes-1 hour. Staphylococcal food poisoning Common. Vomiting, diarrhea; occasionally weakness, dizziness. 30 minutes-8 hours. Trichinosis Rare. Fever, edema of eyelids, muscle pain. 1-2 days.
FREQUENT SIGNS AND SYMPTOMS
Symptoms of food poisoning may include nausea, vomiting, abdominal cramps and diarrhea, even chills, fever, severe headache, and worse, lasting from a few hours to a few days. Some type of food poisoning, such as botulism, are more serious, especially for elderly people and children. As many as 9,000 deaths occur annually from all types of food poisoning. In addition, many cases of food poisoning lead to chronic health disorders, such as reactive arthritis and chronic immune deficiency.
Pathogenic and toxigenic organisms - those that can cause disease and those that can produce harmful toxins - are silent killers because nothing about the taste, odor, or appearance of the food indicates their presence. All types of bacteria can potentially become toxigenic.
There are different types of food poisoning, depending on the agent that causes it (See the quick reference table above).
Salmonellosis, or Salmonella infection:
Description:
Salmonella is one of the most common types of food poisoning. In 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella from the intestine of a pig. This strain was called Salmonella choleraesuis, the designation that is still used to describe the genus and species of this common human pathogen.
Salmonella is a type of bacteria that causes typhoid fever and many other infections of intestinal origin. Typhoid fever, rare in the U.S., is caused by a particular strain designated Salmonella typhi. But illness due to other Salmonella strains, just called "salmonellosis," is common in the U.S. Today, the number of known strains (technically termed "serotypes" or "serovars") of this bacteria total over 2300.
Salmonella serotypes typhimurium and enteritidis are the most common serotypes in the United States. In recent years, concerns have been raised because many strains of Salmonella have become resistant to several of the antibiotics traditionally used to treat it, in both animals and humans.
Salmonella bacteria are part of the natural intestinal flora of many animals. They are easily transmitted through the food supply, the hands of the food preparers, and the surfaces of objects such as knives and tabletops. Salmonella thrive in livestock that have been given antibiotics in their feed to make them grow faster and prevent disease in crowded and unsanitary conditions. At least one third of all chickens in the United States are infected with salmonella. Salmonellosis is the leading cause of food poisoning death in America.
Symptoms:
Salmonella infection symptoms can range from mild abdominal pain to severe diarrhea and dehydration to typhoid-like fever. The incubation period for salmonellosis (the time in between ingestion and the onset of the first symptom) may be from 6 hours to 10 days, but symptoms usually develop within 6-8 hours to 36-48 hours of eating contaminated foods. Diarrhea is often the first sign, often with fever and abdominal cramping. The onset may be sudden and there may be nausea and vomiting initially. The diarrhea often includes mucous and is occasionally bloody.
Infants, the elderly, immune suppressed persons and persons with sickle cell anemia are most susceptible to disease and suffer the most severe symptoms. It is in these individuals that the organism is most likely to gain access to the blood stream and possibly persist in sites of the body distant from the intestine, such as on the aorta or in the bone. Salmonella can also weaken the immune system and cause kidney and cardiovascular damage as well as arthritis.
Causes:
Outbreaks of salmonellosis occur primarily in the warmer months. Most cases are the result of the consumption of contaminated foods, primarily chicken, eggs, beef, and pork products. People who eat raw or incompletely cooked meats are at greater risk of developing the disorder. Cooks who first handle raw meat or poultry and then handle other foods without washing their hands in between, endanger others; cooks who lick their hands or fingers after handling raw meat or poultry put themselves at risk of salmonella infection. People taking antibiotics are also at greater risk. Antibiotics can effectively treat bacterial infections, but, paradoxically, they can also promote infection by destroying good, competing bacteria and permitting the growth of bacteria that are antibiotic resistant.
In 1985, an outbreak of Salmonella from contaminated milk occurred in five Midwestern states. As a result, 17,000 people became ill and 2 died. Eggs were once thought to be free of Salmonella. However, there has been a dramatic increase in the number of reported cases of food poisoning from foods containing raw or only partly cooked eggs, particularly in the Northeast. These foods include ice cream, eggnog, Caesar salad dressing, and Hollandaise sauce. Of 35 outbreaks of illness that were reported over a recent 2-year period and determined to be food poisoning, 24 were caused by contaminated eggs or foods containing these infected eggs. Certain strains of bacteria found in eggs are not destroyed if the eggs are poached or prepared over easy or sunny-side up, in addition to other ways.
Salmonellosis as a result of the consumption of raw clams, oysters, and sushi made from raw fish has also been reported. Although this does not occur as often as Salmonella infection from eggs, meat, and poultry, it does happen.
Risk of Infection:
Salmonella is one of the most common enteric (intestinal) infections in the U.S. In some states (e.g. Georgia, Maryland) it is the most common, and overall it is the second most common food borne illness (usually slightly less frequent than Campylobacter infection.) The reported incidence of salmonellosis is about 17 cases per each 100,000 persons. Over 40,000 actual cases are reported yearly in the U.S. As only about 3% of Salmonella cases are officially reported nationwide, and many milder cases are never diagnosed, the true incidence is undoubtedly much higher. It is more common in the warmer months of the year. Approximately 5003 to 1,000 5 persons die from Salmonella infections in the U.S. every year.
Complications of Infection:
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons who are infected with Salmonella will go on to develop pains in their joints, irritation of the eyes, and discomfort on urination. This is called Reiter's syndrome, or reactive arthritis, and starts a few weeks after the gastroenteritis. It can last for months or years, and can lead to chronic arthritis that may be difficult to treat. Antibiotic treatment does not make a difference in whether or not the person later develops Reiter's syndrome.
Salmonella septicemia (invasion of the blood stream) has been associated with the subsequent infection of virtually every organ system. In persons with atherosclerosis of the aorta it may grow there and persons with sickle cell disease or its variants tend to get infection in the bone (osteomyelitis) or joints (septic arthritis). Salmonella infection may persist in the gallbladder for months or years in rare individuals.
Diagnosis:
The diagnosis of salmonellosis is confirmed by cultures of stool or blood. In other words, specimens of blood or feces are placed in nutrient broth or on agar and incubated for 2-3 days. After that time, a trained microbiologist can recognize Salmonella bacteria if present by its unique characteristics. However, blood cultures are often not performed and in most cases the blood stream is not infected. In the stool, the laboratory is challenged to pick out Salmonella from many other similar bacteria that are normally present. In addition, many persons submit cultures after they have started antibiotics, which may make it even more difficult for a microbiology lab to grow Salmonella. So, the diagnosis of salmonellosis may be problematic and many mild cases are culture negative.
Prevention:
In order to stop the increasing numbers of cases of Salmonella, consumers and producers must be educated on proper handling and cooking of eggs and other high-risk foods. Quick reporting and cooperation between all local, state and federal agencies are critical in identifying outbreaks, so fewer people are affected once food borne outbreaks occur.
- Cross-contamination of foods must be avoided. Uncooked eggs, poultry and meats should be kept separate from produce and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after handling uncooked foods. It is recommended that bleach be used to wash cutting boards and counters used for food preparation immediately after use to avoid cross contaminating other foods.
- Hands should be washed before and after handling any food, and between handling different food items, after using the bathroom or changing a baby's diaper, and after contact with animals.
- Cook poultry, ground beef, and eggs thoroughly before eating. In order to insure that eggs do not contain viable Salmonella they must be cooked at least until the yoke is solid and meat and poultry must reach 160ºF or greater throughout. This is important especially for for meats cooked in a microwave oven.
- Do not eat or drink foods containing raw eggs. Examples include homemade eggnog, Hollandaise sauce, and under cooked French toast. Note: There is more salmonella on the shell of the egg than in the egg itself. Some cooks drop an egg on a grill then pull the shell out, which is exactly the wrong thing to do!
- Never drink raw (unpasteurized) milk. Purchase only inspected eggs, animal food products and pasteurized milk.
- If you are served under cooked meat, poultry or eggs in a restaurant don't hesitate to send it back to the kitchen for further cooking.
- Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with foods of animal origin.
- Be particularly careful with foods prepared for infants, the elderly, and those with a compromised immune system.
- Wrap fresh meats in plastic bags at the market to prevent blood from dripping on other food items. Refrigerate foods promptly. Defrost meats in the refrigerator, minimize holding at room temperature.
- Make sure children, particularly those who handle pets, wash their hands properly.
- Wash hands with soap after handling reptiles, amphibians or birds, or after contact with pet feces. Infants and immunocompromised persons should have no direct or indirect contact with such pets.
Resources:
Salmonella Outbreaks
About-Salmonella.com: Legal Information Regarding Food Poisoning Cases
Salmonella.org
CDC: Salmonellosis - General Information
FDA/CFSAN: Bad Bug Book - Salmonella spp.
The Microbial Underground's Salmonella Page
McKinley Health Center: Salmonella Infection
Reptile-Associated Salmonellosis Information
Medmicro: Salmonella
Egg Safety Section Index
Iowa State Food Safety Project: Salmonella
Staphylococcus aureas:
Description:
Staphylococcus aureus is a spherical bacterium (coccus) which on microscopic examination appears in pairs, short chains, or bunched, grape-like clusters. These organisms are Gram-positive. Some strains are capable of producing a highly heat-stable protein toxin that causes illness in humans.
S. aureus is another frequent cause of food-borne illness. Staphylococci are responsible for approximately 25 percent of all cases of food poisoning. This microorganism is commonly found in the nose and throat, but if a food product becomes contaminated with it (by being sneezed or coughed on, for example), the bacteria can grow and produce an enterotoxin, a toxin that specifically targets the cells of the intestines. It is this toxin, rather than the bacteria itself, that causes the food poisoning.
All people are believed to be susceptible to this type of bacterial intoxication, however, intensity of symptoms may vary.
Symptoms:
Symptoms of staphylococci infection include diarrhea, nausea, vomiting, abdominal cramps, and prostration, usually beginning from 2 to 8 hours after consumption of the contaminated food. The onset of symptoms in staphylococcal food poisoning is usually rapid and in many cases acute, depending on individual susceptibility to the toxin, the amount of contaminated food eaten, the amount of toxin in the food ingested, and the general health of the victim. Some individuals may not always demonstrate all the symptoms associated with the illness. In more severe cases, headache, muscle cramping, and transient changes in blood pressure and pulse rate may occur. Recovery generally takes two days, However, it us not unusual for complete recovery to take three days and sometimes longer in severe cases.
Infective dose--a toxin dose of less than 1.0 microgram in contaminated food will produce symptoms of staphylococcal intoxication. This toxin level is reached when S. aureus populations exceed 100,000 per gram.
Risk of Infection:
Foods that are frequently incriminated in staphylococcal food poisoning include meat and meat products; poultry and egg products; salads such as egg, tuna, chicken, potato, and macaroni; bakery products such as cream-filled pastries, cream pies, and chocolate eclairs; sandwich fillings; and milk and dairy products. Foods that require considerable handling during preparation and that are kept at slightly elevated temperatures after preparation are frequently involved in staphylococcal food poisoning.
Staphylococci exist in air, dust, sewage, water, milk, and food or on food equipment, environmental surfaces, humans, and animals. Humans and animals are the primary reservoirs. Staphylococci are present in the nasal passages and throats and on the hair and skin of 50 percent or more of healthy individuals. This incidence is even higher for those who associate with or who come in contact with sick individuals and hospital environments. Although food handlers are usually the main source of food contamination in food poisoning outbreaks, equipment and environmental surfaces can also be sources of contamination with S. aureus. Human intoxication is caused by ingesting enterotoxins produced in food by some strains of S. aureus, usually because the food has not been kept hot enough (60°C, 140°F, or above) or cold enough (7.2°C, 45°F, or below).
Complications of Infection:
Dehydration and muscle cramping from diarrhea and vomiting may occur with Staphylococcus aureus food poisoning. Fluid and electrolyte balance must be maintained when diarrhea and vomiting are present. Death from staphylococcal food poisoning is very rare, although such cases have occurred among the elderly, infants, and severely debilitated persons.
Diagnosis:
In the diagnosis of staphylococcal foodborne illness, proper interviews with the victims and gathering and analyzing epidemiologic data are essential. Incriminated foods should be collected and examined for staphylococci. The presence of relatively large numbers of enterotoxigenic staphylococci is good circumstantial evidence that the food contains toxin. The most conclusive test is the linking of an illness with a specific food or in cases where multiple vehicles exist, the detection of the toxin in the food sample(s). In cases where the food may have been treated to kill the staphylococci, as in pasteurization or heating, direct microscopic observation of the food may be an aid in the diagnosis. A number of serological methods for determining the enterotoxigenicity of S. aureus isolated from foods as well as methods for the separation and detection of toxins in foods have been developed and used successfully to aid in the diagnosis of the illness. Phage typing may also be useful when viable staphylococci can be isolated from the incriminated food, from victims, and from suspected carrier such as food handlers.
For detecting trace amounts of staphylococcal enterotoxin in foods incriminated in food poisoning, the toxin must be separated from food constituents and concentrated before identification by specific precipitation with antiserum (antienterotoxin) as follows. Two principles are used for the purpose: (1) the selective adsorption of the enterotoxin from an extract of the food onto ion exchange resins and (2) the use of physical and chemical procedures for the selective removal of food constituents from the extract, leaving the enterotoxin(s) in solution. The use of these techniques and concentration of the resulting products (as much as possible) has made it possible to detect small amounts of enterotoxin in food.
There are developed rapid methods based on monoclonal antibodies (e.g., ELISA, Reverse Passive Latex Agglutination), which are being evaluated for their efficacy in the detection of enterotoxins in food. These rapid methods can detect approximately 1.0 nanogram of toxin/g of food.
Prevention:
Handwashing is the most important way to prevent infections from passing from person to person. Wash hands thoroughly before and after all food preparation. Any food service worker who has skin infections should not be handling food. Food preparation equipment must be thoroughly washed before it is used. Refrigerate meats and leftovers promptly. Keep hot foods hot (over 140 degrees F) and cold foods cold (below 40 degrees F).
Resources:
Detection: Bacteriological Analytical Manual - Staphylococcus aureus
Staphylococcus Bacteriology
The Ohio State University Extension Fact Sheet About Staphylococcus aureus
FDA/CFSAN: Bad Bug Book - Staphylococcus aureus
Clostridium botulinum:
Description:
The bacterium Clostridium botulinum, which commonly inhabits the soil in the form of harmless spores, can cause a particularly dangerous type of food poisoning. Of the various types of food poisoning, botulism is the among the most severe. It affects the central nervous system. As with Staphylococcus, it is not the bacteria but rather toxins produced by C.botulinum block the transmission of impulses from nerves to muscles, thus paralyzing the muscles.
These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.
Symptoms:
The paralysis often begins with the muscles that are responsible for eye movement, swallowing, and speech, and progresses to those in the torso and the extremities. Early symptoms of botulism include extreme weakness, double vision, droopy eyelids, slurred speech, dry mouth, and trouble swallowing. These symptoms typically appear 12 to 48 hours after the ingestion of the contaminated food, but they can occur as early as 6 hours or as late as 10 days. Eventually, muscle weakness affecting the entire body, including the muscles required for breathing, can result. Paralysis and death may occur in severe cases.
Risk of Infection:
In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Even though the U.S. Centers for Disease Control (CDC) reported only 42 cases of botulism in the United States in 1994, it still remains a threat. Botulin toxin has been found in asparagus, beets, corn, stuffed eggplant, smoked and salted fish, green beans, ham, lobster, luncheon meats, mushrooms, peppers, sausage, soups, spinach, and tuna. Canned foods, especially those canned at home, are particularly prone to contamination with this potentially lethal organism. This is often due to improper canning techniques, usually the failure to use a pressure cooker to seal the jars adequately. A bulging lid or cracked jar can be a sign that the food within is contaminated, but botulism can occur even if a food container shows no sign of damage. Keeping food at room temperature for prolonged periods of time can also be a problem. In one reported case, a restaurant allowed a large batch of sautéed onions to be kept out throughout the day, instead of keeping them refrigerated, and small amounts were used as needed. Several people became very ill from botulin toxin in the onions.
Freezing, drying, and treatment with chemicals such as sodium nitrate prevent C.botulinum spores from growing and producing toxins. Although it does not kill the spores themselves, heating food to a temperature of at least 176°F for 30 minutes prevents food poisoning by destroying the lethal toxins.
Complications of Infection:
Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid recovery.
Diagnosis:
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism. These tests can be performed at some state health department laboratories and at CDC.
Treatment of botulism: The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Health care providers may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant botulism.
Prevention:
Botulism can be prevented. Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets and corn. However, outbreaks of botulism from more unusual sources such as chopped garlic in oil, chili peppers, tomatoes, improperly handled baked potatoes wrapped in aluminum foil, and home-canned or fermented fish. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Instructions on safe home canning can be obtained from county extension services or from the US Department of Agriculture. Because honey can contain spores of Clostridium botulinum and this has been a source of infection for infants, children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.
Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers. State health departments and CDC have persons knowledgeable about botulism available to consult with physicians 24 hours a day. If antitoxin is needed to treat a patient, it can be quickly delivered to a health care provider anywhere in the country. Suspected outbreaks of botulism are quickly investigated, and if they involve a commercial product, the appropriate control measures are coordinated among public health and regulatory agencies. Health care providers should report suspected cases of botulism to a state health department.
Resources:
Food Poisoning Prevention
Food Poisoning Information
VDACS: Food Safety - Food Poisoning
Michigan State Adult Health Advisor: Food Poisoning - Botulism
Ask Noah About: Food Poisoning
Campylobacter jejuni:
Description:
A microorganism called Campylobacter jejuni, (Pronounced "camp-e-low-back-ter j-june-eye") was not recognized as a cause of human foodborne illness prior to 1975. It has long been known to cause illness in cattle, has now been implicated in human illness as well. Many experts believe that the incidence of this infection is much higher than reported, because many people mistake it for a stomach virus. People tend not to associate their illness with food because it takes 3 to 5 days for these bacterial to produce symptoms.
Most cases Campylobacter infection occur as isolated, sporadic events, not as a part of the large outbreaks. Even though surveillance is very limited, over 10,000 cases are reported to the Centers for Disease Control and Prevention (CDC) each year. Active surveillance for cases indicates that over 17 cases for each 100,000 persons in the population (or about 46,000 cases) are diagnosed yearly. Undoubtedly, many more cases go undiagnosed and unreported. Campylobacteriosis occurs more frequently in the summer months than in the winter. Although Campylobacter doesn't commonly cause death, it has been estimated that 100 persons with Campylobacter infections die each year from the infection.
Symptoms:
Symptoms of C. jejuni food poisoning include abdominal cramps, diarrhea, fever, and possibly blood in the stool. Diarrhea is the most consistent and prominent manifestation of campylobacteriosis. It is often bloody. Typical symptoms of C. jejuni infection also include fever, nausea, vomiting, abdominal pain, headache, and muscle pain. A majority of cases are mild and do not require hospitalization and may be self-limited. However, C. jejuni infection can be severe and life threatening. Death is more common when other diseases (e.g., cancer, liver disease, and immuno-deficiency diseases) are present.
Children under the age of 5 and young adults aged 15-29 are the age groups most frequently affected. The incubation period (the time between exposure on onset of the first symptom) is typically 2 to 5 days, but onset may occur in as few as 2 days or as long as 10 days after ingestion. The illness usually lasts no more than one week; however, severe cases may persist for up to 3 weeks.
It can be present in the intestinal tracts of apparently healthy cattle, turkeys, chickens, and sheep, and can be spread to all parts of the meat during the slaughtering process. Fortunately, heat destroys the bacteria, so it is possible to avoid this type of food poisoning by eating meat only if has been cooked thoroughly.
Risk of Infection:
Food is the most common vehicle for the spread of Campylobacter and poultry is the most common food implicated. Some case-control studies indicate that up to 70% of sporadic cases of campylobacteriosis are associated with eating chicken. Surveys by the USDA demonstrated that up to 88% of the broiler chicken carcasses in the USA are contaminated with Campylobacter while a recent Consumer Reports study identified Campylobacter in 63% of more then 1000 chickens obtained in grocery stores. Other identified food vehicles include unpasteurized milk, under cooked meats, mushrooms, hamburger, cheese, pork, shellfish, and eggs.
Most cases of campylobacteriosis are sporadic or involve small family groups, although some common-source outbreaks involving many people have been traced to contaminated water or milk.
Other sources of Campylobacter, in addition to food water, that have been reported include children prior to toilet-training, especially in child care settings, and intimate contact with other infected individuals. C. jejuni is commonly present in the gastrointestinal tract of healthy cattle, pigs, chickens, turkeys, duck, and geese, and direct animal exposure can lead to infection. Pets that may carry Campylobacter include Birds, cats, dogs, hamsters, and turtles. The organism is also occasionally isolated from streams, lakes and ponds.
Campylobacter jejuni is a gram-negative, microaerophilic, thermophilic rod, growing best at 42°C and low oxygen concentrations. These characteristics are adaptations for growth in its normal habitat-the intestine of warm-blooded birds and mammals. Food, becomes contaminated from intestinal material during processing, but C. jejuni grows poorly on properly refrigerated foods. It does, however, survive refrigeration and will grow if contaminated foods are left out at room temperature. Campylobacter is sensitive to heat and other common disinfection procedures. Pasteurization of milk, adequate cooking of meat and poultry, and chlorination or ozonation of water will destroy this organism. Several closely related species with similar characteristics, C. coli, C. fetus, and C. upsalienis, may also cause disease in man.
Selected Listings of Prior Campylobacter Outbreaks
Pathogen Cases / Source Location Campylobacter 200 / unknown WA Campylobacter 30 / Unknown WA Campylobacter 38 / Unknown WA Campylobacter 87 / Unknown CA Campylobacter 14 / Lettuce /lasagna OK Campylobacter 70 / Salad ( suspected) NY Campylobacter 82 / Tuna Salad WI Campylobacter 17 / Chicken/Coleslaw/Potato Salad FL Campylobacter 62 / Fruit Salad MN Campylobacter 48 / Melon/strawberries MN Campylobacter 50 / Raw Milk MN Campylobacter 34 / Pasta salad/Au gratin potatoes IN Campylobacter 23 / Milk NY Campylobacter 20 / Cold Meat Tray NY Campylobacter 10 / Chicken/Fruit PA Campylobacter 42 / Raw Milk TX Campylobacter 13 / Raw Milk WA Campylobacter 23 / Raw Milk CA Campylobacter 39 / Poultry NY
Click here for a list of foodborne disease outbreaks as reported to CDC through the Foodborne Disease Outbreak Surveillance System.Complications of Infection:
Long-term consequences can sometimes result from a Campylobacter infection. Some people may develop a rare disease that affects the nerves of the body following campylobacteriosis. This disease is called Guillain-Barré syndrome. Although rare, it is the most common cause of acute generalized paralysis in the Western world. It begins several weeks after the diarrheal illness in a small minority of Campylobacter victims. It occurs when a person's immune system makes antibodies against components of Campylobacter and these antibodies attack components of the body's nerve cells because they are chemically similar to bacterial components.
Guillain-Barré syndrome begins in the feet and spreads up the body. Prickling sensations gives way to weakness that may lead to paralysis. It lasts for weeks to months and often requires intensive care. Full recovery is common, however victims may be left with severe neurological damage. Approximately 15 percent of Guillain-Barré victims remain bedridden or wheelchair bound at the end of one year.
Two therapies, intravenous immunoglobulin infusions and plasma exchange, may improve the rate of recovery in patients with Guillain-Barré syndrome.
It is estimated that approximately one in every 1000 reported campylobacteriosis cases leads Guillain-Barré syndrome. As many as 40 percent of Guillain-Barré syndrome cases in this country occur following campylobacteriosis. Miller Fisher Syndrome is another, related neurological syndrome that can follow campylobacteriosis and is also caused by immunologic mimicry. In Miller Fisher syndrome, the nerves of the head are affected more than the nerves of the body.
Another chronic condition that may be associated with Campylobacter infection is an arthritis called Reiter's syndrome. This is a reactive arthritis that most commonly affects large weight-bearing joints such as the knees and the lower back. It is a complication that is strongly associated with a particular genetic make-up; persons who have the human lymphocyte antigen B27 (HLA-B27) are most susceptible.
Campylobacter may also cause appendicitis or infect the abdominal cavity (peritonitis), the heart (carditis), the central nervous system (meningitis), the gallbladder (cholecystitis) the urinary tract, and the blood stream.
Diagnosis:
Many kinds of infections can cause diarrhea and the other symptoms associated with campylobacteriosis. Health care providers can look for bacterial causes of diarrhea by asking a laboratory to culture a sample of stool from an ill person. Microbiology laboratories now routinely perform culture procedures on stool specimens that are specifically designed to promote the growth and identification of Campylobacter jejuni and the other species of Campylobacter.
For treatment of Campylobacteriosis, patients with campylobacteriosis should drink plenty of fluids as long as the diarrhea lasts in order to maintain hydration. Antidiarrheal medications such as loperamide may allay some symptoms.
Campylobacter is usually causes a self-limited illness, but when it is identified, specific treatment with antibiotics is indicated, as treatment may shorten the course of the illness. In more severe cases of gastroenteritis, antibiotics are usually begun before culture results are known. Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are the most effective agents for C. jejuni. Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin) can also be used, but resistance to this class has been rising, at least in part due to the use of this class of antimicrobial in poultry feed.1 In the U.S. these antibiotics are available only by prescription.
Prevention:
Infection control measures at all stages of food processing may help to decrease the incidence of Campylobacter infections, but the single most important and reliable step is to adequately cook all poultry products.
The most reliable method to ensure this is to use a cooking thermometer. A metal stem-type thermometer that is numerically scaled should be used to assure that food is cooked to the proper temperature. The thermometer should be accurate to + or - 2 degrees Fahrenheit. Document that the thickest part of the chicken, turkey, duck or goose (the center of the breast) reaches 180°F or higher, as recommended by the U.S. Food and Drug Administration. The agency recommends at least 165°F for stuffing, 170°F for ground poultry products, and that thighs and wings be cooked until juices run clear.
Other control measures of import that are available to consumers and food service personnel include the following:
- Choose the coolest part of the vehicle (generally the trunk in winter and cab in summer) to transport meat and poultry home from the market.
- Defrost meat and poultry in the refrigerator. Place the item on a low shelf, on a wide pan, lined with paper towel; ensure that drippings do not land on foods below. If there is not enough time to defrost in the refrigerator, then use the microwave.
Do not cook stuffing actually inside the bird.
Rapidly cool leftovers.
Never leave food out at room temperature (either during preparation or after cooking) for more than 2 hours.
Avoid raw milk and products made from raw milk. Drink only pasteurized milk products.
Wash hands thoroughly using soap and water, concentrate on fingertips and nail creases, and dry completely with a disposable paper towel at the following times:
- After contact with pets, especially puppies, or farm animals.
- Before and after preparing food, especially poultry.
- After changing diapers or having contact with an individual with an intestinal infection.
- Children on arrival home from school or day-care.
Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
Resources:
HomeFoodSafety.com: Food Poisoning Prevention
About-Campybacter.com: Resources
HACCP.com: Food Safety - Food Poisoning Links
CDC: Campylobacter Infections
Ask Noah About: Food Poisoning
Clostridium perfringens:
Description:
Another type of bacteria that can cause food poisoning is Clostridium perfringens. As early as 1895,Clostridium perfringens was associated with human diarrhea, although it wasn't until the 1940s that it was confirmed to be a cause of food poisoning.
Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.
C. perfringens often survives heat well, so it is not affected by normal cooking. The bacteria multiply, forming spores and generating toxins that proliferate as foods cool and while they are stored. The toxins also are often heat-resistant. Meats, meat products, and gravy are the foods most frequently implicated.
Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. A more serious but rare illness is also caused by ingesting food contaminated with Type C strains. The latter illness is known as enteritis necroticans or pig-bel disease.
Symptoms:
The symptoms of C.perfringens poisoning are usually limited to mild nausea and vomiting that last a day or less, but that can be a very serious problem for elderly people. The hallmark of Clostridium food poisoning is sudden, watery diarrhea accompanied by abdominal pain that can range from mild to severe. Usually there is no fever associated with this type of food poisoning. Contaminated meat and meat products are the most common sources of this type of food poisoning.
The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of those C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals, such as in the elderly or infirm, for 1 or 2 weeks. A few deaths have been reported as a result of dehydration and other complications but, are considered rare.
Necrotic enteritis (pig-bel) caused by C. perfringens is often fatal. Symptoms of this infection include abdominal pain, vomiting, bloody diarrhea and shock may occur. This disease also begins as a result of ingesting large numbers of the causative bacteria in contaminated foods. Deaths from necrotic enteritis (pig-bel syndrome) are caused by infection and necrosis of the intestines and from resulting septicemia. This disease is very rare in the U.S.
Infective dose--The symptoms are caused by ingestion of large numbers (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation. This disease is a food infection; only one episode has ever implied the possibility of intoxication (i.e., disease from preformed toxin).
Risk of Infection:
Clostridium bacteria are found in soil, in stool, and in the intestines of healthy people and of animals. Packages of uncooked meat or poultry frequently contain Clostridium. Clostridium can also be transferred into food from the hands of those preparing it. Proper handwashing is necessary since someone with dirty hands can introduce the bacteria into food where it will germinate and multiply.
Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. There were 1,162 cases in 1981, in 28 separate outbreaks. At least 10-20 outbreaks have been reported annually in the U.S. for the past 2 decades. Typically, dozens or even hundreds of person are affected. It is probable that many outbreaks go unreported because the implicated foods or patient feces are not tested routinely for C. perfringens or its toxin. CDC estimates that about 10,000 actual cases occur annually in the U.S.
Institutional feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving is the most common circumstance in which perfringens poisoning occurs. The young and elderly are the most frequent victims of perfringens poisoning. Except in the case of pig-bel syndrome, complications are few in persons under 30 years of age. Elderly persons are more likely to experience prolonged or severe symptoms.
Complications of Infection:
Dehydration from diarrhea and vomiting may result. The young and elderly, or those with other illnesses may have more complications.
Diagnosis:
Clostridium perfringens food poisoning is suspected by the history and physical exam. A diagnosis might be confirmed with stool studies. Keep in mind that Clostridium are found in the stool of healthy people, so either large numbers (more than 1,000,000 organisms per gram of stool) or evidence of the toxin are needed.
Sometimes the diagnosis is made by finding Clostridium in the food.
Standard bacteriological culturing procedures are used to detect the organism in implicated foods and in feces of patients. Serological assays are used for detecting enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The procedures take 1-3 days.
Usually no treatment is needed, other than taking steps to prevent or treat dehydration. Antibiotics are not useful in Clostridium food poisoning.
Prevention:
Unlike many other types of bacteria that cause foodborne disease, clostridium perfringens isn't completely destroyed by ordinary cooking. This is because it produces heat-resistant spores.
The bacteria are killed at cooking temperatures, but the heat-resistant spores they produce are able to survive and may actually be stimulated to germinate by the heat. If the food is not eaten at once but is allowed to cool slowly, the bacteria produced when the spores germinate multiply rapidly. Unless the food is reheated so that it is piping hot (at least to 60°C and preferably to 75°C), the bacteria will survive. After ingestion, if there are sufficient numbers present, the bacteria will produce toxins and the toxins will cause symptoms.
Foods most likely to be associated with clostridium perfringens food poisoning are those that are cooked slowly in large quantities and left to stand for a long time at room temperature.
Clostridium grows best between 45 and 140 degrees. Prepared foods should be kept cooler or warmer than this.
Wash hands before preparing or serving foods. When handling raw meat or poultry, consider them contaminated! Wash your hands and any surfaces they have touched before proceeding. Be sure that meat, poultry, and fish dishes are fully cooked and don't interrupt cooking to finish it later.
Don't leave prepared foods unrefrigerated for more than two hours. When foods are taken from warming tables, they should be refrigerated immediately, not left at room temperature to cool.
Prepared foods should be reheated to at least 165 degrees before serving.
Resources:
Clostridium Information
Clostridium perfringens
Medical Library: Food Poisoning
KidsHealth.org: Clostridial Infections
Clostridium perfringens epsilon toxins
Giardia lamblia:
Description:
Not all food-borne illness is the result of bacterial contamination. Giardia lamblia is a protozoan that infects the small intestine. It is a single celled parasitic animal that moves with the aid of five flagella. In Europe, it is sometimes referred to as Lamblia intestinalis. It lives in the intestines of humans and some wild and domestic animals. Organisms that appear identical to those that cause human illness have been isolated from domestic animals (dogs and cats) and wild animals (beavers and bears). A related but morphologically distinct organism infects rodents, although rodents may be infected with human isolates in the laboratory. Giardiasis is associated with the consumption of contaminated water. It can also be transmitted to raw foods that have grown in contaminated water. Cool, moist environments are conducive to the growth of this microorganism. It is the most frequent cause of non-bacterial diarrhea in North America.
Symptoms:
Symptoms generally occur within 1 to 3 weeks of infection and include chronic diarrhea with frequent loose and pale greasy stools, constipation, abdominal cramps and pain, flatulence, bloating, loss of appetite and weight loss, fatigue, nausea, and vomiting. Asymptomatic infection (i.e. where persons are infected, carry and excrete but do not develop any symptoms) is common with Giardia lamblia, and for this reason it is recommended that all household members are tested where one is known to be infected.
The incubation period (i.e. the time between ingestion of the Giardia lamblia cysts and onset of illness) can be anywhere from 3 to 25 days or longer but the average period is 7 to 10 days.
Cause and Risk of Infection:
Food contaminated by an infected food handler, either after cooking or food to be eaten without cooking. Poor personal hygiene can result in the infection being passed from person to person, especially in children. In this and other westernized countries water is rarely contaminated by human or animal excreta. In less developed countries contaminated water is more common and can only be made safe by boiling or filtration. Chlorination and water purifying tablets are not effective.
Complications of Infection:
If the symptoms are severe and/or prolonged, seek medical advice. It is particularly important that young children and the elderly, and those already under medical supervision are treated.
Giardiasis is more prevalent in children than in adults, possibly because many individuals seem to have a lasting immunity after infection. This organism is implicated in 25% of the cases of gastrointestinal disease and may be present asymptomatically. The overall incidence of infection in the United States is estimated at 2 percent of the population. This disease afflicts many homosexual men, both HIV-positive and HIV-negative individuals. This is presumed to be due to sexual transmission. The disease is also common in child day care centers, especially those in which diapering is done.
About 40 percent of those who are diagnosed with giardiasis demonstrate disaccharide intolerance during detectable infection and up to 6 months after the infection can no longer be detected. Lactose (i.e., milk sugar) intolerance is most frequently observed. Some individuals (less than 4%) remain symptomatic more than 2 weeks; chronic infections lead to a malabsorption syndrome and severe weight loss. Chronic cases of giardiasis in immunodeficient and normal individuals are frequently refractile to drug treatment. Flagyl is normally quite effective in terminating infections. In some immune deficient individuals, giardiasis may contribute to a shortening of the life span.
Diagnosis:
Normally illness lasts for 1 to 2 weeks, but there are cases of chronic infections lasting months to years. Chronic cases, both those with defined immune deficiencies and those without, are difficult to treat. Giardiasis occurs throughout the population, although the prevalence is higher in children than adults. Chronic symptomatic giardiasis is more common in adults than children.
The disease mechanism is unknown, with some investigators reporting that the organism produces a toxin while others are unable to confirm its existence. The organism has been demonstrated inside host cells in the duodenum, but most investigators think this is such an infrequent occurrence that it is not responsible for disease symptoms. Mechanical obstruction of the absorptive surface of the intestine has been proposed as a possible pathogenic mechanism, as has a synergistic relationship with some of the intestinal flora.
Giardia can be excysted, cultured and encysted in vitro; new isolates have bacterial, fungal, and viral symbionts. Classically the disease was diagnosed by demonstration of the organism in stained fecal smears.
Several strains of G. lamblia have been isolated and described through analysis of their proteins and DNA; type of strain, however, is not consistently associated with disease severity. Different individuals show various degrees of symptoms when infected with the same strain, and the symptoms of an individual may vary during the course of the disease.
Infectious Dose - Ingestion of one or more cysts may cause disease, as contrasted to most bacterial illnesses where hundreds to thousands of organisms must be consumed to produce illness.
Giardia lamblia is frequently diagnosed by visualizing the organism, either the trophozoite (active reproducing form) or the cyst (the resting stage that is resistant to adverse environmental conditions) in stained preparations or unstained wet mounts with the aid of a microscope. A commercial fluorescent antibody kit is available to stain the organism. Organisms may be concentrated by sedimentation or flotation; however, these procedures reduce the number of recognizable organisms in the sample. An enzyme linked immunosorbant assay (ELISA) that detects excretory secretory products of the organism is also available. So far, the increased sensitivity of indirect serological detection has not been consistently demonstrated.
Food is analyzed by thorough surface cleaning of the suspected food and sedimentation of the organisms from the cleaning water. Feeding to specific pathogen-free animals has been used to detect the organism in large outbreaks associated with municipal water systems. The precise sensitivity of these methods has not been determined, so that negative results are questionable. Seven days may be required to detect an experimental infection.
Prevention:
Always wash your hands after using the toilet and before preparing, handling or eating food.
Do not drink water from rivers, streams, etc. If you have to drink water from outside sources, you should boil it first. Endeavor not to swallow water accidentally when swimming or taking part in other water sports on fresh water lakes, reservoirs, rivers, etc.
When abroad in under-developed countries do not drink tap water unless it has been boiled for at least a minute or properly filtered. Water purifying tablets will not kill the cysts. Be careful with uncooked or cold foods, ice, salads and unwashed fruit.
Increase household hygiene precautions if anyone has diarrhea.
Ensure that children, especially in close communities, such as playgroups or nursery schools, are properly toilet trained and that hand washing is supervised. Children with diarrhea should not attend playgroups or nursery.
Giardia lamblia can easily be passed from one person to another if there is a breakdown in personal hygiene. If someone in your household has Giardia lamblia, follow these precautions when taking care of an infected individual:
- Where possible use rubber or disposable gloves when cleaning up. Wash hands after contact with an infected person.
- Soiled clothing or bedding should be washed on the hot cycle of your washing machine.
- Clean surfaces and rubber gloves with hot water and disinfectant, and wash your hands thoroughly.
- When the toilet is flushed the lid should be down to prevent water droplets settling on surfaces in the room. After flushing always wash your hands and clean surfaces and handles frequently using a suitable disinfectant. Clean and disinfect the toilet, the toilet handle, water faucets and door handles regularly with a disinfectant.
- Shared towels can spread the cysts from one person to another. The person with Giardia lamblia should be allocated separate face wash cloths and towels that should not be used by anyone else.
- Young children should not be bathed together or share the same bath water as the water temperature will not be sufficient to destroy the cysts.
- Ideally the infected person should not prepare food. If this is not possible, then hands should be washed thoroughly, nails scrubbed and prepare only food that will be thoroughly cooked afterwards. Dishes should be washed in hot soapy water and preferably not by the infected person.
- Food handlers in commercial food premises must not under any circumstances work while they have symptoms of a gastrointestinal illness (vomiting or diarrhea). Food handlers who have been free of symptoms for at least 48 hours and are not taking any anti-diarrheal medicines (this does not include antibiotics) may return to work providing they are meticulous with regard to their personal hygiene. It is important for food handlers to inform their employer of their illness as some employers insist that food handlers are able to submit a negative stool specimen prior to their return to work. If you visit your health care provider, remember to say that you are a food handler if this applies to your situation.
Prevention of food poisoning is the aim and good personal hygiene, hygienic kitchen practices, proper storage of food items in the fridge, and thorough cooking will help protect you and your family from infection.
Resources:
Giardia lamblia Information
CDC: Giardiasis Infection Fact Sheet
Gastrointestinal Pathology
OutdoorPlaces.com: Giardia lamblia - Don't Get Beaver Fever
Giardia lamblia Intestinal Parasites Pictorial
Trichinella spiralis:
Description:
Trichinella spiralis is a roundworm that causes the infection known as trichinosis. Trichinosis is caused by the colonization of trichinella larvae in muscles where they grow an encyst. It is most often the result of eating raw or improperly cooked or processed pork or pork products and bear meat.
The worm was first reported in man in 1835 and was first recorded in the United States in 1846. It was demonstrated that Trichinella caused serious disease in man in 1865. This nematode was first discovered by a medical student in London who noted during dissection of a cadaver that muscle tissue contained gritty particles which tended to dull a scalpel.
The worm was at one time widely distributed in Europe and the United States. It is thought to have originated in the northern hemisphere, but now is known from some areas in South America and Africa. It occurs in New Zealand but not in Australia.
Symptoms:
First symptoms of infection include nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort and are due to invasion by adult worms. Migrating juveniles cause pain as they invade muscles tissue and the larvae cause a severe host reaction that results in soreness and tenderness of the muscles. Headaches, fevers, chills, cough, eye swelling, aching joints and muscle pains, itchy skin, diarrhea, or constipation follow the first symptoms. There may also be edema (swelling), delirium, cardiac and pulmonary difficulty (heart and breathing problems), pneumonia, nervous disorders, deafness and delayed or lost reflexes if infection is heavy. Severe symptoms are likely if the levels exceed 100 larvae per gram of muscle (8,400 per 3 ounces of muscle tissue). Although this parasite probably only rarely causes fatalities in humans, it can cause extreme discomfort.
Abdominal symptoms can occur 1-2 days after infection. Further symptoms usually start 2-8 weeks after eating contaminated meat. Symptoms may range from very mild to severe and relate to the number of infectious worms consumed in meat. Often, mild cases of trichinellosis are never specifically diagnosed and are assumed to be the flu or other common illnesses.
Trichinella spiralis is a parasitic roundworm. The life cycle of the parasite begins when the infectious cysts are eaten with the flesh of any meat eating animal. The cysts are digested by the acid in the stomach, dissolving the hard covering of the cyst, releasing the worms. The worms pass into the small intestine and, in 1-2 days, become mature. After mating, adult females lay eggs. The female hatches the immature worms (larvae) that are carried by the blood and travel through the arteries and lymph to the muscles. Within the muscles, the worms curl into a ball and encyst (become enclosed in a capsule). Infection occurs when these encysted worms are consumed in meat.
The Trichella Life Cycle:
This nematode has no stages outside a host. The adult worms are found attached to or buried in the mucosa of the duodenum. After mating the males die. Females (ovoviviparous) produce living young (approximately 1,500 per female over a period of 4 to 16 weeks) and then die. Juveniles enter the lymphatics and mesenteric veins and are found throughout the arterial circulation between the 7th and 25th day after infection. They travel in the hepatoportal system through the liver, then to the heart, lungs, and the arterial system, which distributes them throughout the body. They are transported to striated muscles, penetrate individual fibers, and cysts are formed around the juveniles. Within cysts, juveniles remain viable for many years, up to 25 years in man and 11 years in pigs. There is agreement that there are four juvenile stages but disagreement in the literature as to whether or not nematode development occurs within the cyst. When viable encysted juveniles are ingested, they are digested from the cysts and pass to the duodenum where they mature. Humans are essentially a dead end for the parasites.
Characteristics: The males measure 1.4 to 1.6 mm long and are more slender at the anterior than the posterior end. The anus is nearly terminal and has a large papilla on each side of it. A copulatory spicule is absent. Stichocytes are arranged in a row following a short muscular esophagus. Females are about twice the size of males, also tapering toward the anterior end. The anus is nearly terminal. The vulva is located near the middle of the esophagus, which is about a third the length of the body. The single uterus is filled with developing eggs in its posterior portion, whereas the anterior portion contains fully developed, hatching juveniles.
Cause and Risk of Infection:
Trichinosis is probably best known as a parasite that humans contract from eating raw or under cooked pork. If you eat raw or under cooked meats, particularly pork, bear, wild feline (such as a cougar), fox, dog, wolf, horse, seal, wild boar, or walrus, you are at risk for trichinosis. Through an aggressive program of meat inspection, the incidence of trichinosis in pigs in the United States has been lowered to less than 1%, so it is unlikely (but not impossible) that pork products purchased in your local supermarket will contain Trichinella larvae. Most recent outbreaks of trichinosis in the United States have been traced to pork products from pigs that have not been inspected and that have been slaughtered privately. Because of its low host-specificity, almost any "wild" meat should be considered suspect, and hunters should be careful when preparing meat from their kills. In particular, a number of infections have been traced to contaminated bear meat.
Infection can only occur by eating raw or under cooked meat containing Trichinella worms so you cannot spread it to others.
Complications of Infection:
In severe cases, death can occur. For mild to moderate infections, most symptoms subside within a few months. Fatigue, weakness, and diarrhea may last for months.
Diagnosis & Treatment:
If you think you or other family member might have trichinellosis, see your health care provider. Your health care provider can order tests and treat symptoms of trichinellosis infection. If you have eaten raw or under cooked meat, you should tell your health care provider.
Many cases are never diagnosed because of the vagueness of the symptoms. Muscle biopsy can be conducted and involves pressing muscle tissue between glass plates to look for cysts. Xenodiagnosis involves feeding suspected muscle to laboratory rats. A blood test can show if you have trichinellosis.
There is no cure for this infection. Relieve of symptoms are usually done with analgesics and corticosteroids. Check with your health care provider about safe and effective prescription drugs that may be available to treat Trichinellosis. Treatment should begin as soon as possible and the decision to treat is based upon symptoms, exposure to raw or under cooked meat, and laboratory test results.
Prevention:
Infection was once very common; however, infection is now relatively rare. From 1991-1996, an annual average of 38 cases per year were reported. The number of cases has decreased because of legislation prohibiting the feeding of raw meat garbage to hogs, commercial and home freezing of pork, and the public awareness of the danger of eating raw or under cooked pork products. Cases are less commonly associated with pork products and more often associated with eating raw or under cooked wild game meats.
- Thoroughly cook pork (at least 160°F) and other potential infected meats (bear, walrus, wild pigs, etc).
- Cook garbage fed to hogs and avoid cross-contamination of beef with pork. The concern from trichinosis is not as great today with improved pork production practices.
- Proper meat handling, ordinary curing and salting of pork products will not kill encysted juveniles.
- Freezing is effective if carried out properly. The freezing requirements differ with the size of the meat. Pieces not exceeding 6 inches in thickness require 20 days at 5°F, 10 days at -10°F, 6 days at -20°F. Larger pieces require longer periods. Quick freezing and storage for 2 days is effective.
Although there have been marked reductions in the percentage of hogs carrying encysted juveniles in the United States, there is considerable variation from one part of the United States to another. It is therefore a wise precaution to avoid uncooked pork products. In the United States Trichinella occurred in 0.4 to 2.5 percent of the prepared pork products examined in some areas (1961); however some areas had as much as 10 percent infection. In Chile 0.22 percent of 500,000 hogs were infected (1964). In Germany only 0.00026 percent of 14,000,000 hogs were infected (1965). It has been estimated that 3/4 of the persons infected with Trichinella are from North America.
Resources:
Trichinella spiralis Pictorial
Trichinella spiralis Information
Trichinella.org: Trichinella Biological Page
Scombroid Poisoning:
Description:
Scomboid poisoning (also called histamine poisoning) is a relatively rare type of food poisoning that can occur after the consumption of foods that contain high levels of histamine and possibly other vasoconstrictive amines and compounds. Histamine and other amines are formed by the growth of certain bacteria and the subsequent action of their decarboxylase enzymes on histidine and other amino acids in food, either during the production of a product such as Swiss cheese or by spoilage of foods such as fishery products, particularly tuna or mahi mahi and mackerel. After the fish is caught, decomposition by bacteria in the fish can trigger the production of high levels of a chemical called histamine.
Symptoms:
When the fish is eaten, initial symptoms may include a tingling or burning sensation in the mouth and throat, a rash (hives) on the upper body, sweating, dizziness, and a drop in blood pressure. In a matter of minutes the histamine can cause symptoms to progress to include facial flushing, nausea, vomiting, abdominal pain, and/or diarrhea. Frequently headaches and itching of the skin are encountered. Severe cases may blur vision and cause respiratory distress and swelling of the tongue. Hospitalization may be required, particularly in the case of elderly or people with allergies that may be very sensitive to a histamine reaction, and impaired patients. Fortunately, symptoms usually last for approximately 4 to 6 hours and subside in 24 hours, rarely exceeding one to two days.
Cause and Risk of Infection:
Fishery products that have been implicated in scombroid poisoning include the tunas (e.g., skipjack and yellowfin), mahi mahi, bluefish, sardines, mackerel, amberjack, and abalone. Many other products also have caused the toxic effects. The primary cheese involved in intoxications has been Swiss cheese. The toxin forms in a food when certain bacteria are present and time and temperature permit their growth. Distribution of the toxin within an individual fish fillet or between cans in a case lot can be uneven, with some sections of a product causing illnesses and others not. Neither cooking, canning, or freezing reduces the toxic effect. Common sensory examination by the consumer cannot ensure the absence or presence of the toxin. Chemical testing is the only reliable test for evaluation of a product.
Scombroid poisoning remains one of the most common forms of fish poisoning in the United States. Even so, incidents of poisoning often go unreported because of the lack of required reporting, a lack of information by some medical personnel, and confusion with the symptoms of other illnesses. Difficulties with underreporting are a worldwide problem. In the United States from 1968 to 1980, 103 incidents of intoxication involving 827 people were reported. For the same period in Japan, where the quality of fish is a national priority, 42 incidents involving 4,122 people were recorded. Since 1978, 2 actions by FDA have reduced the frequency of intoxications caused by specific products. A defect action level for histamine in canned tuna resulted in increased industry quality control. Secondly, blacklisting of mahi mahi reduced the level of fish imported to the United States.
All humans are susceptible to scombroid poisoning; however, the symptoms can be severe for the elderly and for those taking medications such as isoniazid. Because of the worldwide network for harvesting, processing, and distributing fishery products, the impact of the problem is not limited to specific geographical areas of the United States or consumption pattern. These foods are sold for use in homes, schools, hospitals, and restaurants as fresh, frozen, or processed products.
Complications of Infection:
The onset of intoxication symptoms is rapid, ranging from immediate to 30 minutes. The duration of the illness is usually 3 hours, but may last several days.
Diagnosis & Treatment:
Diagnosis of the illness is usually based on the patient's symptoms, time of onset, and the effect of treatment with antihistamine medication. The suspected food must be analyzed within a few hours for elevated levels of histamine to confirm a diagnosis. The suspected food must be analyzed within a few hours for elevated levels of histamine to confirm a diagnosis.
An official method was developed at FDA to determine histamine, using a simple alcoholic extraction and quantitation by fluorescence spectroscopy. There are other untested procedures in the literature.
Confirmation for scombroid poisoning is a simple histamine analysis of the suspect fish. A common, routine fluorometric procedure can determine milligrams (mg) of histamine per 100 grams (g) of edible fish. Histamine concentrations near or above 100mg/100g are typically noted in actual illnesses. Regulatory guidelines have not been established for all the various fishes of concern, but 50mg/100g is inferred from the U.S. FDA's poisonous action level for tuna.
Symptoms for scombroid poisoning can be easily confused with an allergy or other form of food poisoning, and vice versa. For example, some symptoms for scombroid poisoning are similar to ciguatera, another form of marine fish poisoning. Distinguishing these illnesses can be complicated, particularly about warm water regions.
What should one do if they suspect scombroid poisoning?
- Consult a health care provider, explaining your concerns, types and amount of food eaten, and when the symptoms began.
- Try to obtain portions of the meal, particularly the suspect fish. These portions must be carefully handled, packaged and frozen to prevent any deterioration.
- Try to verify the species and size of suspect fish, and how it was cooked and handled prior to cooking. Inquire where the fish came from. Knowledge of species, source and prior handling could implicate other forms of food poisoning. Note the method or source used to verify the species, realizing local vernaculars and menu nomenclature can be misleading.
- Consult with other professional in public health, food safety regulation or academic research that can better advise your health care provider. Many health care providers are not familiar with scombroid poisoning.
Prevention:
Avoid foods that may produce scombroid poisoning if you have severe histamine reactions.
Scombroid poisoning cannot be detected by appearance or taste. Proper handling of fish is the best safeguard. Studies have demonstrated that toxic histamine levels can be generated within less than six to 12 hours exposure without ice or refrigeration.
Remember potential scombrotoxic fish belong to a particular group of species that have been allowed to initially spoil. These species should always receive special care in handling, washing, and proper icing, refrigeration or immediate freezing to prevent bacterial growth and spoilage. Studies have demonstrated toxic histamine levels can be generated within less than 6 to 12 hours exposure without ice or refrigeration. This problem is of particular concern immediately after catch aboard a commercial or recreational boat. Likewise, the recreational catch lying on a warm dock or beach is prone to histamine production in certain species. The adverse consequence is not severe, but discomforting and alarming enough to warrant a little extra care. Prevention is simple and preferable to treatment which is similar as used for allergic reactions. Common advice from health care providers includes treatments with antihistamines.
Resources:
Scombroid Poisoning
Recreational Seafood Safety - Scombroid Poisoning
Food Safety Facts on Scombroid Poisoning
Other Food Poisoning Agents E-Coli 0157
Escherichia coli is a common organism found in the intestinal tract of man and animals and, like some other potential pathogens, it is also readily found in damp, ambient temperature environments e.g. soil, vegetation, moist or wet areas in factories, untreated water etc. There are many types and strains of E.coli, a few of which are potentially pathogenic. Different strains may cause illness by different infective and toxin-producing mechanisms. Symptoms vary according to the strain of E.coli encountered, and the resistance of the individual to such illnesses. Infants, young children, elderly and sick people are generally more susceptible to E.coli (and other) infections than healthy older children and adults.
E.coli 0157 are bacteria which can cause illness ranging from mild diarrhea to severe inflammation of the large intestine.
Diarrhea is the most common symptom; this can be mild and settle within two weeks but it can sometimes be more severe with abdominal pain and bloody diarrhea. Some people can be infected but may not show any symptoms. A very small number of cases may develop what is called hemolytic uremic syndrome (HUS), which is a form of acute kidney failure. HUS is a more likely complication in children and the elderly and requires admission to hospital for treatment.
The bacteria are found in the gastrointestinal tract of some cattle and other domesticated animals. Transmission to humans usually occurs through eating contaminated foodstuffs particularly beef products. Outbreaks have been associated with under cooked beef burgers and mince, lamb, pork, chicken and turkey, and unpasteurized milk, contaminated water and vegetables. Infection can also follow contact with infected animals, particularly on farms and animal sanctuaries.
The length of time from ingestion of the organism until the start of the symptoms is usually between 1 and 6 days but may be as long as 14 days.
Minimizing the risk of infection:
- Wash your hands before preparing food and after handling raw meat.
- Regularly clean and disinfect kitchen surfaces, equipment and utensils.
- Ensure that meat is defrosted thoroughly before being properly cooked - follow the manufacturer's cooking instructions. This particularly applies to minced beef.
- Keep cooked meat separate from raw meat at all times.
- Thoroughly rinse salads, fruit and vegetables in clean, running water.
- Keep raw meat separate from all other foods, especially desserts, cooked meats and salads, which do not need cooking.
If you have E.coli symptoms:
- If the symptoms are severe and/or prolonged, seek medical advice. It is particularly important that young children and the elderly, and those already under medical supervision are treated.
- If a member of the household is suffering from vomiting and diarrhea, the infection could be passed on to others.
- Clean and disinfect the toilet, toilet flush, taps and door handle regularly with a disinfectant.
- Make sure you wash your hands after contact with an infected person.
- If you work as a food handler, make sure that you tell your employer and the health care provider.
Link: E.Coli Infection
Hepatitis A
Hepatitis A is a viral Disease which affects the liver. It occurs most often in school children and young adults.
The illness usually begins with a sudden onset of fever (temperature), feeling unwell, loss of appetite, nausea and stomach pain. This is followed within a few days with jaundice: a yellow discoloration of the whites of the eyes and the skin. Children may have mild infections without jaundice.
The infection is most commonly spread from person to person by infected feces. The feces are infectious for two weeks before the person becomes ill and for about a week after the jaundice appears. The greatest risk of spread occurs where there is a possibility of contact with untreated sewage. People traveling abroad to developing countries where sanitation is poor are therefore at risk of becoming infected. Infection can occur also after consuming raw shellfish, for example uncooked oysters.
Symptoms may appear within 2 weeks after contact with an infected person.
Minimizing the risk of Hepatitis A infection:
- Wash hands thoroughly after using the toilet and before preparing food or eating.
- Avoid swimming where water may be contaminated with untreated sewage.
- Avoid eating uncooked shellfish, such as oysters and mussels.
- If you are traveling to a developing country, protection can be given from the virus by a single injection at least 10 days before traveling.
If you have Hepatitis A symptoms:
- If the symptoms are severe and/or prolonged, seek medical advice. It is particularly important that young children and the elderly, and those already under medical supervision are treated.
- If a member of the household is suffering from vomiting and diarrhea, the infection could be passed on to others.
- Clean and disinfect the toilet, flush taps and door handle regularly with a disinfectant.
- Make sure you wash your hands after contact with an infected person.
- If you work as a food handler, make sure that you tell your employer and your health care provider.
GENERAL PREVENTION & TREATMENT Many people have the idea that food poisoning is a thing of the past. After all, the United States is among the wealthiest nations on Earth. Our homes are equipped with the most modern appliances and conveniences, and most kitchens are reasonably clean. Thanks to our food safety, labeling, and inspection laws, our supermarket shelves are stocked with a nearly endless variety of foods that must meet strict governmental standards. Yet the truth is that food poisoning remains a major problem in this country, and strikes with a frequency that is both surprising and alarming.
The CDC offers several reasons for this. First, food animals are now raised in very close, confined quarters, a situation that is conducive to the spread of bacteria such as Salmonella. At the same time, food processing is becoming more and more centralized, so a single ingredient that is tainted with a contaminant can eventually show up in a multitude of different products. The United States now also imports record amounts of food from overseas, often from developing countries where proper hygiene in food production may not be as reliable as it is in this country.
Then there is a matter of food preparation. An increasing number of Americans are simply unaware of the prevalence of potentially dangerous microorganisms in the food supply, and lack knowledge of basic techniques for handling, preparing, and storing food safety. Most cases of food poisoning are easily preventable, provided you know how. (See General Tips for Preventing Food Poisoning below). Also more and more Americans, rather than eating meals prepared at home, purchase ready-made food at restaurants and from takeout establishments. One of the problems with this is that restaurants and food service companies may prepare large servings of turkey, chicken, beef, and other foods, and then leave them out at room temperature. Keeping food at room temperature encourages the growth of bacteria. C. botulinum, which is sometimes referred to as the "cafeteria germ", and Salmonella often breed in food that has not been cooked properly, or that has not been kept cold or hot enough.
General Tips for Preventing Food Poisoning
Here are some fast, easy rules to help prevent food poisoning at home and while eating out:
Keep food either hot or cold. Leaving food at room temperature encourages the growth of bacteria.
Keep perishable products refrigerated.
Refrigerate leftovers as soon as possible. Do not refrigerate foods in the same containers they were cooked or served in; transfer leftovers into clean containers so that they will cool more quickly.
Cook meat, poultry, and seafood thoroughly. Meats should be cooked to an internal temperature of at least 165°F.
Never use raw eggs that are cracked.
Wash your hands before handling food, and then after handling raw meat or poultry. Harmful bacteria can be transmitted if you handle food after diapering a baby or blowing your nose.
Keep two cutting boards, one for meat and the other for vegetables. This will prevent the transfer of bacteria from meat to vegetables. At least three times a week, wash your cutting boards with a solution of 1/4 cup of 3 percent hydrogen peroxide and 2 gallons of water. As an alternative, you can use a mixture of 1/2 cup of chlorine bleach and 1 quart of water, then rinse the board thoroughly with clean water.
Go home directly after grocery shopping, especially in warm weather. Store foods immediately according to the instructions on the labels.
Clean any utensil that has come in contact with raw hamburger, poultry, eggs, or seafood. Such utensils should not be allowed to come into contact with other foods until they have been disinfected.
Wash out lunch boxes and Thermos bottles after every use.
Beware of bulging cans, cracked jars, or loose lids on products. These can indicate botulism. Throw away cans that are bulging, rusted, bent, or sticky. Beware of cracks in jars and leaks in paper packaging, and exercise caution when consuming home-canned foods.
When reheating food, bring it to a rapid boil, if possible, and cook it at that temperature for at least four minutes.
Set your refrigerator temperature at 40°F or below. Freezers should be set at 0°F or below.
Wash kitchen towels and sponges with a bleach-and-water solution (1 part bleach to 20 parts water) daily.
Do not leave foods such as mayonnaise, salad dressing, and milk products at room temperature or, worse, out in the sun. Be especially careful at picnics and cookouts.
Do not give honey to a young baby. This can lead to infant botulism, in which botulinal spores colonize the digestive tract and produce botulin toxin there. Honey is safe for babies after age one.
Mold commonly grows on spoiled food products. The following foods should be avoided if mold is growing on them: bacon, bread, cured luncheon meats, soft dairy products, flour, canned ham, hot dogs, dried nuts, peanut butter, roast poultry, soft vegetables, and whole grains. Throw away any cooked or raw foods that are covered with mold.
Thaw all frozen foods, especially meats and poultry, in the refrigerator.
Eat hamburger and other meats only if they have been cooked at least until they turn brown. Meat or poultry that is even a little pink in color may still harbor bacteria. To ensure that all bacteria have been destroyed, it is best to cook meat until it is well done.
When preparing a chicken or turkey with dressing, do not stuff the bird until you are ready to pout it in the oven. Either cook the dressing separately or place it in the poultry immediately before putting it in the oven and then remove it as soon as the bird is done.
Exercise caution when eating at restaurants and salad bars. Do not eat at salad bars that do \ not look fresh and clean or that do not have protective glass over them. Avoid the following foods when eating at salad bars: chicken, fish, creamed foods, foods containing mayonnaise, under cooked foods, and soups that are not kept at near-boiling temperatures.
Before eating out, take 2 garlic tablets to help prevent food poisoning, as well as a product called ACES+Zinc from Carlson Labs to destroy any free radicals created by unknown toxins and oxidized fats in the food. HERBS
At the first sign of food poisoning, take a dropperful of alcohol-free goldenseal extract. Repeat this every 4 hours for one day. Goldenseal is a natural antibiotic that aids in destroying bacteria in the colon. Caution: Do not take goldenseal internally on a daily basis for more than one week at a time, do not use it during pregnancy, and use it with caution if you are allergic to ragweed.
Milk thistle and red clover aid in liver and blood cleansing.
Use lobelia tea enemas to rid the body of the poison. Adding a dropperful of alcohol-free goldenseal extract to the enema is beneficial as well. See Enemas for more information.
Nutrients Supplement Suggested Dosage Comments Very Important Charcoal tablets 5 tablets at first signs of illness and again 6 hours later. Take separately from other medications and supplements. Removes toxic substances from the colon and bloodstream. Garlic (Kyolic) 2 capsules 3 times daily, with meals. A powerful detoxifier that also destroys bacteria in the colon. Also destroys common parasites. Potassium 99 mg daily. To restore proper electolyte balance. Vitamin C with bioflavonoids 8,000 mg daily, in divided doses. Detoxifies the body and aids in removing bacteria and toxins. Plus
Vitamin E600 IU daily. Reduces symptoms by enhancing immune function. Important Acidophilus (Kyo-Dophilus from Wakunaga, Bifido Factor from Natren) As directed on label, twice daily, on an empty stomach. Replaces essential intestinal bacteria. Lecithin As directed on label, with meals. Promotes energy, enhances immunity, aids in brain function, and improves circulation. Fiber ( Aerobic Bulk Cleanse [ABC] from Aerobic Life Industries and Oat Bran are good sources) As directed on label, 6 hours after second dose of charcoal tablets and twice daily thereafter. Take separately from other supplements and medications. Removes bacteria that have attached themselves to the colon walls, preventing them from entering the bloodstream; this reduces symptoms and speeds recovery. Aerobic 07 (from Aerobic Life Industries) 20 drops in a glass of water every 3 hours. Destroys harmful bacteria such as Salmonella. Kelp 1,000-1,500 mg daily. Contains needed minerals to restore electrolytes. Or
ACES+Zinc from Carlson LabsAs directed on label. Contains vitamins A, C, and E plus the minerals selenium and zinc to protect immune function. L-Cysteine
And
L-Methionine
Plus
Selenium
And
Superoxide dismutase (SOD)500 mg daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption.
Selenium: 200 mcg daily.
SOD: 5,000 mg daily.All of these nutrients are essential in immune function.
RECOMMENDATIONS
If you suspect food poisoning, call your regional poison control center immediately. Poison control centers can be reached 24 hours a day, and can provide you with up-to-date information regarding treatment. See American Association of Poison Control Centers for more information or call 1-800-222-1222. It is a good idea to keep the number of your local center posted by your telephone and/or entered into your telephone's automatic dialing program.
At the first suspicion of food poisoning, protect your immune system by taking 6 charcoal tablets. These are available at most health food stores and should be kept on hand for emergencies. The agents in these tablets circulate through the bloodstream and help to neutralize and eliminate poisons. After 6 hours, take 6 more tablets. Consume a lot of quality water to aid in flushing toxins from the system. Activated charcoal is also available in liquid form, but this is often very difficult to swallow. Liquid activated charcoal can be obtained from most drug stores and pharmacies.
- Activated Charcoal Information
- Preventing Poisoning
- BetterLife.com: Activated Charcoal Tablets Purchase
Use cleansing enemas to remove toxins from the colon and bloodstream. See Enemas for more information.
If vomiting occurs, make sure that the individual does not choke. If vomiting does not subside in 24 hours, collect a sample of the vomit for analysis to aid in pinpointing the cause of the illness.
If you suspect that you have bee poisoned by food from a public restaurant or other eating place, contact your local health department right away. It may be possible to save others from food poisoning.
For some cases of poisoning, it may be desirable to induce vomiting to help expel the toxin that is the cause of the problem. Keep syrup of ipecac (available in drugstores) on hand for this purpose. Caution: Syrup of Ipecac should be used only at the direction of a health care provider or poison control center.
If symptoms of food poisoning are severe or prolonged, consult with your health care provider or go to your nearest emergency room for treatment.
CONSIDERATIONS
David Hill, a microbiologist at England's University of Wolverhampton, monitored all the bacteria present in the intestines and found that in the presence of garlic, disease-causing microbes were eliminated. According to Hill, the sulfur compounds in garlic are the secret weapon that knocks out dangerous bacteria. See MoonDragon's Articles: Superbugs: Is this the final warning? for more information about alternatives to using antibiotics to fight bacterial infections.
It was once believed that nylon or plastic cutting boards were preferable to the wooden variety. Since then, research has indicated that wood is probably better after all. Researchers have discovered that when cutting boards are contaminated with organisms that can cause food poisoning, almost all the bacteria on the wooden boards die off within 3 minutes, while almost none die on the plastic ones. For added security, you can wash your wooden cutting board periodically with hydrogen peroxide and water or a bleaching and water solution (see "General Tips for Preventing Food Poisoning" above). Articles about Plastic VS Wooden Cutting Boards (Pro and Con):
University of Florida: Plastic VS Wooden Cutting Boards
University of Minnesota: Plastic & Wooden Cutting Board (both carry organisms)
Department of Human Nutrition: Plastic VS Wood Cutting Boards (opposite view)
WhatsCookingAmerica: Types of Cooking Boards
Department of Agriculture: A Comparison of Wooden & Plastic Cutting Surfaces
The overwhelming majority (an estimated 90 percent) of cases of botulism in the United States are attributable to improper home-canning techniques. The best safeguard against this illness is to avoid all home-canned meats, fruits, and vegetables unless they have been prepared in a pressure cooker in scrupulous accordance with the manufacturer's directions. The old "stovetop" method of home canning is not a reliable way to seal the jar lids properly. If you use the "stovetop" method, be sure to follow directions carefully and can only those foods that are considered "safe" for this method. Links for Homecanning:
Homecanning.com: Low Acid Foods Step-by-Step
Homecanning.com: High Acid Foods Step-by-Step
Dialadietitian.org: Food Safety Homecanning
Homecanning.com: Canning Basics
A person who experiences a severe headache and vomiting soon after eating my be suffering from food allergies. Charcoal tablets and a coffee retention enema can help rid the body of substances that cause allergic reactions. See Allergies, Enemas, and Coffee Retention Enema for more information.
Interestingly, botulin toxin, one of the most potent toxins known to humans, has been attracting attention from the medical community as a potential therapeutic tool. The U.S. Food and Drug Administration recently approved the use of the purified form of botulin toxin as a drug to treat two muscle disorders that affect the eyes, blepharospasm (uncontrolled muscle spasms of the eyelids) and strabismus (a tendency of one eye to deviate from parallelism with the other). A tiny amount of the toxin is injected directly into the muscles to paralyze them, reducing symptoms. BOTOX® Cosmetic treatments are also used in the cosmetic surgical medical community as a cosmetic treatment. It is a simple, nonsurgical procedure that smoothes the deep, persistent lines between your brows that develop over time. Links Regarding Botulin Toxin (Botox) Uses:
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Seek immediate help: If you feel dizzy, lightheaded, or confused, or if you pass out. If you recognize symptoms of botulism. You need immediate medical treatment for a life-threatening illness. If you recognize symptoms of chemical food poisoning. You need immediate medical treatment to avoid potential damage to one or more of your vital organs.
If you have a fever over 101°F or sharp or gripping pains that last more than 15 minutes.
If you can't keep fluids down or have been vomiting for eight hours, call a health care provider; you may need IV fluids or medicine to stop the vomiting. The vomiting or diarrhea is severe and lasts for more than two days. You are at risk of becoming dehydrated.
If your symptoms don't let up within two days, it's time to see a health care provider. You might have a microbe that requires antibiotics or a more serious problem.
Other signals that you need help: You vomit blood, you have bloody bowel movements, or you stop urinating. *This guide is for generally healthy adults. Decisions on when to seek care can vary greatly for children, the elderly, or anyone with a preexisting condition, says Tom Scaletta, M.D., board member of the American Association of Emergency Medicine. The advice given here should not supersede common sense or your health care provider's opinion.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
MoonDragon's Health Index Page