​Kembara Xtra - Medicine - Bacterial Food Poisoning

​Kembara Xtra - Medicine - Bacterial Food Poisoning 
Food poisoning, also known as foodborne illness, is an illness that can be contracted by eating or drinking something that has been contaminated with harmful microorganisms, parasites, or viruses. Ingestion of molds, toxins, pollutants, and/or allergies are further potential causes of mold-related illness.
Foodborne disease is normally self-limiting and resolves with supportive care, but in some cases can lead to severe dehydration and critical illness. Symptoms are most commonly gastrointestinal in origin. Foodborne sickness is typically self-limiting and resolves with supportive care.
Up to eighty percent of the time, the root cause is a mystery.
The majority of illnesses that are spread by food are caused by viruses, with norovirus being the most prevalent of these. Hepatitis A, rotavirus, and adenovirus are three more viruses that might lead to this condition.
Since 2013, Campylobacter and nontyphoidal Salmonella have been the two bacteria that have been responsible for the most cases of bacterial foodborne illness in the United States.
Additional, less frequent infections such as Shiga toxin-producing Escherichia coli (STEC), Shigella, Cyclospora, Yersinia, Listeria, and Vibrio
Salmonella infections, also known as nontyphoidal infections, are the most common type of foodborne sickness that can lead to hospitalization and even death.
Incidence
Each year, approximately 1 in 6 people in the United States (48 million) and 1 in 10 people in the rest of the globe become ill from a foodborne illness.

There are 128,000 cases of foodborne illness that result in hospitalization in the United States, and 3,000 of those cases result in death.


Causes and effects: etiology and pathophysiology 
A brief incubation time, ranging from one to six hours, for the Bacillus cereus toxin.
The toxin is resistant to the effects of high temperatures.
 The following foods should be avoided: red meats and rice that has been inadequately cooked
Staphylococcus aureus is associated with the following symptoms: abrupt onset of severe nausea; vomiting and diarrhea The poison acts as a mediator; the toxin is not affected by heat.
 Food sources include meats that have not been refrigerated or have been refrigerated incorrectly, as well as potato, mayonnaise, and egg salads.
 Acute onset of severe nausea and vomiting, as well as abdominal cramps and fever Medium incubation period (eight to sixteen hours) - B. cereus (4)
 The following are potential sources of food: meat, stews, gravy, and vanilla sauce
 Some symptoms include cramping, nausea, and diarrhea that is watery.
— Clostridium perfringens Long incubation period (more than 16 hours) Food sources: dry/precooked or undercooked meats, home-canned goods Symptoms: watery diarrhea, nausea, and cramps Food sources: dry/precooked or undercooked meats Toxin-producing organisms:
○ Clostridium botulinum
Food source: foods that have been canned either commercially or in an incorrect manner at home
Enterohemorrhagic E. coli (e.g., 0157:H7) Food sources: undercooked ground beef, juice, unpasteurized milk; raw produce; and contaminated water Risk factors: daycare centers, nursing homes, and extremes of age Symptoms: severe diarrhea that often becomes bloody, abdominal pain, and vomiting Enterohemorrhagic E. coli (e.g., 0157:H7) Symptoms: severe diarrhea
 Enterotoxigenic E. coli (also known as "traveler's diarrhea") Food sources: food or water that has been contaminated by human feces Symptoms: watery diarrhea, abdominal cramps, tenesmus, fecal urgency, and vomiting Vibrio cholerae Food sources: contaminated water, fish, and shellfish, particularly food sold by street vendors Symptoms: profuse watery "rice water"
○ Salmonella, nontyphoidal
Contaminated food sources include eggs, chicken, raw fruit and vegetables, unpasteurized milk or juice, cheese, raw poultry and eggs, and peanut butter.
One of the potential dangers is having interaction with animals.

 Symptoms: cramps, fever, diarrhea that is bloody or mucopurulent, and vomiting Campylobacter jejuni Food sources: raw and undercooked poultry, unpasteurized milk, and infected meats Symptoms: bloody diarrhea, cramps, and fever Shigella Food sources: raw and undercooked poultry, unpasteurized milk, and contaminated meats Food sources: raw and undercooked poultry, unpasteurized
Food sources include contaminated water, raw produce, undercooked foods, and foods handled by infected food workers. Risk factors include men who have sex with other men. Symptoms include abdominal cramps, fever, and diarrhea that is mucopurulent and bloody. Vibrio parahaemolyticus is the organism that causes these illnesses.
Food source: undercooked or raw seafood, particularly shellfish; Risk factors: cirrhosis; Symptoms: nausea, vomiting, diarrhea, abdominal pain; Vibrio vulnificus; Food source: undercooked or raw seafood, particularly oysters; Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, wound infections; can be fatal in patients with liver disease or those who are immunocompromised;
○ Yersinia enterocolitica
Food sources include rare beef and pork, unpasteurized milk and tofu, and contaminated water. Cirrhosis, hemochromatosis, and blood transfusions are risk factors.
Patients may experience abdominal pain, fever, diarrhea (which may be bloody), and vomiting.
○ Listeria monocytogenes
Symptoms include nausea, vomiting, fever, and diarrhea that is watery. Pregnant women may experience a flu-like illness that can lead to premature delivery or stillbirth. Immunocompromised patients may develop meningitis and bacteremia. Food sources include unpasteurized or contaminated milk, soft cheese, and processed deli meats. Risk factors include pregnancy. Food sources include unpasteurized or contaminated milk, soft cheese, and processed deli meats.

Risk Factors Recent travel to developing countries Food handlers, daycare attendees, nursing home residents, recently hospitalized patients, or patients recently exposed to antibiotics Altered immunity due to underlying disease or use of certain medications, including antacids, H2 blockers, and proton pump inhibitors Cross-contamination and subsequent ingestion of improperly prepared and stored foods Cross-contamination and subsequent ingestion of improperly prepared and stored foods Pregnancy Children older than 5 years and adults older than 65 years

Prevention 

When preparing food, make sure to wash your hands, cutting boards, and any other surfaces that will come into contact with the food.
Before ingesting, make sure to properly wash all fresh produce. Separate raw meat, poultry, and fish, as well as their liquids, from other foods (like salad, for example). Put on gloves before handling raw meat, cook the meat thoroughly, and store any leftovers in containers that are clean, shallow, and covered in the refrigerator within two to three hours. Refrigerate within an hour if the temperature is higher than 90 degrees Fahrenheit.
Eat only food that has been freshly made if you are going to be traveling to a developing country. Steer clear of beverages and foods that have been prepared with nonpotable water. – It is okay to consume beverages that have been bottled, carbonated, or boiling.  It is recommended that travelers who are at a high risk of getting traveler's diarrhea (such as those who are immunocompromised) take chemoprophylaxis.

Conditions That Often Occur Together 

 Botulism is a neuroparalytic disorder that has the potential to be fatal. It is characterized by symmetric neurologic impairments and changes in mental status, and it is caused by the intake of toxin types A, B, and E that are generated by Clostridium botulinum. Foods that have been home-canned, such as fruits, vegetables, and meats, are often the source of outbreaks.

 Neonatal meningitis — Immunocompromised hosts, in particular neonates (younger than 29 days old), are at risk for developing meningitis as a result of a systemic L. monocytogenes infection.
Hemolytic uremic syndrome (HUS) is a hematologic disorder that is characterized by microangiopathic hemolytic anemia, renal impairment, and thrombocytopenia; it is caused by both Shigella and STEC; it can be precipitated in individuals harboring enterohemorrhagic E. coli who are treated with antibiotics; it is caused by both Shigella and STEC. 
 Guillain-Barré syndrome, which is characterized by ascending paralysis and is strongly linked to infection with C. jejuni
Reactive arthritis is a type of arthritis that can develop following severe infections with Salmonella, Shigella, Yersinia, or Campylobacter species.

The presentation of the history should include the onset, length, frequency, intensity, and nature (such as watery, bloody, mucus-filled, etc.) of the patient's diarrhea.
The passage of >3 or more unformed stools daily or the passage of >250 g of unformed stool per day is considered to be the definition of diarrhea.

Suspect bacterial food poisoning when numerous people experience rapid start of symptoms soon after eating the same meal; high fever; blood or mucus in stool; severe stomach discomfort; signs of dehydration; or recent travel to a foreign country.

 Additional examination and treatment in the event that the patient has a high temperature (more than 101.3 degrees Fahrenheit), less than six stools per day, blood in the stools, an elevated white blood cell count, indications of dehydration, or diarrhea that lasts for more than two to three days


The Patient's Clinical Examination 

 The most important symptoms of dehydration are a delayed capillary refill, reduced skin turgor, dry mucous membranes, and orthostatic hypotension.
Invasive germs or bacteria that produce toxins could be the cause of fever.
Examine the patient's abdomen for pain, peritoneal signs, and bowel activity in order to differentiate this condition from other acute abdominal processes. Perform a rectal exam to check for blood, rectal pain, and stool consistency.

Differential Diagnosis 

Additional infectious gastrointestinal diseases (such as those caused by viruses or parasites), Clostridium Difficile colitis, inflammatory bowel disease, appendicitis, acute cholecystitis, acute choledocholithiasis, acute diverticulitis, acute hepatitis, and malabsorption diseases (such as celiac disease, Helicobacter pylori infection, and short bowel syndrome) are all examples of conditions that can be caused by a bacterial overgrowth in the digestive tract.

Results From the Laboratory Initial Examinations (lab, imaging)

Unless there are evidence of fever, blood, or severe diarrhea, a stool culture is normally not indicated and is unlikely to modify the management of the condition if it is a moderate sickness that will resolve on its own.

 It is not necessary to test for fecal leukocytes and fecal occult blood unless the patient has a fever or bloody diarrhea (6). Additionally, it is important to examine ova and parasites in cases of dehydration, a history of international travel, or symptoms that have lasted for more than two weeks.

 Complete blood count and basic metabolic profile for severe instances associated with dehydration, hospitalization, or nursing home exposure

● Consider endoscopic assessment for severe instances. Patients who have AIDS and recurrent diarrhea should have a low threshold for endoscopy. Abdominal CT may be helpful when intra-abdominal pathology is in the differential diagnosis and the clinical presentation is uncertain.

Additional Examinations, as well as Other Important Factors
Investigation using epidemiologic methods might be appropriate. The standards for reporting are different depending on the state and the organism.


Management 
The majority of instances of food poisoning resolve on their own.

The First Line Of Defense Is Medication

In cases of acute diarrheal disease, the initial treatment that is recommended is rehydration by mouth.

The majority of patients with mild illness do not require formal ORS and can rehydrate with fluids and salt-rich foods. Empiric antibiotic therapy is not recommended for most cases of acute diarrhea (unless it is suspected to be traveler's diarrhea).
Second in Rank
Antibiotics should only be considered for patients who have serious illnesses that require hospitalization, as well as individuals who have fever and hematochezia, or when diagnostic testing indicates that a bacterial source is the cause of the infection.
 Treatment that is particular to the pathogen:
B. cereus patients are only eligible for supportive care.
a moderate case of C. jejuni requires simply supportive therapy because antibiotics may lead to the development of resistance. For severe cases, take 500 mg of azithromycin once day for three to five days. Fluoroquinolones are no longer recommended .

 Care limited to supportive measures only for C. botulinum. When used early on in the course of an illness, antitoxin can be beneficial.
Care only limited to supportive treatment for C. perfringens
(1) Patients with enterohemorrhagic E. coli (for example, 0157:H7) should only receive supportive care. Maintain a close eye on the patient's platelets, hemoglobin, and renal function. Infection that is linked to HUS. Steer clear of antibiotics if you can, as doing so could make your HUS risk higher.
Enterotoxigenic E. coli, the most prevalent cause of traveler's diarrhea, typically resolves itself without medical intervention. Antibiotics can cut the length of an illness in half. Azithromycin 1 g as a single dose or once daily for three days; ciprofloxacin 500 mg BID or 750 mg once daily for one to three days; or rifaximin 200 mg TID for three days

 Salmonella (nontyphoidal): There is no treatment for mild sickness (although medications may extend the shedding process). Moderate: use ciprofloxacin 500 mg twice daily (BID) for 5 to 7 days, levofloxacin 500 mg once daily (BID) for 7 to 10 days, or TMP/SMX DS 160/800 mg twice daily (BID) for 5 to 7 days. Severe diarrhea, being immunocompromised, showing indications of the body's systems, and having positive blood cultures: IV administration of 1 to 2 grams of ceftriaxone every day for 7 to 10 days
Shigella: ciprofloxacin 500 mg BID or 750 mg daily for 3 days, or a single dosage of 2 g; additional alternatives include azithromycin (the treatment of choice subsequent to quinolone resistance) 500 mg BID for 3 days, TMP/SMX DS 160/800 mg BID for 5 days, or ceftriaxone 2 to 4 g single dose.

S. aureus patients should receive just supportive care. Noncholeraic Vibrio 1 patients should take either ciprofloxacin 750 mg daily for 3 days or azithromycin 500 mg daily for 3 days.
• V. cholerae: doxycycline 300 mg as a one-time dose in the majority of cases, or tetracycline 500 mg QID for three days, or erythromycin 250 mg TID for three days, or azithromycin 1,000 mg as a single dose or 500 mg/day for three days.
Yersinia: in most cases, just supportive care is necessary. Treatment options for severe cases include combining doxycycline and aminoglycoside; taking TMP/SMX DS 160/800 milligrams twice daily for five days; or taking ciprofloxacin 500 milligrams twice daily for seven to ten days.


Extra Medical Interventions 

Promethazine is an excellent treatment for severe cases of nausea and vomiting in adults. Ondansetron is helpful in treating nausea and vomiting in children.

Unless there is a high temperature, bloody diarrhea, and/or severe stomach discomfort present (evidence of enteroinvasion), the recommended starting dose of loperamide is 4 milligrams, followed by 2 milligrams after each loose stool up to a maximum of 8 milligrams in a period of 24 hours.

Taking bismuth subsalicylate in a dose of 525 milligrams twice daily (QID) is useful in treating traveler's diarrhea to a moderate degree.
There is little and contradictory evidence to support the claims that probiotics and prebiotics are effective. Outside of infectious diarrhea caused by antibiotics, use is not currently suggested. Washing your hands frequently while you have an illness is the best way to prevent it from spreading to other people.

Ongoing Medical Attention 

When nausea is prevalent or vomiting prevents food intake, your eating habits should be adjusted. Take in a lot of fluids in little sips as much as possible, and as soon as the queasy feeling passes, start eating bland, low-fat meals and get some rest. Avoid things like alcohol, caffeine, tobacco, and foods that are particularly spicy.
Breastfeed nursing newborns whenever they are hungry. The typical fare ought to be served to both infants and children of older ages. Consider following a bland diet if you have diarrhea.
● The use of dairy products should be restricted for at least 24 hours after the conclusion of the last episode of diarrhea.

The majority of infections are self-limiting and will go away on their own within a number of days. When treating moderate to severe cases of traveler's diarrhea, antibiotics can cut the length of the illness by several days.