Diseases Acquired through the alimentary route

1. Diseases Acquired through the alimentary route Botulism Hemorrhagic colitis (Escherichia Coli 0157:H7)

2. Clostridium botulinum • Gram-positive bacteria • Rod shaped • Most commonly found in the soil • Spore forming • Strict anaerobe • Heat sensitive • Prefers low acidic environment

3. Botulism • Severe intoxication from the exotoxin produced by Clostridium botulinum • Results in a life-threatening paralytic illness • Systemic illness • When the toxin is ingested in contaminated food is absorbed from the intestine into the system, it results in the paralysis of cranial and peripheral nerves

4. Transmission • Generally the result of eating foods that have been inadequately cooked, allowing the toxin to form • In the U.S. home canned fruit and vegetables have been involved in most botulism cases

5. Outbreaks • The largest botulism outbreaks in the U.S. in the past 19 yrs. occurred in El Paso, Texas: April 1994 • The toxin had formed in aluminum foil-wrapped baked potatoes held at room temperature for several days before they were used in a potato-based dip at a restaurant • 30 people were affected and 4 required mechanical ventilation

6. Symptoms • The first signs generally relate to the effects of the toxin on the nervous system • Person may experience dizziness, difficulty in swallowing, and double vision • Nausea, vomiting, and diarrhea may occur earlier, ant the same time or later • Descending paralysis and death usually occurs from respiratory paralysis

7. Treatment and Prevention Prevention Effective control of processing and preparation of commercially canned and preserved foods Educating everybody that prepares and serves food Any bulging cans or jars that do not seem sealed should not be opened or used Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated Treatment • Intramuscular (IM) or IV administration of botulinum antitoxin

8. E. coli

9. E. Coli • Gram negative • Morphology: Straight rods • Aerobic/Facultative anaerobic • Not spore forming • Non capsulated and motile

10. E. Coli • E. coli is a normal inhabitant of the intestines of all animals including humans • Useful function in the body: suppresses the growth of harmful bacterial species and helps in the synthesis of vitamins • Only some E. coli are pathogenic • Cause either diarrhea or illness outside the intestinal wall

11. E. coli • Consists of a diverse group of bacteria • Pathogenic E. coli strains are categorized into pathotypes • Six pathotypes are associated with diarrhea • EHEC- enterohemorrhagic E. coli: hemorrhagic colitis or hemolytic uremic syndrome • Also referred to as Shiga toxin producing E. coli (STEC) • ETEC- enterotoxogenic E. coli- traveler’s diarrhea • EPEC- enteropathogenic E. coli- childhood diarrhea • EIEC- enteroinvasive E. coli- Shigella like dysentery • EAEC- eteroadherent E. coli- childhood diarrhea, some cases of traveler’s diarrhea • EAggEC- enteroaggregative E. coli- persistent diarrhea in developing countries

12. Transmission Organism responsible for hemorrhagic colitis: Escherichia coli 0157:H7 • By ingestion of contaminated food or water • Person to person • Organism can be found in hamburger and other meats • different sources including apple juice, coleslaw, jerky made from dear meat, and alfalfa sprouts http://www.cdc.gov/ecoli/2012/O157H7-11-12/index.html

13. Symptoms • Severe cramping and diarrhea are the first symptoms • Diarrhea is watery at first, but in most victims, becomes bloody • Occasional vomiting • Low grade fever or none at all • Illness lasts and avg. of 8 days

14. Treatment • Most cases require not therapy, but fluid replacement may be necessary • Some evidence has shown that antibiotic treatment can increase the risk of complications, but further investigation needs to be done

15. Prevention • Families of people who are ill need to be educated about possible person-to person transmission • “Ten Golden Rules for Food Preparation” by WHO • Choose food processed for safety • Cook food thoroughly • Eat cooked food immediately • Store cooked food carefully • Reheat cooked foods thoroughly • Avoid contact between raw and cooked foods • What hands repeatedly • Keep all kitchen surfaces meticulously clean • Protect foods from insects, rodents, and other animals • Use pure water