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Gastroenterology & Nutrition > Food-borne Illness > Flashcards

Food-borne Illness Flashcards

1
Q

Probiotics

A
  • Alter microecology: reduce harmful organisms, stimulate immune response
  • Examples: lactobacillus, bifidobacterium
  • Sources: yogurt, supplements
  • Uses: diarrheal dx, ulcerative colitis, crohn’s, IBS, ABX
  • Prebiotics: non-digestible, stimulate growth or activity of beneficial organisms
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2
Q

Incubation Period - Important in food-borne illness

A
  • Toxin-mediated: <8hrs
  • Virus: 24-48 hrs
  • Bacteria: 1-5 days
  • Parasite: >5 days
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3
Q

Top 5 Pathogens Causing Domestically Acquired Food-borne Illness

A
  1. Norovirus
  2. Salmonella, nontyphoidal
  3. Clostridium perfringens
  4. Campylobacter spp.
  5. Staphylococcus aureus
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4
Q

Top 5 Pathogens Requiring Hospitalization

A
  1. Salmonella, nontyphoidal
  2. Norovirus
  3. Campylobacter spp
  4. Toxoplasma gondii
  5. E. coli O157
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5
Q

Top 5 Pathogens Causing Death in the U.S.

A
  1. Salmonella, nontyphoidal
  2. Toxoplasma gondii
  3. Listeria monocytogenes
  4. Norovirus
  5. Campylobacter spp.
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6
Q

Foodborne Illness Risk Groups

A
  • Infants and children
  • Pregnant women
  • Older adults (>65)
  • Chronic disease (liver disease, diabetes, cancer)
  • Immunocompromised (HIV, chemo, steroids, other immunosuppressive drugs)
  • Decreased gastic acidity (achlorhydria)
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7
Q

What is the most common bacterial cause of foodborne illness in the U.S?

A

Salmonella

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8
Q

Samlonella Etiology

A
  • Gram negative bacilli
  • S. enterica three serotypes - typhi, typhimurium, and enterica
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9
Q

Salmonella Sources of Infection

A
  • Raw meat - poultry, eggs, fish, raw milk, water
  • Feces of pets (reptiles and birds)
  • Common cross-contamination - drippings, utensils, surfaces, and other foods
  • Multiples rapidly at room temperature
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10
Q

Salmonella: Gastroenteritis

A
  • Incubation Period: 8-48 hours
  • Signs & Symptoms:
    • N/V/D (maybe bloody), headache, fever and chills, abdominal cramps
    • Self-limited: usually resolves in 3-5 days
  • Diagnosis: stool culture
  • Treatment: symptomatically and supportive generally
    • Non-pharm: oral fluids
    • may require IV fluids
  • Abx recommended for: severe cases, high-risk patients (bacteremia can occur)
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11
Q

Salmonella: Bacteremia

A
  • Potential complications:
    • Septicemia - blood cultures
    • Local bone or joint infections
    • Rare: mycotic AAA (patients with HIV)
  • Abx options:
    • Fluoroquinolones (Ciprofloxacin or Lexofloxacin)
    • Third-generation cephalosporins (Ceftriaxone and Cefixime)
    • Seeing growing drug resistance
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12
Q

Salmonella: Enteric Fever

A
  • Caused by serotype typhi
  • Signs & symptoms:
    • Gradual onset of N/V, abdominal pain, headache, and malaise
    • Bradycardia, splenomegaly, abd distention
    • Rose spots - second week of disease. Salmon-colored, blanching, 2-3mm in diameter
    • Stepladder rise of fever (103-104 F), then normal
    • Leukopenia
    • Positive stool, blood, and urine cultures
  • Several complications, including death
  • Other issues: carrier state and immunization
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13
Q

Campylobacter jejuni

A
  • Etiology: gram-negative spiral shaped bacteria
  • Source of infection: raw meat, poultry, raw milk, shellfish, water contaminated with animal feces
  • Incubation Period: onset 2-4 days, duration 2-7 days
  • Signs and symptoms:
    • Diarrhea (frequently bloody) - 1/3 of cases, abdominal pain, fever - 2/3 of cases, occasionally N/V
    • Invasive dysentery - small intestine and colon
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14
Q

Campylobacter jejuni - Diagnosis, Treatment, Complications

A
  • Diagnosis: stool culture
  • Treatment:
    • usually self-limiting
    • prolonged cases may need abx:
      • Fluoroquinolone (cipro or levo) or Azithromycin (preferred)
      • Growing abx resistance
  • Complications:
    • Guillan-Barre syndrome: 2-3 weeks after illness
    • Sepsis: immunocompromised patients
    • Death
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15
Q

Shigella

A
  • Etiology: 4 species
  • Sources of infection:
    • Fecal-oral route (including fomites, contaminated food or water)
    • Passed by food handlers or foods from contaminated soil
    • Daycare settings
    • Multiplies in small intestine then progresses to colon/colitis
  • Incubation period: onset 1-3 days
  • Typical duration: 4-7 days
  • Signs & Symptoms: Diarrhea with blood and mucous, crampy abdominal pain, fever, tender abdomen
  • Labs: fecal leukocytes with red blood cells, positive stool culture
  • Treatment: supportive, abx if indicated
  • Complications: reactive arthritis (HLA-B27), Hemolytic Uremic Syndrome
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16
Q

E. Coli 0157:H7

A
  • Enterohemorrhagic E. coli
  • Incubation Period: 1-8 days
  • Source: undercooked beef, unpasturized milk and juice, raw fruits and vegetables
  • Reservoir: found in feces of warm blooded animals
  • Person-to-person is feasible
  • Signs & Symptoms: bloody watery diarrhea (>5 stools daily), hemorrhagic colitis, abdominal pain
    • Usually resolves in 1 week
  • Diagnosis: stool culture
  • Treatment: NO abx or antiperistalic agents, supportive treatment
17
Q

Hemolytic Uremic Syndrome (HUS)

A
  • Affects 6-9% of those infected with EHEC. 15% in children <10 years old
  • Triad of HUS:
    • Acute renal failure
    • Microangiopathic hemolytic anemia
    • Thrombocytopenia
  • Patients with fever and neurological symptoms can have TTP
18
Q

Enterotoxogenic E. Coli (ETEC)

A
  • Most common form of traveler’s diarrhea
  • Source: water, contaminated food (salads, fruit, vegetables)
  • Incubation: 1-3 days
  • Duration: 3-7 days
  • Signs & symptoms: profuse, watery diarrhea, nausea with or without vomiting, abdominal cramping. Rarely life-threatening; self-limiting
  • Antibiotics only if prolonged course (FQ, Azithromycin, Rifaximin)
  • Prevention: peel it, cook it, boil it - or forget it!
19
Q

Vibrio Vulnificus

A
  • Incubation: 1-4 days
  • Source: undercooked or raw seafood (oysters)
  • Signs & symptoms: watery diarrhea, N/V, abdominal pain and cramping
  • Testing: stool culture on special medium
  • Treat suspected cases immediately!
    • Doxycycline or 3rd generation cephalosporin
  • Complications:
    • Immunocompromised (especially chronic liver disease) - sever sepsis and/or bullous cellulitis. 50% mortality rate
    • Causes skin infections through open wounds exposed to seawater
20
Q

Vibrio cholera

A
  • Incubation: 1-3 days
  • Source: contaminated water, food (fish, shellfish)
  • Signs & symptoms: asymptomatic or acute onset of vomiting, profuse watery diarrhea, dehydration
  • Treatment:
    • Oral rehydration
    • IV fluids and electrolytes
    • Abx in severe or moderate disease: doxycycline
21
Q

Listeria Monocytogenes

A
  • Etiology: gram-negative rod
  • Source:
    • soft cheeses, deli meats, hot dogs, smoked seafood, unpasturized dairy
    • soil, leafy vegetables, strawberries, raspberries, juices
    • food processing environments
  • Difficult to kill (survives cold temperatures)
  • Commonly affects: older adults, pregnant women, newborns, and adults with weakened immune systems
  • Incubation period: GI symptoms wtihin 24 hours
  • Signs & symptoms: vary; fever, watery diarrhea, N/V, headache, joint/muscle pain
    • Older adults & immunocompromised: septicemia and meningitis
    • Preg. women: fever and nonspecific sxs. may result in fetal loss or severe illness in newborn
  • Diagnosis: blood cultures
  • Treatment: ampicillin
22
Q

Staphylococcus aureus

A
  • Common bacteria found on the skin
  • Etiology: preformed toxin produced when contaminated foods are stored at room temperature
  • Sources: meat, poultry, eggs, tuna; potato and macaroni salads; bakery items
  • Incubation period: 1-8 hours (rapid onset)
  • Duration: 2-3 days
  • Signs and symptoms: intense N/V, fever is NOT common, usually self-limiting
23
Q

Clostridium perfringens

A
  • “cafeteria germ”
  • Etiology: spore forming gram-positive bacilli, toxin produced in the intestines
  • Source: beef, poultry, gravies, and dried or precooked foods, soil
  • Incubation period: 8-16 hours
  • Duration: self-limited (24-48 hours), up to 2 weeks in high-risk groups
  • Signs & symptoms: abrupt onset of profuse watery diarrhea, abdominal cramps, nausea, vomiting - little to none
  • Treatment: supportive, IV fluid and abx if indicated
24
Q

Clostridium botulinum

A
  • Source: home canned beans, mushrooms, olives, spinach, and beef, honey and corn syrup
  • Incubation period: 18-36 hours
  • Signs & symptoms: N/V/D followed by constipation
    • classic sxs of botulism (descending paralysis)
    • can be fatal
  • Antibiotics are not recommended
  • Antitoxin plays a role - slows progress
25
Q

Trichinosis

A
  • Parasite
  • Source: undercooked meat (pork and wild game)
  • Incubation period: varies; 1-2 weeks (enteral phase), 2-8 weeks (parenteral phase)
  • Signs & Symptoms:
    • Early: asymptomatic (majority), N/V/D, abdominal pain, muscle weakness
    • Later: fever, myalgias, periorbital edema, splinter hemorrhages, eosinophilia
  • Diagnosis: history, signs and symptoms, labs (serology, muscle biopsy)
  • Treatment: antiparasitic
26
Q

Hepatitis A

A
  • Virus
  • Transmission: fecal-oral
  • Sources: shell fish, fruits, vegetables, water, ice
  • Incubation period: 30 days
  • Symptoms: mild, but may last for several months
    • dark urine, fatigue, low-grade fever, poor appetite, N/V, jaundice, pale or clay-colored stools
    • young children may be asymptomatic
  • Treatment: supportive
27
Q

Norovirus (norwalk virus)

A
  • Common source: infected food handlers contaminate food
    • person-to-person
    • fecal-oral with contaminated food or water
  • Incubation: 12-48 hours
  • Signs & Symptoms: N/V, watery diarrhea, abdominal pain
  • Treatment: self-limiting

Gastroenterology & Nutrition (6 decks)

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