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Food Safety (PUB508) > Gram positive pathogens > Flashcards

Gram positive pathogens Flashcards

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1
Q

GI symptoms related to the consumption of food can also be the result of what?

A

A food allergy (ex. peanuts, tree nuts, milk products, eggs, fish, shellfish, soy, wheat, sesame seeds)

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2
Q

What is the difference between food poisoning and food borne illness?

A

FBI= infection or toxin-mediated infection or intoxicated AND allergic reaction
Food poisoning= intoxication

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3
Q

What is the single most important aspect of food safety?

A

Temperature control

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4
Q

What is shelf life?

A
  • Recommended period of time during which a material may be stored and remain suitable for use
  • Foods with an atincipated shelf life greater than 90 days are not required to be labeled with a “best before” date or storage information
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5
Q

What is shelf stable?

A

Foods that can be safety stored at room temperature or “on the shelf”, do not require refrigeration after opening

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6
Q

What foods are shelf stable?

A

Non-perishable products (ex canned and bottled, jerky, rice, pasta, sugar, spices, oils, etc.)

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7
Q

How are foods shelf stable?

A
  • Heat and/or dried
  • Packaged in sterile airtight containers
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8
Q

What virus implicated in FBI has a vaccine?

A

Hepatitis A

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9
Q

What is FATTOM and what is the significance?

A

Food- nutrient and protein
Acid- grows best in pH 6.5-8.5
Time- grows more over time
Temperature- higher temperatures
Oxygen- some bacteria need oxygen, some don’t
Moisture- water activity under 0.5 isn’t hazardous (can reduce by adding sugar or salt)

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10
Q

Give an example of when it would be useful for a PHI to know the aw of a food?

A

Food is dried up and suspected of not having an aw of <0.85 and is held at room temperature or thought to be a food vehicle in an outbreak (ex fermented dried salami)

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11
Q

How does antibiotic resistance spread?

A
  • In animal farming
  • In the community
  • In healthcare settings
  • Through travel
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12
Q

How many gram positive pathogens cause diarrhea in humans?

A

7 classic gram+ pathogens that cause diarrhea in humans (the rest are gram -)

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13
Q

What are three cocci (spherical) gram positive pathogens?

A

Stretococcus, Enterococcus, Staphyloccocus

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14
Q

What are four bacilli (rod shaped) gram positive pathogens?

A

Two produce spores: Bacillus and Clostridium
Two do not produce spores: Corynebacterium, Listeria

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15
Q

Endospores are only formed by 2 genera of gram + bacteria: _____ and ______

A

Bacillus and Clostridium

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16
Q

Endospores: Sporulation occurs during _____ conditions

A

Harsh environmental conditions (ex lack of nutrients- starvation)

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17
Q

Endospores: bacterial spores are major __________ contaminants

A

environmental

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18
Q

Endospores are metabolically dormant resistant to ____, _____, _____, and _____.

A

heating (boiling), cold, drying, and chemical agents

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19
Q

Endospores: spores become active when exposed to _______

A

a favourable nutrient of environment

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20
Q

Clostridium perfringens: gram + or -, spore or non-spore forming, anaerobic or aerobic?

A

Gram +, spore forming rod, anaerobic (but aero tolerant)

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21
Q

Clostridium perfringens: responsible for a large % of _________

A

Foodborne diarrheal disease worldwide

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22
Q

Clostridium perfringens: reportable and notifiable?

A

Not reportable in Ontario, not notifiable in Canada

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23
Q

Clostridium perfringens outbreaks are common in Canada:

A
  • Community events and institutions, including hospitals, cafeterias, catering firms, and long-term care facilities
  • Likely very under-reported as laboratory does not routinely test for C. perfringens or its toxin
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24
Q

Clostridial Food Poisoning: food poisoning can be caused by _______ produced by _______ in the small intestine

A

C. perfrigens enterotoxin (CPE), C. perfringens spores

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25
Q

Clostridium perfringen spores can germinate in foods such as _____ and _____

A

Meats and poultry

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26
Q

Clostridium perfringens: exotoxins can also cause what other infections?

A
  • Clostridial myonecrosis (gas gangrene)
  • Clostridial cellulitis
  • Enteritis necrotican (pigbel)
  • CNS manifestations
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27
Q

C. perfrigens: small numbers of the organisms often are present after the food is cooked due to __________

A

germination of its spores

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28
Q

C. perfringens: spores survive _____ heat, relatively _____ tolerant

A

high heat, cold tolerant

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29
Q

C. perfringens: bacteria can grow at temperatures from ____C to ____C and grow _____ quickly

A

10C to 60C and grow VERY quickly

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30
Q

C. perfringens symptoms
- symptomatic or asymptomatic?
- severe or mild?
- profuse _____ with severe ______
- little or not _____, very few cases with ____ or _____
- recovery usually in _____ hours

A
  • often asymptomatic
  • typically relatively mild illness and unnoticed
  • bloating and gas
  • profuse diarrhea with severe lower abdominal cramps
  • little or not vomiting, very few cases with headache or fever
  • recover usually in 24 hours
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31
Q

C. perfringens: what is enteritis necroticans or “pig-bel disease”?

A
  • more severe than the other form of the illness, and often fatal
  • not found in Canada but in areas where conditions favour the disease
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32
Q

Why does pig-bel disease (clostridial necrotizing enteritis) mostly occur in developing countries ?

A
  • caused by C. perfrigens type C
  • mainly affects children with severe malnutrition; rare in Canada but cases have been seen in diabetics
  • prevalent globally in 1940s but then disappeared as nutritional status improved in some countries
  • called pig-bel disease because was associated with consumption of pig meat
  • overall very rare and mainly an issue in areas with severe malnutrition
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33
Q

C. perfringens infectious dose

A

> 10^6 live vegetative cells or >10^6 spores

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34
Q

C. perfringens type of illness?

A
  • Infection
  • Enterotoxin production in the digestive tract
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35
Q

C. perfringens route of transmission?

A
  • food poisoning/intoxication: ingestion of large numbers of vegetative cells present in the food, zoonotic
  • no secondary transmission
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36
Q

C. perfringens reservoirs?

A
  • soil, water, air, faeces of healthy and infected individuals, dust, vegetation, gastrointestinal tract of humans and animals, and variety of dehydrated and processed foods
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37
Q

C. perfringens incubation periods?

A

6-24 hours; median 12 hours

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38
Q

C. perfringens duration of illness?

A

24 hours, but can last as long as 1-2 weeks

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39
Q

C. perfringens mortaility?

A
  • rare for gastro-enteritis but possible
  • enteritis necroticans often fatal
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40
Q

C. perfringens outbreaks?

A
  • often institutions where large quantities of food are prepared and held in the danger zone
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41
Q

C. perfringens diagnosis/treatment?

A
  • feces/supportive care (antibiotics for pigbel)
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42
Q

C. perfringens pH?

A

5 minimum, 9 maximum

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43
Q

C. perfringens temperature growth range

A
  • approx 10 to 60C
  • grows VERY QUICKLY to infectious dose
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44
Q

C. perfringens oxygen

A

anaerobic (but aerotolerant)

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45
Q

C. perfringens water activity?

A

0.93-0.95

46
Q

C. perfringens biofilm formation?

A

Yes

47
Q

Factors most contributing to outbreaks?

A
  • allowing foods to remain at room temperature
  • slow cooling
  • inadequate reheating
  • inadequate hot holding
48
Q

Foods associated with C. perfringens infection include:

A
  • thick soups
  • stews
  • raw meat, poultry and beef
  • meat products
    -gravies
  • dried or pre-cooked foods
  • cooked beans
  • meat pies
49
Q

Prevention of C. perfringens

A
  • throughly cook foods to a safe internal temperature
  • use a digital food thermometer
  • keep food hot after cooking (at 60C)
  • microwave reheated foods thoroughly (74C)
  • refrigerate perishable foods within 2 hours (at 4C)
  • divide leftovers into shallow containers and refrigerate immediately. do not let cool on counter
  • do not overstock the fridge to allow circulation of air. ensure thermometer is present in fridge
50
Q

Why is reheating the last line of defence in preventing C. perfringens outbreaks?

A
  • spores can survive cooking; now they are vegetative cells that can be killed by reheating steps
51
Q

Why are ‘large’ chunks of meat in the food vehicles in outbreaks rather than thin meats such as hamburgers?

A
  • harder to get adequate internal temperature with larger meats rather than thin
  • should divide into small quantities
52
Q

Clostridium botulinum: Gram ___, ____ forming rod, _____

A

gram +, spore forming, anaerobic

53
Q

Clostridium botulinum: ubiquitous _____ spores

A

heat resisting spores = survives standard cooking and food-processing

54
Q

Clostridium botulinum: food borne caused by ingestion of ________

A

highly toxic neurotoxin preformed by the organism growing in food = food intoxication.

55
Q

C. botulinum: once in digestive tract, neurotoxin is _________

A

absorbed in the bloodstream

56
Q

ONE case of botulism = _______ = _______ = ________

A

outbreak= emergency= immediate notification to province and feds (rare, 4 clinical syndromes)

57
Q

C. botulinum: potent neurotoxin causes _______

A

Paralysis
- flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, to the throat, chest and extremities

58
Q

C. botulinum: fatal when paralysis involves ________

A

the respiratory system

59
Q

C. botulinum: toxin will work its way out of the victim’s system if ________

A

breathing assistance is provided

60
Q

C. botulinum: anaerobic milieu, non-acidic pH, low salt, and low sugar content = ________

A

small number of cases

61
Q

What pH level of foods can C. botulinum be found in?

A

low acid foods: pH> 4.5

62
Q

C. botulinum is _______ in the environment

A

widely distributed in the environment (ubiquitous)

63
Q

How many types of botulinum toxin?

A

7 types (A-G)

64
Q

A & some B= _______ = ________= _______

A

proteolytic= break off sulfur groups from proteins= SMELL

65
Q

Type E & some B= _____ = _______

A

non-proteolytic = NOT SMELLY

66
Q

Human cases are caused mostly by toxin __, __, __, and rarely __

A

A, B, E, and rarely F

67
Q

Toxin __ and __ cause botulism in animals; Toxin __ and __ cause botulism in birds

A

C and D; C and E

68
Q

No outbreaks of type __ have been reported

A

G

69
Q

Block acetylcholine transmission across NMJ= _______

A

neuromuscular blockade and flaccid paralysis

70
Q

Type __ most common in Canada

A

85%- Type E, followed by A & B

71
Q

C. botulinum is formed during growth of _____

A

vegetative cells

72
Q

C. botulinum toxin is heat ______

A

labile
- canning processes developed for prevention of C. botulinum
- all toxins are inactivated by heating to 85C for 5 min (some references say 1 min)

73
Q

C. botulinum toxin is used for _____ and may cause botulism (unlikely)

A

botox

74
Q

What is food borne botulism?

A
  • ingestion of foods containing the toxin produced by C. botulinum
  • spores survive in incorrectly or minimal processed foods, then germinate to produce toxin
  • improperly processed and inadequately cooked foods (home-preserved foods, low acid) (commercially produced foods)
75
Q

What is infant botulism?

A
  • ingestion of C. botulinum spores that colonize and produce toxin in the intestinal tracts of infants
  • bees may pick up the botulism spores from flowers or soil and the spores are not destroyed in the processing honey
  • after the age of one, children’s intestinal bacteria successfully prevent growth of C. botulinum
76
Q

What is adult intestinal botulism?

A
  • usually preceded by intestinal surgery or altered bacterial gut flora due to the use of antibiotics
77
Q

What is wound botulism?

A
  • rare
  • C. botulinum colonizes in a wound and produces toxins, which read other parts of the body via the bloodstream
  • injection drug use, occupational injury (farm)
78
Q

C. botulinum reportable and notifiable?

A

Reportable in Ontario and notifiable in Canada

79
Q

C. botulinum is the _____ reportable enteric disease in Ontario

A

rarest

80
Q

C. botulinum: from 2003-2016= ___ confirmed cases in ON

A

34 cases
- food borne (45%)
- infant (34%) and adult (17%) colonization
- no wound botulism cases, one case unknown
- most cases in older ages= may reflect increased likelihood of preparing and consuming high risk food such as home-canned vegetables
- most food borne cases related to consumed home-canned foods (46%), rarely from contaminated commercial products
- last outbreak= 2012= type E botulism in salted and fermented fish

81
Q

Foods related to C. botulinum?

A

low-acid; moist food with pH above 4.6
- some vegetables
- meat and poultry
- seafoods
- soup and milk
- spaghetti sauce with meat, vegetables, and tomatoes

82
Q

_____ cases of Botulism in Canada in 2019. Most outbreaks in _____ communities.

A

7 cases; northern communities (Nunavik, northern QC or BC)

83
Q

Botulism is primarily associated with ____ foods or _____ products

A

marine mammal foods or canned products

84
Q

Case fatality of C.botulism has dropped from __% to __% in Canada

A

17% to 5%

85
Q

Type A and B= primarily associated with _____
Type E= associated with ____, ____, _____

A

A and B= canned products
E= fish products, seal, whale meat

86
Q

Why do fish have high risk for food borne botulism?

A
  • Fesikh prepared salted and fermented fish (common exposure)
  • botulism spores are very present in the viscera of fish; difficult in reaching those areas
  • salt products create an anaerobic environment; botulism spores can germinate and product toxin
87
Q

Why are baked potatoes an issue with botulism?

A
  • spores could survive the cooking process
  • because cooking potatoes in aluminum foil creates an anaerobic environment
  • if left on counter, spores are allowed to germinate and produce toxin
  • should unwrap it and expose it to air; keep in fridge until ready to eat
88
Q

What are C. botulinum GI symptoms?

A
  • nausea
  • vomiting
  • diarrhea
89
Q

What are C.botulinum neurological symptoms?

A
  • weakness, constipation, dizziness, general muscle weakness, vertigo, double vision, blurred vision, respiratory paralysis (may result in death), facial weakness, pharyngolaryngeal paralysis
90
Q

Symptoms for food borne botulism:

A
  • blurred vision
  • nausea and vomiting
  • fatigue
  • weakness and ultimately paralysis
  • difficulty swallowing, speaking, breathing
91
Q

Symptoms for infant botulism:

A
  • same as adult
  • loss of appetite
  • head control
  • constipation
  • altered cry
  • limited movement of the limbs
92
Q

C. botulism infectious dose?

A

extremely small amount- a few nanogram of toxin

93
Q

C. botulism type of illness?

A

intoxication- ingestion of toxin, or creation of toxin

94
Q

C. botulism route of transmission?

A
  • food eaten without sufficient heat or post-production cooking
  • no secondary transmission
95
Q

C. botulism incubation period?

A

food borne: 18 to 36 hours, 4 hours to 8 days

96
Q

C. botulism duration of illness?

A

weeks to months, depending on the severity of illness and promptness of anti-toxin administration

97
Q

C. botulism mortality?

A

high CFR if not treated immediately and properly but typically 5-10%

98
Q

C. botulism outbreaks

A

primarily sporadic illness; limited outbreaks

99
Q

C. botulism diagnosis treatment

A
  • serum/stool
  • early administration of botulinum antitoxin supportive care
100
Q

C. botulism pH

A
  • toxin produced at pH >4.8
  • group I, type A, B, and F (proteolytic): 4.6 min, 9 max
  • group II, type B, E, and F (non-proteolytic): 5 min, 9 max
101
Q

C. botulism temperature growth range

A
  • group I, type A, B and F (proteolytic): min:10C optimum: 35-40C
  • group II, type B, E, and F (non-proteolytic): min 3C optimum: 18-25C
102
Q

C. botulism oxygen

A

anaerobic

103
Q

C. botulism water activity

A

Group I, type A, B, and F (proteolytic): 0.935
Group II, type B, E and F (non-proteolytic): 0.97

104
Q

C. botulism biofilm formation

A

unknown; unlikely

105
Q

Foods associated with C. botulism

A
  • canned product, smoked and salted fish, garlic in oil, etc.
  • low acid foods canned foods (asparagus, green beans, beets, corn, and fish or meat)
  • traditional dishes, which are fermented and consumed without cooking
106
Q

Factors most often impacted to C. botulism outbreaks?

A
  • inadequate time/temp during processing of low-acid foods or
  • anaerobic processing of sea mammals (Canada)
107
Q

How to prevent botulism? (food processing)

A
  • spore inactivation in low-acid foods by heating to 121C for 3 mins
  • toxin inactivated by treatment at 85C for 5 min, 80C for 6 min, or 65C for 1.5 hours
  • cooling rates that will prevent growth to hazardous levels
  • heat resistance of spores decreases at pH values >5 & >9
  • reduce pH of food to <_ 4.6
108
Q

How to prevent botulism at home?

A
  • preparing and canning foods safely
  • eliminating unpasteurized honey and peanut butter from the diets of infants
  • Covering wounds to avoid contamination with non-sterile substances and soil
  • Boiling canned foods for 10 minutes, whether they’re home-made or store-bought
  • Abstaining from injection drug use
109
Q

Do not taste or eat foods from containers that:

A
  • Are leaking
  • Have bulges or are swollen
  • Look damaged or cracked, or
  • Seem abnormal in appearance
110
Q

What is the issue with vegetables and herbs in oil?

A
  • Anaerobic conditions
  • Vegetables or herbs can be contaminated
  • Low acid food
  • Homemade or retail made; mixtures not provided in ideal environment
111
Q

Is the botulinum toxin a threat as a bioweapon?

A

Yes it is a threat; in aerosolized form it produces same symptoms

112
Q

How can I ensure safe home canning to prevent botulism?

A

Need high temperature and/or acidic environment to control and eliminate the germination of bacterial spores

Food Safety (PUB508) (2 decks)

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