IO 1

Food Intoxication
Dr. dr. I Gede Arinton,SpPD-KGEH
The Internal Medicine Department
FKIK Unsoed/Margono Hospital
Purwokerto,2010.
IO 2
Introduction
Classifying Foodborne Illness :
Foodborne Infections
Result when a person eats food containing
pathogens, which then grow in the intestines and
cause illness
Foodborne Intoxications
Result when a person eats food containing toxins
that cause illness
Foodborne Toxin-Mediated Infections
Result when a person eats food containing
pathogens, which then produce illness-causing
toxins in the intestines
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Introduction
Adverse reactions to food :
Food intolerance (most common) :
toxins
infections
pharmacological properties of food
host factors (lactase deficiency)
Food allergy (hypersensitivity)
Food aversion (phobia)
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Introduction
Toxicology = the science of poisons/toxicants/toxins-
substance capable of causing harm - = seriously injuring or,
ultimately, causing the death
Food toxicology - substances found/contaminate food -
consume sufficient quantities - harmful
Poisons were known and studied by the ancient Greeks.
The fundamental concept of toxicology - Paracelsus (1493 -
1541) - his commentary :
all substances are potential to be a poison poisons
the right dose - cure.
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TOXICANTS IN FOODS
Potential sources of toxicants in food
Nutrients :
= A food substance that provides energy or is necessary
for growth and repair.-- Ex. vitamins, minerals,
carbohydrates, fats, and proteins.
Natural food toxicants:
plants and some animals that are sources of food
Contaminants- Chemical & pathogen
Chemicals or substances - food additives- food
reservation+ processing.
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GIT Physiology
The primary function of the GI tract :
break down complex food components into substances
appropriate for absorption into the body.
waste removal
keep substances that are of no value or are potentially
dangerous out of the body.
Food enters the mouth- chewing mixes it with saliva -
Amylase - destroys some of the bacteria.
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GIT Physiology
The stomach - hormone gastrin is released- stimulates the
release of HCl & pepsinogen- pH 2.0 critical defense &
protects from many pathogens by the partial denaturation of
proteins- eg. Salmonella
4 - 6 h chyme - intestine - absorption
Bile- Enterohepatic circulation- excretion toxicants
metabolic degradation to urinary excretion - eliminates the
toxicant from the body.
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Food microbiology
Bacteria :
Salmonellosis
Shigellosis
Vibrio Gastroenteritis
Hemorrhagic Colitis
Staphylococcal Intoxication
Botulism
Virus- Hepatitis A
Parasite
Fungus
Two groups of food contaminates
Pathogen (cannot see or smell or taste)
Spoilage (can be seen or smelled or tasted)


IO 9
Food microbiology
Staphylococcal food intoxication :
most prevalent foodborne disease.
Onset may 30 min - 8 hrs
Symptoms: nausea, vomiting, cramps, sweating, chills,
weak pulse, shallow respiration, subnormal body
temperature.
Recovery usually occurs within 24-48 hrs.
Source of infections:
infected wounds and lesions of food handlers
coughing and sneezing
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Food microbiology
Salmonellosis :
40% of all recorded foodborne diseases
usually self limiting acute gastroenteritis
the incubation period 6-48hrs (12-36hrs]
symptoms: diarrhea, abdominal cramps, vomiting and
fever. Generally last 1-7 days.
Associated both with animals both wild and domestic
Food associated: beef, turkey, home-made ice cream, pork,
chicken and raw eggs.

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Food microbiology
Clostridium botulinum
Sporeforming anaerobic bacteria that produces very potent
toxin
Symptoms: double vision, inability to swallow, speech
difficulty, progressive respiratory paralysis.
Onset: after 12-36 hrs or even 8 days.
Food implicated: canned low-acid food, smoked fish

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Outbreaks
E. coli 0157:H7 (Northwest)
Cryptosporidium (Milwaukee)
Norwalk virus (Cruise ships)
Vibrio cholerae (South America)
Listeria (New York, New J ersey, CT)
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Prevention
Application of heat
Adequate refrigeration
Adequate time and storage conditions
Sanitation
Safe thawing practices
Food additives (antimicrobials)
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Manifestations of food allergy
SKIN: urticaria angioedema > eczema
RESPIRATORY: rhinitis asthma
GI TRACT: diarrhea vomiting
GENERAL: anaphylactic shock
OTHER: migraine, hyperactivity,
sleep disturbances etc ?

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Sensitization to food

eating, touching and

smelling
peanuts
fish
hens egg
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Future immunomodulatory therapies
for food allergy
Humanized monoclonal anti-IgE
Mutated allergen protein immunotherapy
Peptide immunotherapy
Immuno-stimulatory sequences
Probiotics