Salmonellosis is an infection with Salmonella bacteria.

Most people infected with Salmonella

develop nausea, diarrhea which can lead to dehydration, fever, vomiting, and abdominal cramps

8 to 72 hours after infection. In most cases, the illness lasts 4 to 7 days and most people recover

without treatment. Food must be cooked to 68–72°C (145–160°F) and liquids like soups or

gravies must be boiled. Freezing kills some Salmonella, but it is not sufficient to reliably

reduce Salmonella below infectious levels. While Salmonella is usually heat-sensitive, it does

acquire heat resistance in high-fat environments such as peanut butter.

Sources of Bacteria

Contaminated meats and poultry

Poultry, pork, and cattle, if the meat is prepared incorrectly or is infected with the bacteria after

preparation.

Infected eggs, egg products, and milk when not prepared, handled, or refrigerated properly.

Reptiles such as turtles, lizards, and snakes, which may carry the bacteria on their skin.

Pet rodents.

Tainted fruits and vegetables.

How is Salmonella transmitted to humans?

Salmonellosis is spread to people by ingestion of Salmonella bacteria that contaminate

food. Salmonella is worldwide and can contaminate almost any food type, but recent outbreaks

of the disease involve raw eggs, raw meat (ground beef and other poorly cooked meats), egg

products, fresh vegetables, cereal, pistachio nuts, and contaminated water. Contamination can

come from animal or human feces that contact the food during its processing or harvesting. 

How do Salmonella spp cause disease in people?

Usually, Salmonella spp are ingested. It is commonly accepted that at between 1 million to 1

billion bacteria are needed to cause infection although some investigators suggest some people

may be infected by far fewer bacteria. Nevertheless, most data suggest food, water, or other

sources of contamination contain large amounts of bacteria. Although human stomach acid can

reduce and sometimes eliminate Salmonella spp, occasionally some bacteria get through to the

intestine and then attach and penetrate the cells. Toxins produced by the bacteria can damage and

kill the cells that line the intestines, which results in intestinal fluid loss (diarrhea).

Some Salmonella can survive in cells of the immune system and can reach the bloodstream,

causing blood infection (bacteremia). Other Salmonella spp can enter the gallbladder, leaving the

affected patient a chronic carrier of the organisms. Salmonella can then be shed with the bile

from the gallbladder into the feces and then may infect other people. Perhaps the most famous

such carrier, the first to be identified in 1907, was a cook named Mary Mallon, also known as

"Typhoid Mary." She was suspected of infecting hundreds of individuals.

How do you diagnose a Salmonella infection?

Feces of patients that have symptoms of food poisoning or typhoid fever are cultured for

Salmonella. Often, the diagnosis is first suggested by recognition of an outbreak (multiple

patients having symptoms of a disease all at about the same time and often, from the same food

or water source). Again, many organisms and toxins can cause food poisoning, so it is sometimes

difficult to determine the outbreak's cause. Usually, the laboratory needs to be notified that S.

spp is suspected as the cause so they will choose the correct testing media (selective agar media)

to distinguish Salmonella from other potential bacterial pathogens. The majority of Salmonella

isolates come from the feces. Occasionally, Salmonella can be cultured from blood samples.

Serovars are identified by serotyping (detecting bacterial proteins by using specific

immunological tests).

How can Salmonella infection be prevented?

Cleanliness is a key to prevention. Hand washing with soap and hot water, especially after

handling eggs, poultry, and raw meat is likely to reduce the chance for infections. The use of

antibacterial soaps has been recommended by some investigators. By using chlorine-treated

drinking water, washed produce, and by not ingesting undercooked foods such as eggs, meat or

other food, people can also reduce the chance of exposure to Salmonella. Avoiding direct contact

with animal carriers of Salmonella (for example, turtles, snakes, pigs) also may prevent the

disease.
Listeria monocytogenes, commonly referred to as Listeria, is a pathogen that causes listeriosis, a

serious human illness. It is unlike most other foodborne pathogens because it can grow at proper

refrigeration temperatures. L. monocytogenes causes listeriosis, a serious infection with high

hospitalization rates for those who become ill. People at highest risk for a severe case include the

elderly, the fetuses of pregnant women, and the immunosuppressed. It is unique among

foodborne pathogens since its incubation time (time from ingestion of cells to illness) is at least

seven days.

L monocytogenes can also cause mild, flu-like symptoms in healthy individuals when consumed

at very high levels2. A person with listeriosis has fever, muscle aches and occasional

gastrointestinal symptoms such as nausea or diarrhea. If infection spreads to the nervous system,

symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur.

Infected pregnant women may experience only a mild, flu-like illness; however, infections

during pregnancy can lead to miscarriage or stillbirth, premature delivery or infection of the

newborn.

L. monocytogenes can survive on cold surfaces and can also multiply slowly at 34° F. It has also

been shown to grow to a water activity as low as 0.92 and over a pH range of 4.4-9.43.

Listeria has been found in a variety of raw foods, such as uncooked meats and unpasteurized

(raw) milk or foods made from unpasteurized milk. Listeria is killed by pasteurization and

cooking; however, in certain ready-to-eat foods, like hot dogs and cold cuts from the deli

counter, contamination may occur after cooking but before packaging. Adults can get listeriosis

by eating food contaminated with Listeria, but babies can be born with listeriosis if their mothers
eat contaminated food during pregnancy. The mode of transmission of Listeria to the fetus is

either transplacental via the maternal blood stream or ascending from a colonized genital tract.

Infections during pregnancy can cause premature delivery, miscarriage, stillbirth, or serious

health problems for the newborn. Although healthy persons may consume contaminated foods

without becoming ill, those at increased risk for infection can probably get listeriosis after eating

food contaminated with even a few bacteria.

Individuals at increased risk include (CDC website, 2009):

Pregnant women: They are about 20 times more likely than other healthy adults to get listeriosis.

About one-third of listeriosis cases happen during pregnancy.

Newborns: Newborns rather than the pregnant women themselves suffer the serious effects of

infection in pregnancy.

Persons with weakened immune systems

Persons with cancer, diabetes, or kidney disease

Persons with AIDS: They are almost 300 times more likely to get listeriosis than people with

normal immune systems.

Persons who take glucocorticosteroid medications (such as cortisone)

The elderly
Symptoms Of Listeriosis

The incubation period (time between ingestion and the onset of symptoms) for Listeria ranges

from three to 70 days and averages 21 days (Bryan, 1999).

A person with listeriosis may develop fever, muscle aches, and sometimes gastrointestinal

symptoms such as nausea or diarrhea (CDC website, 2009). If infection spreads to the nervous

system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can

occur. In immune-deficient individuals, Listeria can invade the central nervous system, causing

meningitis and/or encephalitis (brain infection). Infected pregnant women ordinarily experience

only a mild, flu-like illness; however, infection during pregnancy can lead to miscarriage,

infection of the newborn or even stillbirth.

Newborns may present clinically with early-onset (less than 7 days) or late-onset forms of

infection (7 or more days) (Bortolussi, 2008). Those with the early-onset form are often

diagnosed in the first 24 hours of life with sepsis (infection in the blood). Early-onset listeriosis

is most often acquired from the mother through transplacental transmission. Late-onset neonatal

listeriosis is less common than the early-onset form. Clinical symptoms may be subtle and

include irritability, fever and poor feeding. The mode of acquisition of late-onset listeriosis is

poorly understood.
Treatment For Listeriosis

Invasive infections with Listeria can be treated with antibiotics. When infection occurs during

pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the

fetus or newborn. Babies with listeriosis receive the same antibiotics as adults, although a

combination of antibiotics is often used until physicians are certain of the diagnosis.

How To Prevent Listeriosis

The CDC (CDC website, 2009) provides several recommendations to avoid infection with

Listeria:

Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.

Wash raw vegetables thoroughly before eating.

Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.

Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.

Wash hands, knives, and cutting boards after handling uncooked foods.

Consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened

immune systems, in addition to the recommendations listed above include:

Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation

surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.

Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-

style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly

state they are made from pasteurized milk.

Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may

be eaten.

Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a

casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel,

is most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” The fish is found

in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or

shelf-stable smoked seafood may be eaten.

What is yersiniosis?

Yersiniosis is an infectious disease caused by a bacterium of the genus Yersinia. In the United

States, most human illness is caused by one species, Y. enterocolitica. Infection with Y.

enterocolitica can cause a variety of symptoms depending on the age of the person infected.

Infection with Y. enterocolitica occurs most often in young children. Common symptoms in

children are fever, abdominal pain, and diarrhea, which is often bloody. Symptoms typically

develop 4 to 7 days after exposure and may last 1 to 3 weeks or longer. In older children and

adults, right-sided abdominal pain and fever may be the predominant symptoms, and may be
confused with appendicitis. In a small proportion of cases, complications such as skin rash, joint

pains, or spread of bacteria to the bloodstream can occur.

The major animal reservoir for Y. enterocolitica strains that cause human illness is pigs, but

other strains are also found in many other animals including rodents, rabbits, sheep, cattle,

horses, dogs, and cats. In pigs, the bacteria are most likely to be found on the tonsils.

How do people get infected with Y. enterocolitica?

Infection is most often acquired by eating contaminated food, especially raw or undercooked

pork products. The preparation of raw pork intestines (chitterlings) may be particularly risky.

Infants can be infected if their caretakers handle raw chitterlings and then do not adequately

clean their hands before handling the infant or the infant’s toys, bottles, or pacifiers. Drinking

contaminated unpasteurized milk or untreated water can also transmit the infection. Occasionally

Y. enterocolitica infection occurs after contact with infected animals. On rare occasions, it can be

transmitted as a result of the bacterium passing from the stools or soiled fingers of one person to

the mouth of another person. This may happen when basic hygiene and handwashing habits are

inadequate. Rarely, the organism is transmitted through contaminated blood during a transfusion.

How can Y. enterocolitica infections be diagnosed?

Y. enterocolitica infections are generally diagnosed by detecting the organism in the stools.

Many laboratories do not routinely test for Y. enterocolitica,so it is important to notify laboratory

personnel when infection with this bacterium is suspected so that special tests can be done. The
organism can also be recovered from other sites, including the throat, lymph nodes, joint fluid,

urine, bile, and blood.

How can Y. enterocolitica infections be treated?

Uncomplicated cases of diarrhea due to Y. enterocolitica usually resolve on their own without

antibiotic treatment. However, in more severe or complicated infections, antibiotics such as

aminoglycosides, doxycycline, trimethoprim-sulfamethoxazole, or fluoroquinolones may be

useful. .

Are there long-term consequences of Y. enterocolitica infections?

Most infections are uncomplicated and resolve completely. Occasionally, some persons develop

joint pain, most commonly in the knees, ankles or wrists. These joint pains usually develop about

1 month after the initial episode of diarrhea and generally resolve after 1 to 6 months. A skin

rash, called "erythema nodosum," may also appear on the legs and trunk; this is more common in

women. In most cases, erythema nodosum resolves spontaneously within a month.

What can be done to prevent the infection?

1. Avoid eating raw or undercooked pork. 2. Consume only pasteurized milk or milk products. 3.

Wash hands with soap and water before eating and preparing food, after contact with animals,

and after handling raw meat. 4. After handling raw chitterlings, clean hands and fingernails
scrupulously with soap and water before touching infants or their toys, bottles, or pacifiers.

Someone other than the foodhandler should care for children while chitterlings are being

prepared. 5. Prevent cross-contamination in the kitchen: -Use separate cutting boards for meat

and other foods. -Carefully clean all cutting boards, counter-tops, and utensils with soap and hot

water after preparing raw meat. 6. Dispose of animal feces in a sanitary manner.

What Is

E. coli is a common type of bacteria that can get into food, like beef and vegetables. E. coli is

short for the medical term Escherichia coli. The strange thing about these bacteria — and lots of

other bacteria — is that they're not always harmful to you.

E. coli normally lives inside your intestines, where it helps your body break down and digest the

food you eat. Unfortunately, certain types (called strains) of E. coli can get from the intestines

into the blood. This is a rare illness, but it can cause a very serious infection.

It causes hamburger disease: bloody diarrhea (hemorrhagic colitis).

It causes the hemolytic-uremic syndrome, a blood and kidney disease in children.

It causes thrombotic thrombocytic purpura, a dire disease in the elderly.

Someone who has E. coli infection may have these symptoms:

bad stomach cramps and belly pain

vomiting

diarrhea, sometimes with blood in it

Foods to Watch

E. coli can be passed from person to person, but serious E. coli infection is more often linked to

food containing the bacteria. The person eats the contaminated food and gets sick.

Here are some foods that can cause E. coli poisoning:

undercooked ground beef (used for hamburgers)

vegetables grown in cow manure or washed in contaminated water

fruit juice that isn't pasteurized (pasteurization is a process that uses heat to kill germs)

Heat can kill E. coli, so experts recommend that people cook beef (especially ground beef) until

it is cooked through and no longer pink. Choosing pasteurized juice is another way to avoid

possible infection.
Lastly, some experts recommend washing and scrubbing vegetables before eating them. But

others say E. coli is hard to remove once it has contaminated produce, such as spinach, lettuce, or

onions. The solution, they say, is to take more steps so that E. coli doesn't come in contact with

crops.

What Will the Doctor Do?

If someone has symptoms of E. coli poisoning, the doctor will run some blood tests and take a

sample of the person's stool (poop). The blood and stool can be checked to see if a harmful strain

of E. coli is present. Even though diarrhea is one of the main symptoms, the person shouldn't

take anti-diarrhea medicines because they can slow down recovery time.

Some people recover at home, while others need to be in the hospital. In some cases, E. coli

poisoning can cause life-threatening kidney problems.

What are E. coli symptoms, and how is it diagnosed?

In patients suspected of having E. coli 0157:H7 infection (for example, patients with bloody

diarrhea, severe abdominal pain and tenderness with no fever), a stool specimen is tested for the

presence of E. coli O157:H7. Some hospitals test for E. coli 0157:H7 in all stool samples

submitted to their laboratories while others only test for E. coli 0157:H7 in samples from patients

with bloody diarrhea. Still others only test for E. coli 0157:H7 upon request by the doctors.
There are two methods of testing for E. coli 0157:H7 in stool samples; 1) growing the bacteria in

culture dishes, or 2) testing for the shiga toxin produced by the bacteria. Even though toxin

detection methods are becoming more common, it is important to confirm the presence of E. coli

0157:H7 in cultures of stool containing toxin.

Blood tests such as complete blood count (CBC), and blood levels of electrolytes, blood urea

nitrogen (BUN), and creatinine (blood tests that measure function of the kidney) are performed

periodically to look for the development of hemolytic-uremic syndrome.

What is the treatment for E. coli 0157:H7?

For the acute diarrheal illness, antibiotics have not proven useful. In fact, some studies have

shown that antibiotic use may increase the chances of developing hemolytic-uremic syndrome.

Treatment includes the replacement of fluids and electrolytes to prevent dehydration. Infection

with E. coli 0157:H7 should be treated by a physician. Hemolytic-uremic syndrome and

thrombotic thrombocytopenic purpura require complex supportive care in the hospital. Patients

with kidney failure may need dialysis.

How can you prevent infection with E. coli 0157:H7?

The following precautions are recommended.

Handle raw meat correctly

Put raw ground beef (hamburger) in the refrigerator or freezer as soon as possible until ready to

use.

Thaw frozen meat by putting it in the refrigerator or in the microwave.

NEVER thaw meat at room temperature.

Wash everything touched by raw meat with warm soapy water.

Wash work surfaces, dishes, utensils, and your hands.

Be careful with hamburger

Cook burgers thoroughly. The inside of the patty should not be pink. If it is, cook the burger

longer. When you cut it, the meat should not be pink and the juice should be clear.

In a restaurant, order burgers cooked "medium well" or "well done." If you see pink or if the

juice is not clear, send the burger back to the kitchen for additional cooking.

Do not drink raw milk or eat raw milk products

Avoid raw milk and raw milk products. Raw milk is not healthier.

Consume only pasteurized milk and milk products.

Know where your water is coming from

Drink water from a well only if you know it's free from contamination.

Do not drink untreated water from streams or lakes.

Wash your hands

Wash your hands with soap and water before and after handling food. It cuts the risk of

spreading E. coli (and other germs).

Be sure children wash their hands carefully and often.

Clostridium perfringens Food Poisoning

Clostridium perfringens food poisoning results from eating food contaminated by the bacterium

Clostridium perfringens. Once in the small intestine, the bacterium releases a toxin that often

causes diarrhea.

Some strains cause mild to moderate disease that gets better without treatment, whereas other

strains cause severe gastroenteritis that can damage the small intestine and sometimes lead to

death. Contaminated meat is usually responsible for outbreaks of Clostridium perfringens food
poisoning. Some strains cannot be destroyed by cooking the food thoroughly, whereas others

can.

Symptoms

The gastroenteritis starts about 6 to 24 hours after contaminated food is eaten. The most common

symptoms are watery diarrhea and abdominal cramps. Although usually mild, the infection also

can cause abdominal pain, abdominal expansion (distention) from gas, severe diarrhea,

dehydration, and a severe decrease in blood pressure (shock). Symptoms usually last about 24

hours.

Diagnosis and Treatment

A doctor usually suspects the diagnosis when a local outbreak of the disease has occurred. The

diagnosis is confirmed by testing contaminated food or the stool of affected people for

Clostridium perfringens.

To prevent infection, leftover cooked meat should be refrigerated promptly and reheated

thoroughly before serving. The person is given fluids and is encouraged to rest. Antibiotics are

not given.

Shigella spp. (Shigella sonnei, S. boydii, S. flexneri, and S. dysenteriae)

Shigella are Gram-negative, nonmotile, nonsporeforming rod-shaped bacteria. The illness caused

by Shigella (shigellosis) accounts for less than 10% of the reported outbreaks of foodborne

illness in this country. Shigella rarely occurs in animals; principally a disease of humans except

other primates such as monkeys and chimpanzees. The organism is frequently found in water

polluted with human feces.

Nature of Acute Disease

Shigellosis (bacillary dysentery).

Nature of Disease

Symptoms -- Abdominal pain; cramps; diarrhea; fever; vomiting; blood, pus, or mucus in stools;

tenesmus.

Onset time -- 12 to 50 hours.

Infective dose -- As few as 10 cells depending on age and condition of host. The Shigella spp.

are highly infectious agents that are transmitted by the fecal-oral route.
The disease is caused when virulent Shigella organisms attach to, and penetrate, epithelial cells

of the intestinal mucosa. After invasion, they multiply intracellularly, and spread to contiguous

epitheleal cells resulting in tissue destruction. Some strains produce enterotoxin and Shiga toxin

(very much like the verotoxin of E. coli O157:H7).

Diagnosis of Human Illness

Serological identification of culture isolated from stool.

Associated Foods

Salads (potato, tuna, shrimp, macaroni, and chicken), raw vegetables, milk and dairy products,

and poultry. Contamination of these foods is usually through the fecal-oral route. Fecally

contaminated water and unsanitary handling by food handlers are the most common causes of

contamination.

Relative Frequency of Disease

An estimated 300,000 cases of shigellosis occur annually in the U.S. The number attributable to

food is unknown, but given the low infectious dose, it is probably substantial.

Course of Disease and Complications

Infections are associated with mucosal ulceration, rectal bleeding, drastic dehydration; fatality

may be as high as 10-15% with some strains. Reiter's disease, reactive arthritis, and hemolytic

uremic syndrome are possible sequelae that have been reported in the aftermath of shigellosis.

Target Populations

Infants, the elderly, and the infirm are susceptible to the severest symptoms of disease, but all

humans are susceptible to some degree. Shigellosis is a very common malady suffered by

individuals with acquired immune deficiency syndrome (AIDS) and AIDS-related complex, as

well as non-AIDS homosexual men.

Food Analysis
Organisms are difficult to demonstrate in foods because methods are not developed or are

insensitive. A genetic probe to the virulence plasmid has been developed by FDA and is

currently under field test. However, the isolation procedures are still poor.

What is Staphylococcus?

Staphylococcus is a group of bacteria that can cause a multitude of diseases as a result of

infection of various tissues of the body. Staphylococcus is more familiarly known as Staph

(pronounced "staff"). Staph-related illness can range from mild and requiring no treatment to

severe and potentially fatal.

The name Staphylococcus comes from the Greek staphyle, meaning a bunch of grapes, and

kokkos, meaning berry, and that is what Staph look like under the microscope, like a bunch of

grapes or little round berries. (In technical terms, these are gram-positive, facultative anaerobic,

usually unencapsulated cocci.)

Over 30 different types of Staphylococci can infect humans, but most infections are caused by

Staphylococcus aureus. Staphylococci can be found normally in the nose and on the skin (and

less commonly in other locations) of 25%-30% of healthy adults. In the majority of cases, the

bacteria do not cause disease. However, damage to the skin or other injury may allow the

bacteria to overcome the natural protective mechanisms of the body, leading to infection.
Who is at risk for Staph infections?

Anyone can develop a Staph infection, although certain groups of people are at greater risk,

including newborn infants, breastfeeding women, and people with chronic conditions such as

diabetes, cancer, vascular disease, and lung disease. Injecting drug users, those with skin injuries

or disorders, intravenous catheters, surgical incisions, and those with a weakened immune

system all have an increased risk of developing Staph infections.

Clostridium Botulinum (Botulism)

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the

bacterium Clostridium botulinum. Clostridium botulinum is the name of a group of bacteria

commonly found in soil. The bacteria are anaerobic, gram-positive, spore-forming rods that

produce a potent neurotoxin. These rod-shaped organisms grow best in low oxygen conditions.

The bacteria form spores that allow them to survive in a dormant state until exposed to

conditions that can support their growth. The organism and its spores are widely distributed in

nature. They occur in both cultivated and forest soils, bottom sediment of streams, lakes, and

coastal waters, in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs

and other shellfish.

Foodborne botulism is a severe type of food poisoning caused by the ingestion of foods

containing the potent neurotoxin formed during growth of the organism. The incidence of the

disease is low, but the disease is of considerable concern because of its high mortality rate if not

treated immediately and properly. Most of the 10 to 30 outbreaks that are reported annually in

the United States are associated with inadequately processed, home-canned foods, but

occasionally commercially produced foods are implicated as the source of outbreaks. Sausages,

meat products, canned vegetables, and seafood products have been the most frequent vehicles for

foodborne botulism.

They occur in both cultivated and forest soils, bottom sediments of streams, lakes, and coastal

waters, and in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs and

other shellfish.

SYMPTOMS OF BOTULISM

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred

speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear

lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all

symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms

may progress to cause paralysis of the arms, legs, trunk, and respiratory muscles. In foodborne

botulism, symptoms generally begin 18 to 36 hours after consuming contaminated food, but they

can occur as early as 6 hours or as late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural

junction. The flaccid paralysis progresses symmetrically downward, usually starting with the

eyes and face, then moving to the throat, chest, and extremities. When the diaphragm and chest

muscles become fully involved, respiration is inhibited and unless the patient receives treatment

in time, death from asphyxia results.

DETECTION AND TREATMENT OF BOTULISM

Although botulism can be diagnosed by clinical symptoms alone, differentiation from other

diseases may be difficult. The most direct and effective way to confirm the clinical diagnosis of

botulism in the laboratory is to demonstrate the presence of toxin in the serum or feces of the

patient or in the food the patient consumed. Currently, the most sensitive and widely used

method for detecting toxin is the mouse neutralization test, which involves injecting serum or

stool into mice and looking for signs of botulism. This test typically takes 48 hours. Culturing

of specimens takes 5-7 days. Some cases of botulism may go undiagnosed because symptoms are

transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of

toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes

many weeks. Physicians may try to remove contaminated food still in the gut by inducing

vomiting or using enemas.

While botulism has been known to cause death due to respiratory failure, in the past 50 years the

proportion of patients with botulism who die has fallen from about 50% to 8%. The respiratory

failure and paralysis that occur with severe botulism may require a patient to be on a ventilator

for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly

improves.

PREVENTING BOTULISM

The types of foods implicated in botulism outbreaks vary according to food preservation and

eating habits in different regions. Any food that is conducive to outgrowth and toxin production,

that when processed allows spore survival, and is not subsequently heated before consumption,

can be associated with botulism. Almost any type of food that is not very acidic (pH above 4.6)

can support growth and toxin production by C. botulinum. Botulinal toxin has been

demonstrated in a considerable variety of foods, such as canned corn, peppers, green beans,

soups, beets, asparagus, mushrooms, ripe olives, spinach, tuna fish, chicken and chicken livers

and liver pate, and luncheon meats, ham, sausage, stuffed eggplant, lobster, and smoked and

salted fish.

Botulinum toxin is heat-labile, or unstable if heated to a certain temperature, and can be

destroyed if heated and held at 80 degrees Centigrade (176 degrees Fahrenheit) for ten minutes

or longer.