SALMONELLOSIS (S.) TOXI C FOOD–BORNE DISEASES BOTULISM

SALMONELLOSIS (S.)

TOXIC FOOD–BORNE DISEASES

BOTULISM

- acute zoonotic the infectious disease with the faeco-oral mode

of transmission caused by bacteria of a genus Salmonella, described by a prevailing lesion of a GIT as gastrointestinal of the forms of a various degree of gravity or as the generalized forms with intestinal manifestations or without them. (seldom)
Historical reference:

1885 D.Salmon detected S.cholerae suis.

1888 A.Gaertner detected S.enteritidis etc.

To the present the time is revealed more than 2.300 serotypes salmonella

species, 7 subspecieses, 2.300 serotypes
There are for the people

more often cause diseases serotypes :
- S. Enteritidis 26,1%
S. Typhimurium 22,1%
S. heidelberg etc. 4,8%
S. Enteritidis newport 4,3%
S. hadar 2,7%
S. Enteritidis agona 2.0%
S. Enteritidis montevideo 1,7%
S. Enteritidis oranieburg 1,6%
S. muenchen 1,5%
S. Enteritidis thompson 1,5%
S. panama
S. Infantis etc.
S. gram (-) the motile rods (have flaggella) length 1- 4 microns, spores will not derivate, grow on usual mediums.

rate:

- at temperature (-) 10 dg C - 115

days
- at 0 dg С - 142 days
- at 18 - 24 dg C - 80 days
- in water - about 5 months,
- in milk - about 300 days
- in milk and meat are well saved and are multiplied
- in salty or smoked meat - 4 - 8 months
- at boiling perish immediatly
- all disinfectants in usual concentrations inactivate S. in during 30 minutes.

somatic antigene (lipopolysaccharid the complex) thermostable (On this antigene all

S. divided on 50 serogroups)
Н – a flagellar antigene (proteinous) thermolabile
К – a capsula antigene (is proteinous - lipopolysaccharid the complex) facilitates infiltration salmonella inside of cells
Vi – virulence antigene
Toxinoformation
ENDOTOXIN - (lipopolysaccharid the complex of a cellular wall ) - It is released at destroying salmonella and causes a set of toxic symptoms similar by all gram-negative bacteria, thermostable
Enterotoxin - causes a diarrhea, thermolabile.
Exotoxin - its has got only for some strains.

promoting to infiltration into a cell,
- R- plasmide - resistance

to antibiotics !!!
- presence of enzymes of hyaluronidase, neuraminidase,
- ability to cause a bacteriemia or sepsis,
- ability to reproduction in many bodies,
- ability to cause dysbiosis,
- ability to derivate L- of the form,
- presence of toxins: endotoxin , enterotoxin, sometimes - exotoxin ).
The relation of the various factors pathogenic determines features of current of disease.

and carriers is (seldom)
Infectious of some of them makes:

pigs - 20 %, cattle - 5 %, home birds - 50 % eggs- 40 %, rodents- 40 %, cats and dogs - up to 10 %)
Mode of transmission– faeco - oral.
The factors of transmission:
- Foodstuffs– meat, lactic products, eggs, egg’s powder, fish, molluscums etc ( 95,8 - 99,6 % ).
- the water (seldom).
- dust (at processing of the skins animal).
- contact with the subjects of an environment
Are most susceptibility to S. - children till 2 years and elderly. The townspeople is sick more often, than village inhabitants
Seasonal prevalence - summer-autumn.

both dose of the salmonella and state of an organism.

For example:
- the presence for the salmonella K and O antigenes - results to expressed cytophathic to effect
- the presence K antigene at absence O an antigene cytophathic effect misses
- at absence O and K antigenes - minimum damage of an organism)
Infectious a dose 10 5-7 .
- the S. through a mouth penetrate in stomach
mass destruction in a stomach S. with excretion endo- or exotoxin- toxemia.
the destruction all S. at this stage causes only gastric the form of disease

damaging them) in submucous space, colony, reproduction and accumulation there

S.

- activation of the system «adenylcyclase – of cyclic 3,5 adenosinemonophosphates », appearance of a secretory diarrhea with the subsequent violation hydrous and electrolytic of exchange down to circulatory shok and dehydration

- the bacteriemia at gastrointestinal the forms short-term, but part S. can penetrate into a bloodstream as independently as inside phagocytes with the subsequent lesion of bodies of SМP (System Macrophagal of Phagocytes)

at an incompetence of immunity can result in
hematosepses ( 1 - 2 %)

3-5 %
-

gastroenteritic variant 85-90 %
- gostroenterocolic variant 5-10 %
- enterocolitic variant
GENERALIZED
- influenza-like forms 5-10 %
- typhus-like forms 3-5 %
- septicopyemic forms (seldom)
CARRIAGE (transitional, acute up to 3 months, chronic more than 3 months).
SUBCLINICAL (asymptomatic).
THE FOCAL forms - meningitis, pneumonia, abscesses of a liver, brain etc.).
On a degree of an intoxication and degree of a dehydration S. have divided for a forms: mild moderate severe

of gravity mild moderate

severe

2. Duration
the fever (days) 1 - 2 3 - 6 7 and are more

3. Height
fever (dg C) up to 38 up to 39 39 and it is more

4. Duration (days)
the diarrhea up to 3 4 - 10 11 and are more

5. The frequency
of a stool (per day) up to 5 6 - 10 11 and is more

6. The frequency
of a vomiting (per day) 0 – 1 2- 4 5 and is more

7. BP ( mm Hg ) norm up to 90 80 and is lower

8. The pulse rate up to 100 up to 120 120 and is more
9. The cramps
of muscles absent 1 group several groups

3 days)
Acute beginning:

- weakness, chill, headache, giddiness

- Intensive

colicy pain in epigastrium and mesogastrium

- vomiting single or multiple ( brings for alleviation)

- fever (height and duration which depend on a dose of an
endotoxin)

- the diarrhea misses!

in epigastrium then is spreaded in mesogastric area
diarrhea: a stool

fecal, then foamy, mephitic, with green, sometimes with slime, later - watery (secretory diarrhea);
the act of a defecation is controled by the patient, the volume of a stool decreases at weighting a state of the patient;
- tachycardia, decrease BP
- there are signs of a dehydration 1- 3 degrees (TIS+ HVS.)
- obvious signs of a set of symptoms « a toxic kidney »: an oliguria, albuminuria, erythrocytes and cylinders, ARI -acute renal insufficiency

join:
- the pain is spreaded in the right or left

hypogastric areas;
- the volume of a stool decreases with augmentation of quantity of slime, but admixture of a blood does not happen
- the admixture of a blood in a stool occurs at mix -infections – S. + shigellosis, escherichiosis, helminthiases.
THE GENERALIZED FORMS
Typhus-like variant (5 %)
- acute beginning, chill, a continued or remittent fever
- diarrhea 1- 2 days, then stop;
- the sleeplessness, headache, but typhous status does not develops;
- on a skin of a abdomen the roseolous of a rash with 5 - 6 days can appear;
- herpes on lips with 2 - 3 days of disease.

hectic fever.
Clinic of a sepsis (septicopyemic variant) with a symptomatology

of a purulent osteomyelitis, arthritis, endocarditis, cholecystitis, abscesses of a liver, spleen, lungs, soft tissues, pleuritis (for children) meningitis (for newborn),
Especially serious current on a background VIH-infection

THE SUBCLINICAL FORM
- absence of clinical manifestations;
- excretion S. from feces;
- augmentation of an antiserum capacity in serological tests.
COMPLICATIONS
Collapse, TIS, HVS, ARI (acute renal insufficiency), DIC, toxic encephalopathy,odema lungs and brain, reactive pancreatitis or arthritis, exacerbation of chronic infections, thrombosis

(for 1 - 3 %);
- death of the patient

by septic endocarditis, meningitis, late revealing and delayed treatment of complications).

Differential diagnosis

The localized forms - toxic food-borne diseases, shigellosis, salmonelloses, escherichiosis, cholera, appendicitis, pancreatitis, myocardial infarction, cholecystitis, adnexitis, thrombosis mesenterial of vessels, extrauterine pregnency

The generalized forms - typhoids, sepsis, tuberculosis, malaria, pneumonia, lymphogranulomatosis.

to the left; acceleration ESR,
Urinanalysis - signs of a

set of symptoms « a toxic kidney »

Bacteriological research, blood (at fever), feces ,urine, vomitive masses, of lavage water, bile (after a discharge from hospital), CSF. The fluid mediums (selenitic), dense (Плоскирева, bismuth - zinci sulfas) and cholic broth (blood 10 mls and mediums 100 mls (1:10) will be utillized;
Express – diagnosis
detection of antigenes S. by response circular precipitation
in coprofiltrates
- immunofluorescence
Immunological –IHA test (credit 1:160) since 4-5 days of disease) , A test and CFtest since 2 week « of the pair serums). ELISA

IS NOT SHOWN (S. to them steady, extend a diarrhea,

shape a carriage and dysbacteriosis).
Assign antibiotics at threat to a generalization:
immunodeficiency, hemoglobinopathies, children up to 3 months and elderly, oncologic diseases ,severe attendant diseases.
At the GENERALIZED forms:
- chloramphenicol 16-25 mg/kg/day IV q8h
- ampicillinum 25-50 mg/kg/day, IV q6h,
- amoxicillin 7-16 mg/kg/day, PO q8h
- gеntamicin 0.4-1.2 mg/kg/day IM q8h
Spare - ciprofloxacin, norfloxacin, ofloxacin, , amikacinum, tobramycinum, cephalosporins of 3-rd generation, trimethaprim - sulphamethoxazole

3. Adequate rehydration (IV and PO).
4. Indomethacinum 150 mg PO

q8h
5. Ferment drugs.
6. Biological preparations (bificol,colibacterin, linex ect.)
7. At TIS - glucocorticoids.
Discharge from hospital only at clinical convalescence:
- 1 negative bacteriological test of a feces in 2 days after ending treatment
- decree group 2 negative bacteriological testes with the subsequent observation 3 months in polyclinic with monthly bacteriological testing
PROPHYLAXIS
- veterinary supervision of health, slaughter of cattle and birds, technology of processing of skins, preparation and storage of meat and fish dishes,
- regular inspection decree of groups of the population
- constant control behind water supply.

the use contaminated of foodstuffs, and described by a short

incubation, short-term current, damage GIT, set of symptoms of an intoxication and hydroelectrolytes by violations of a various degree of an expressiveness.
« An alimentary poisoning » - disease at the use of toxicant products (funguses, berry, sprouting a grain).
« An alimentary intoxication » - use of the products with toxic substances (pesticides, salts of heavy metals, arsenic).
ETIOLOGY:
Anyone is conditional-pathogenic originators capable to be multiplied in products at violation of rules of storage, preparation and realizetion (E.coli, Staphylococci, Proteus, Streptococci, Cl.perfringens, B.cereus etc.).

antigenic structure is diverse, the adjuvanticity is lowered.
The factors pathogenicity:

- various exotoxins (toxic operation, damage CVS,GIT),
release of an ENDOTOXIN (local action), neuraminidase, hyaluronidase,
for some reproduction in enterocytes (Proteus, E.coli),
- derivation enterotoxin- a diarrhea

EPIDEMIOLOGY
Source - people with purulent diseases, bacteriocarries and animals
The mode of infection - fecal-oral.
The factors of transmission - foodstuffs (meat, milk, fish) in which the pathogens and toxin has collected.

Seasonal prevalence – summer. A sporadic case rate - the year round.

and virulence, dose of a toxin and pathogens.

Common manifestations TOXIC

FOOD–BORNE DISEASES :
- short incubation interval (sometimes 30 minutes),
- acute sudden beginning (sometimes from a collapse or TIS ( staphylococci),
- the nausea and multiple vomiting, brings for alleviation (seldom - at Cl.perfringens, Prоteus),
- colicy pain in epigastriums (very strong at Proteus),
- the set of symptoms of an intoxication (weakness, headache, fever ( frequently misses at Cl.perfringens, Prоteus),
- diarrhea (minimum - at staphylococcal, plentiful, mephitic - at Prоteus, necrotic enteritis - at Cl.perfringens),
- the short-term current, is especial at fast desintoxication of therapy.

of foodstuffs, blood (at a fever) - confirmation of the

etiological diagnosis - detection of the same pathogens in all Inoculations,
Positive agglutination test with autostrain- the antibodies late and not always occur in a blood.
TREATMENT:
- lavage stomach and intestine,
- enteral or IV desintoxication and rehydration , sorbents,
- anti-infectious therapy- in severe cases (at Proteus - fluoroquinolones and cephalosporins).
PROPHYLAXIS:
- sanitary - veterinary measures,
- exact storage and realizetion of products,
- inspection of decree groups and discharge from operation of the persons with purulent by diseases.

botulotoxin mainly cholinergic of structures oblong and a spinal cord

and proceeding with predominance ophthalmo-plegiae and bulbar sets of symptoms.
ETIOLOGY.
Clostridium botulinum (family Bacillaceae, a genus Clostridium), has size 3.4- 8.6 х 0.3-1.3 microns, are motileing, will derivate terminal spores as " « racket ", gram (+), but since 4-5 days are transmuted in gram (-). Strict anaerobes.
The vegetative forms fast perish at boiling. Concentration salt more than 15 % and sugar more than 50 % brakes their reproduction.
The spores are steady against desiccation (are saved by decades), low temperature (at (-)14 dgC - about one year), boiling (2-3 hours), to disinfectants, acids, alkalis.

produce potent neurotoxin which in 10-100 million of time more

strongly than potassium cyanide (lethal dose 0,001-0,35 mkg).

The most strong toxin evolve - A, Е, then - B, G, C, D.

The toxin is destroyed: 3-5 % by alkalis, ethanol, boiling in current 20 min.

The toxin Е - secretes out as a prototoxin, which is activated by enzymes GIT (in 1 hour per 20 times, and in 4 hours per 60 times),

The toxin A - is inactivated by trypsinum, from a blood disappears fast, and the toxin of types B and Е - is long in its circulate

ground it find out in 0.95- 46.5 %, among birds

- in 33,9 %, in a fish up to 14 %, permanently is present at an intestine herbivorous animals, pigs, in molluscums etc.

In USA more often the type A, in Canada, Japan, Scandinavia - type Е, in Europe – type B. meet
On Ukraine - type Е (62,2 %), type B (28,1 %) type A (8,3 %) circulates.
Products more often causing disease: tinned funguses (33 %), vegetables (29 %), fish (22 %), sausage, gammon, stewed meat
Lethality - 11,4 %.
In autumn-winter period the case rate increases. Meet as flashouts and sporadic case rate.

low salt contents (< 11 %) and sugar (< 55

%), insufficiency heat treatment (at 116 dgC less 20 min., at 100dgC - less than 3-5 clocks).
PATHOGENY:

The toxin penetrates in a stomach ( by a hydrochloric acid and enzymes is not inactivated its) and in a small intestine,

then penetrates into a blood and is fixed on the peripheric nervous endings (toxin 10 minutes circulate in a blood and 40 minutes is on a surface of membranes - only at this time it is possible to inactivate by an antitoxin).

The dose of a toxin determines duration of an incubation and gravity of current of disease.

a spinal cord and nervous-muscle synapses:

at a proteolysis is decomposed

to 2 fragments - L and H of a chains,

Н the chain contacts to a synaptic membranes of bonds, derivating pores on their terminal lamina (one is time consists of 4 molecules of a toxin),

that locks contact synaptic of bubbles of acetylcholinum with a membrane and breaking transmission of nervous impulses.

synaptobrevin, A and Е - SNAP-25, C - syntaxin, D,

F - cellulabrevin.
The violation of transmission of impulses - results in appearance of flaccid paralyses of all striated muscles and development of a myasthenic set of symptoms.

In the further carrying on role belongs to a hypoxia:
histotoxic (violation of mastering by tissues of oxygenium),
hypoxitic - paresis of a respiratory musculation,
hemic - violation phosphopentose of cycle in erythrocytes, binding of oxygenium and delivery to its tissues,
circulatory – hemodynamics of violation.
The immunity at a botulism is not shaped.

Alimentary (use of products with a toxin),
Wounded (pollution of

a wound by spores from ground),
Botulism of infant up to 6 months ( transformation of spores in an intestine in the vegetative forms with subsequent production of a toxin).
3 degrees of gravity: mild, moderate, severe
3 periods of illness: initial, height, convalescence.
Gravity of a botulism depends from:
- such as a toxin: the severe forms Е - 33 %, A- 28 %,B - 8,5%.
- dose of a toxin. - the type of a toxin does not play a role
- speed of an adsorption: faster with meat, fish, more slowly with vegetables, fruits.

Incubation - at the severe form - 18 hours,
- moderate - 39,9 hours
- mild - 58 hours.,
- wounded and infant's – 4 -14 days.

fatigability 100 %
- Thirst and dryness in a mouth

100 %
- Giddiness 75 %
- Shaky gait 68 %
- Dyspeptic set of symptoms: 51 %
- nausea 21 %
- mild diarrhea 14 %
- multiple vomiting 12 %
- plentiful diarrhea 0,7 %
- Headache 17 %
- Visual disturbance 10 %
- Dyspeptic синдром+
disorder of vision 28 %
- Disorder of respiration 1 %

HEIGHT of ILLNESS.
Ophthalmoplegical a SET

of SYMPTOMS:
Fog and net before eyes, indistinct vision fuzzy outlines of subjects
Mydriasis and anisocoria
Ptosis of eyelids double-sided
Decrease of response of pupils on light, violation of an accommodation and convergence,
Nystagmus
Diplopia
Ophthalmoplegia
The third cranial nerve is damaged ALWAYS but the visual nerve IS NOT DAMAGED.

(type A can proceed without eye signs !!).

soft palate,

Decrease or disappearance pharyngial of a reflex

The dysphagia

- choke, fluid is poured out through a nose, impossibility swallowing of fluid and hard nutrition, feeling of « a lump in a throat »

Inactive or fixed tongue

Change of force and timbre of a voice, nasal, hoarseness, muffled speech,
Decrease of a sialosis.

NERVOUS SYSTEM:
Decrease of a secretion of glands of mucosas, (glossitis,

conjunctivitis), digestive, inhibition of a diaphoresis, urinary excretion
Paresis of a chewing musculation, dryness, small mobility of tongue - violation of a swallowing,
Mask-like of the face down to an amimia,
Decrease tendinous and abdominal of reflexes or their absence
PATHOLOGICAL REFLEXES MISS!
Delay urinary excretion

Change of temperature of a body:
Normal - 72 %,
Subfebrile - 22 %,
High - 6 % (pneumonia!)

constraint, squeezing and gravity in a breast, shortage of air,
tachypnea

till 40-60 in 1 minites., respiration intermittent, surface, forced position in bed,
Paleness, then cyanosis,
Without controlled artificial respiration - mors from an asphyxia,
Appearance of respiratory disorders:
For 2 day of illness - for 14 % of the patients,
For 3- 4 day - for 6 %,
After 4 day develop seldom,
Already after 30-40 minutes after appearance of respiratory disorders can occur a STOPPING of RESPIRATION.

REASONS of respiratory violations - direct neuroparalysis operation of a toxin + pneumonia (at the severe forms for 40 % of the patients and after controlled artficial respiration for 100 %,).

the bradycardia is replaced by a tachycardia, Decrease

common voltage and wave Р, augmentation PQ, deformation of a wave QRS, reduction it is slowly (5-12 weeks).

MENTAL VIOLATIONS - the consciousness is saved up to death of the patient, they are correctly oriented, realize gravity of a state.

THE GRAVITY of current is determined by a combination of signs and sets of symptoms, their expressiveness.

PERIOD of CONVALESCENCE ALWAYS LINGERING.
The common myasthenia is saved 2-10 weeks
Violation of a swallowing - 2-3 weeks
Ophthalmoplegical a set of symptoms - 2-6 weeks
Appearance of dissymmetric myosites since 3-8 weeks.

in 53,7 % of cases

Poisoning with funguses, diphteria, poisoning

with atropinum, components hemp, phosphoroorganic by substances, methanol, TOXIC FOOD–BORNE DISEASES, virus encephalitises and bulbar forms of a poliomyelitis, disorder functional apoplexy, side effect of medicines.
LABORATORY DIAGNOSIS.
Biological method (detection of a toxin and definition its type).

There is a possibility to determine a toxin by a method PCR.

water, foodstuffs, slices of bodies, contents of wounds on medium

Китта-Тароцци, broth Хоттингера, fungous-caseic medium. The revealing of the originator for the adult does not give the basis for setting the diagnosis.

3. The immunological responses will not utillize (antibody will not be derivated).

TREATMENT.
The main task – elimination and neutralization of a toxin.
lavage stomack and intestine for 10 litres of solution 5% sodii carbonate
Immediate introduction (after definition of sensitivity to heterogeneous protein ) of a polyvalent ANTITOXIN IM or IV
At the mild form - 1- 2, moderate - 2- 4, severe- 8-10 doses.
One dose: A and Е - on 10.000 IU, B – 5.000 IU

repeatedly, but other series.

The antitoxin neutralizes only toxin circulating in

a blood, instead of fixed in nervous - muscle synapses.

At positive intradermal test - introduction human immunoglobulin (1 dose contents - B and Е - 60 IU, A - 130 IU).
antibiotics - (at wounded and children's)
- levomycetinum 0.5 gr q6h PO or IV
- ampicillinum 1.0 – 1.5 gr PO,IV,IM q6h
Power supply (through the probe).
Sufficient hydration.
Controlled artficial respiration,
symptomatic therapy

of tinned nutrition,

heat treatment not less than 20 minutes

doubtful products

- overseeing using the doubtful products 2 weeks and at of
slightest signs disease - introduction of 1 dose of an
antitoxin

- introduction of a polyanatoxin to the persons working with botulotoxin.