In a modern civilized society, perhaps, there is no person who has never heard that his hands must be washed before eating. It is also necessary to wash vegetables, berries, fruits before use. They may contain dangerous bacteria and other pathogenic microscopic creatures that, once in the human body, cause very serious health problems, including foodborne toxicosis. However, this condition can occur in those people who fanatically observe all the rules of hygiene. To do this, it is enough to eat dishes prepared in violation of sanitary standards. The type of food does not always mean that it is seeded with microorganisms, so people do not have any fears.
Currently, a number of state medical organizations have developed and approved clinical recommendations, foodborne toxicoinfections in which are considered depending on the type of pathogen. The presented documents are a practical guide for doctors to help diagnose and prescribe the necessary course of therapy. Consider what types of infections exist, how to protect yourself from them, how to treat them.
General Provisions
Foodborne infection is also called bacterial food poisoning, or bacteriotoxicosis. This condition must be distinguished from food intoxication (poisoning by toxic substances, such as mushrooms). Foodborne infection is a condition that is caused only by pathogenic microbes and the substances released by them that enter the human body in such quantities that the immune system cannot cope with.
This phenomenon has a good seasonality. So, bursts of food-borne bacteriotoxicosis in most regions of our country are observed in the warm months of the year (from May to September), when bacteria appear under conditions conducive to their active life. In southern countries, this ailment is equally dangerous all year round, which should be taken into account by our tourists.
The susceptibility to foodborne bacteriotoxicosis is almost 100%, but it can manifest itself with varying degrees of severity, which depends on the type of microbe and on the strength of the patient's immunity.
This ailment is especially dangerous for young children. If they do not receive medical attention on time, a fatal outcome is possible.
Foodborne bacteriotoxicosis can be observed in isolated cases (if one has eaten a product contaminated with microbes) or in bulk (if poor-quality food has been fed a whole group of people).
Types of pathogens
Dangerous are almost all pathogenic microorganisms that can cause diseases in humans. Most often, bacteria become the causative agents of foodborne toxicoinfections:
- Staphylococci.
- Clostridia (C. Perfringens, C. Botulinum, C. Difficile).
- Cereus.
- Citrobacter (wiped off in soil, in sewage).
- Enterobacteria (salmonella, pathogenic intestinal and plague sticks).
- Proteus bacteria.
- Parahemolytic vibrios (live in salt ponds).
Depending on the type of microbe, there are several codes of foodborne infection infections according to ICD-10, each of which caused a specific microbe:
- And 05.0 - staphylococcus.
- A 05.1 - C. Botulinum (botulism).
- A 05.2 - C. Perfringens (necrotic enteritis).
- A 05.3 - C. perfringens (parahemolytic vibrios).
- A 05.4 - Bacillus cereus (cereus).
- And 05.8 - other specified bacterial food poisoning.
The code for ICD-10 of foodborne toxicoinfections, unspecified - A 05.9.
Each of these microbes has its own characteristics.
So, representatives of the staphylococcus family can be found on the mucous membranes and skin of a person, as well as on various household items that the infected person uses. The most dangerous is Staphylococcus aureus. This is one of the few types of bacteria that can be infected by airborne droplets.
Clostridia feels great in various foods (sausage, land, smoked ham, as well as in the soil, in the silt of water bodies. Botulism bacilli are often found in freshwater fish.
Cereus can be isolated in meat, dairy products, in baby food, in spices and soups, in vegetables.
Cytrobacteria are also found in meat products (minced meat, semi-finished products), in dairy products, where they are actively propagated.
Enterobacteria are present in the soil, and on various plants, and in the body of animals, as well as humans. They can seed meat products (sausages, sausages, minced meat), fish, vegetables. A sign of their spoilage may be mucus and a bitter taste.
Protein bacteria are found in vegetables, meat, fish, usually without signs of unfit for consumption.
Parahemolytic vibrios are microbes, the danger of which many people ignore, because they believe that there can be no bacteria in salt water. However, the aforementioned vibrios cause very serious food poisoning. Cases of infection by them after eating salted hamsa, frozen shrimp, squid were recorded.
Although bacteriotoxicosis is synonymous with foodborne toxicosis, some fungi (not mushroom plants) that enter the stomach with food and release dangerous toxins can also cause it.
Clavicepspurpurea is extremely dangerous, which you can catch by eating something from the grain. Symptoms in this case are: damage to the nervous system, colic, diarrhea, vomiting, hallucinations, convulsions, abdominal pains. With this pathology, pregnant women in the later stages can have a premature birth, and in the early - a miscarriage.
No less dangerous is the fungus Fusarium sporotrichiella, which develops on grain that has wintered under snow. Acute poisoning during the day ends in death.
Ways of infection
Depending on the characteristics and lifestyle of a particular microbe, how it can enter the human body and cause foodborne toxicosis.
The main route is fecal-oral. This means that microbes penetrate the body of their victim through the mouth when eating insufficiently washed fruits, vegetables, herbs, berries. On these products you can find many different bacteria that live in the soil and on plants, as well as those that are excreted from the body of a sick person or animal with feces.
Microbes fall on fruits and vegetables with the help of flies, ants and other insects. However, this path is not prevailing, since in order to get food poisoning a person must immediately “eat” a lot of bacteria. Otherwise, he develops not foodborne toxicoinfection, but an intestinal disease (bacteria enter the stomach, then into the intestines, begin to multiply there, which is accompanied by the symptoms characteristic of each ailment).
The more common methods of infection leading to food poisoning are as follows:
- Eating prepared foods seeded with germs. They get on this food from a sick person, for example, a cook, a seller.
- Violation of the rules for their storage, processing and preparation of products, for example, when salting fish. In many products (and in salted ones as well) microbes reproduce very well, forming huge colonies. This is especially true for the warmer months of the year.
- Insufficient heat treatment of meat, eggs, milk. Microbes get into them from sick animals.
- River or sea fish, seafood (even frozen, and then cooked). Microbes get into them from the water, which is their habitat.
- Foodborne infection in young children occurs after playing in the sandbox if they pull dirty hands into their mouths.
- In hospitals, especially in maternity hospitals, outbreaks of staphylococcus infection are often observed, which is transmitted only from infected people through tools, household items and airborne droplets.
- Drinking water from open sources, in which millions of bacteria have bred.
Pathogenesis of foodborne toxicoinfections
The disease can occur within half an hour after infection. In some cases, the incubation period lasts up to 24 hours. This lightning-fast development is due to the fact that hundreds of thousands of microbes simultaneously enter the human body. They do not need time to form colonies - they begin their active pathogenic activity immediately.
In this case, not only inflammation of the mucous membranes of the stomach and intestines occurs, but also the release of a huge amount of toxins seeping into the bloodstream, with the flow of which they are carried throughout the body. Many of these toxic substances destroy the membranes of blood cells, which leads to their death. As a result, the blood no longer fulfills its main function - transporting oxygen cells to the cells and taking carbon dioxide from them. This leads to oxygen starvation.
Part of the toxins penetrates the brain and / or spinal cord, where they block the transmission of nerve impulses.
Cytotoxins secreted by staphylococci and some other bacteria block protein synthesis. This leads to a violation of biochemical processes in the body.
The thermolabile and thermostable poisonous substances collected in the intestine cause a disturbance in enterosorption, which is manifested by diarrhea.
Symptoms of foodborne toxicosis
The main sign of the disease is its sudden and acute onset. The patient has the following general symptoms characteristic of infection with most types of bacteria:
- Strong, very sharp, cramping, cutting, stitching abdominal pains.
- Diarrhea (more than 20 times a day).
- Vomiting
- Nausea that does not subside after the release of vomit.
- Rise in temperature or chills, feeling cold.
- Increased salivation.
- Cold sweat.
- Pallor of the skin.
- Headache.
- Unstable blood pressure.
- Tachycardia.
- Pain in the muscles.
- Labored breathing.
- Urinary retention.
When such signs appear, you need to call an ambulance. It is especially important to follow this recommendation if the child has been poisoned. The children's body is extremely difficult to tolerate toxic infections. Own forces to fight bacteria are very few in babies, so it is vital for them to start treatment without delay. Otherwise, food poisoning threatens to develop into an infectious-toxic shock.
Types, forms and stages
Similarly to the ICD-10 codes, the types of foodborne toxic infections are differentiated. The classification is based on which pathogen caused the poisoning. Each microorganism in its own way affects human health, since it emits toxins that are different in chemical composition.
Therefore, when infected with various pathogens, there are both general and specific symptoms of foodborne toxicosis.
So, when infected with botulism pathogens that secrete a very strong toxin, the patient's nerve impulses are blocked, which is manifested by such signs:
- Paralysis.
- Ptosis.
- Difficulties with moving the tongue, swallowing, pronunciation of words.
- Shaky gait.
The person’s temperature drops, there may be no diarrhea.
When staphylococci are infected, diarrhea may also be absent, but vomiting is more frequent. Patients complain of an unbearable headache, pain in the eyes, muscle weakness, cramping abdominal pain.
When infected with proteins, vomiting and diarrhea are present, and the stool has a very offensive smell.
Penetration of Salmonella into the body is manifested by diarrhea (green-colored stools, fetid, watery). Other symptoms: the temperature jumps to 41 degrees, dizziness and cramps are observed.
When infected with Escherichia, all the main symptoms listed above are observed. A distinctive feature - diarrhea can be with blood.
The form of food poisoning is only one - acute.
Differentiation at the stage with this disease is somewhat different from what we have with other diseases. Most types of foodborne toxicosis with proper treatment after 2-3 days ends in complete recovery. Only when infected with Clostridia Botulinum treatment can take up to 2 weeks.
If therapeutic measures are performed incorrectly or are not carried out at all, food poisoning can go into toxic toxic shock. Its outcome depends on the type of microbe. For example, in case of poisoning with proteins, death occurs in 1.6% of cases, and in case of poisoning with Clostridia Botulinum, whose toxin is 300,000 times stronger than rattlesnake poison, 70% of patients die.
The outcome of food poisoning depends on several reasons:
- How quickly and correctly provided assistance.
- Type of pathogen.
- The strength of human immunity.
As a rule, adult patients recover in 2-3 days.
In children, the situation is more complicated. Their weak body tolerates infection harder, requires longer treatment. Often a complication of food poisoning in children is intestinal dysbiosis, which cannot be cured quickly.
Diagnostics
As a rule, doctors without difficulty determine the food poisoning infection of a patient. The diagnosis is made on the basis that a sharp deterioration in health happened suddenly, after eating some foods. Especially obvious are the cases when the same symptoms and similar pathogenesis are observed immediately in a group of people who reported that they ate the same food.
However, doctors necessarily perform laboratory tests to differentiate foodborne bacteriotoxicosis from other dangerous diseases, such as dysentery, salmonellosis, cholera, the signs and methods of infection which are very similar.
If there is only one patient with symptoms of diarrhea, vomiting and abdominal pain, food poisoning from appendicitis, pancreatitis, intestinal obstruction, acute gastritis is differentiated.
For the diagnosis of foodborne infections, vomit, feces, urine, and blood are taken for analysis. In these biomaterials, the pathogen and its resistance to drugs are detected by bacteriological tests, serological tests, PCR and other methods.
If, as a result of the ingress of toxins into the blood, paresis of arterioles and venules occurred, which is manifested by point bleeding, the patient undergoes hardware examinations of internal organs.
Sometimes (if possible) for food they take the food that caused the disease.
Dehydration
One of the very dangerous complications of foodborne illness, accompanied by vomiting and / or diarrhea, is dehydration. His symptoms:
- Dry mucous membranes in the mouth.
- Loss of skin turgor.
- Decrease in urine volume and the number of acts of urination.
- Sunken eyes.
- Crying without tears (a characteristic sign of dehydration in children).
- Dry ("caked") lips.
- Confusion.
- Dry skin.
- Hyperthermia.
With dehydration, the position of the patient with food poisoning is aggravated, since the work of all organs is disrupted.
Nursing
Since in most cases, little time passes from the moment of infection to the appearance of the first signs of poisoning, food does not have time to completely digest. Therefore, gastric lavage is a very relevant method of treating foodborne diseases. Nursing care consists in giving the patient drink enough clean water and induce vomiting in him so many times until only the same water that the person poured into himself begins to leave the stomach. If the patient is not able to drink, gastric lavage should be carried out through a probe. You can induce vomiting several times in a row at home, as soon as signs of poisoning have appeared.
After this, the victim is laid on his back in such a position that his head is slightly raised, wrapped up, a heating pad is placed on his stomach.
When dehydrating, the patient is required to put droppers with glucose-salt solutions or give water orally every 5-10 minutes if his consumption does not cause new attacks of vomiting.
Treatment
Usually, the state of patients with food poisoning does not reach an infectious toxic shock. After cleansing the stomach, the treatment of foodborne toxicoinfections consists of prescribing sorbents to the patient (Polysorb, activated carbon, Smecta), as well as
- For pain in the abdomen, the patient is given a pill with belladonna.
- To prevent dehydration, they are given oral drinking or rehydrants are administered intravenously.
- Doctors often prescribe siphon enemas for patients to flush out bacteria and their toxins from the lower intestines, and in some infections, prescribe a laxative.
- If the poisonous substances managed to seep into the blood, as can be seen from the more severe symptoms (there is a dynamics of lowering blood pressure, difficulty breathing) and is confirmed by tests, the patient undergoes a series of resuscitation measures, introducing glycocorticosteroids intravenously, “Dopamine” to restore blood flow, “Albumin” for conducting infusion therapy.
Doctors prescribe antibiotics depending on the condition of the patient. .
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Children, if they have dysbiosis as a result of food poisoning, are prescribed probiotics and prebiotics.
How to avoid infection
Prevention of foodborne diseases includes the following measures:
- Personal hygiene.
- Eating only pure fruits and vegetables, herbs (dill, parsley and others), berries.
- Compliance with the shelf life of products.
- Teaching kids that you can’t put fingers, toys and other objects in your mouth, and that you must wash your hands, even before you eat one candy.
- Boiling water from open sources before use.
- Storage of raw meat and fish, dairy products, vegetables (especially root vegetables) separately from cooked dishes.
- With great care, eat smoked products (fish, chicken legs, sausages).
- At the slightest suspicion that the product is spoiled (mucus, unusual color, incomprehensible plaque), refuse to use it.
- Properly conduct cooking. All bacteria die when exposed to heat, but each species requires a different time. For example, for staphylococcus - boiling for 2 hours, for clostridia - heating for 15 minutes at 80 ° C, half an hour at 65 ° C is enough to destroy the proteas.
After suffering food poisoning, the diet should be followed for some time. It is allowed to eat low-fat fish, meat, kefir, cereals on the water (you can add olive oil), baked and boiled vegetables, low-fat soups.