DEFINITION OF FOOD POISONING
Food poisoning is general term for health problem arising
from eating contaminated food by bacteria, viruses, or
environment toxins that present within the food it self
characterized by nausea, vomiting with/without diarrhea.
The contamination of food may occur at any stage in the
process from the food production to consumption
Epidemiology of Food Poisoning
Food poisoning, occurs commonly throughout the world. It is estimated that in
the United States alone, approximately 48 million episodes occur annually,
resulting in approximately 3000 deaths per year.
In the United Kingdom about 2 million people a year suffer from an attack of
diarrhea with/without vomiting due to food poisoning. Most do not consult
their doctor and the cause is not often found.
In Malaysia, Melaka registered the highest incidence rate (IR)of food poisoning
cases per 100,000 population at (108.6) followed by Perlis (102.3) and
Terengganu (78.2). Meanwhile, W.P. Labuan recorded the lowest IR in 2012 at
Two types of salmonella infections:
1) Systemic infections (enteric fever): S. Typhi, S. Paratyphi A – C
2) Gastroenteritis (salmonellosis): S.enteritidis
with the invasion of intestinal epithelia
1. invasion continues and infection becomes generalized → little or
no diarrhea, but pronounced fever & other general symptoms
2. infection is localized to ileocaecal region → diarrhea, nausea &
vomiting, abdominal pain, temperature may be elevated
Source of infection by asymptomatic carriers, contaminated food &
water,contaminated poultry animals & products.
Route of infection is faeco-oral route.
Laboratory diagnosis :
Widal test(agglutination test),ELISA.
for typhoid fever ciprofloxacilin/ceftriaxone/ampicillin.
Self limiting & symptomatic for gastroenteritis.
C. perfringens is found frequently in the intestine of humans, animals, present in
soil and areas contaminated by human or animal feces.
results by eating improperly cooked and stored foods.
Commonly infected foods = meats, meat products, and gravy.
cause intense abdominal cramps and watery diarrhea.
*Stool culture and blood tests may be done to confirm the diagnosis.
*treat C. perfringens food poisoning by managing any complications (dehydration
caused by diarrhea and vomiting)
Cl.botulinum-gram positive bacilli with sub terminal spores
Pathogenesis by botulinum toxin.
Mode of infection by soil,contaminated food.
Treatment with penicillin,antitoxin.
good food manufacturing practice.
adequate cooking of food before consumption
Staphylococcus aureus –Gram positive cocci in cluster
2nd most reported food borne disease.
Heat resistant exotoxin acts as enterotoxin – boiling for 30 mins not sufficient to
denature the exotoxin
Incubation period 1 – 6 hours; rapid recovery
Contaminated meats , fish, potato salad, custards, etc.
inoculated into foods during pre.paration
Mode of transmission: Human reservoir (nose), skin abscesses
Specimens-suspected food,vomits & faeces.
Culture on blood agar media grows beta haemolytic colonies.
Grows well on ordinary media like nutrient agar,blood agar,gelatin agar media.
Virulence factors enterotoxins .
Mode of infection by spores in soil &food.
Causes gastroentritis ie food poisoning.
Treatment-ciprofloxacin in anthrax cases & symptomatic treatment in food poisoning
Refrigerated cooked food should be reheated.
Mode of infection is faeco-oral route.
Through ingestion of contaminated water or sea food or by exposure of disrupted skin and
mucosal surfaces to contaminated water.
Cholera toxin activates adenylate cyclase → hyper secretion of water & electrolytes → death by
dehydration and electrolyte abnormalities
“Rice-Water” stools, painless, non-bloody diarrhoea
Severe Dehydration-thirst, oliguria, anuria, cramps, weakness, decrease turgor
Circulatory collapse- cyanosis, stupor, renal tubular necrosis, death
Metabolic Acidosis may be severe loss of bicrabonates.
specimen-stool,rectal swabs in acute phase of diarrhoea.
Culture on TCBS agar media yellow – green coloured colonies.
Serodiagnosis very less efficient agglutination& anti toxin test.
Treatment: rehydration & antimicrobial agents like tetracycline or doxycycline
Chloramphenicol,ampicillin or trimethoprim-sulfamethoxazole.
Gram staining and Loeffler methylene blue staining of the stool for WBCs help to differentiate
invasive disease from noninvasive disease.
Perform microscopic examination of the stool for ova and parasites.
Bacterial culture for enteric pathogens, such as Salmonella becomes mandatory if a stool
sample shows positive results for increase WBCs or if patients have fever or symptoms
persisting for longer than 3-4 days.
Perform blood culture if the patient is notably febrile.
CBC with differential, serum electrolyte assessment, and BUN and creatinine levels help to
assess the inflammatory response and the degree of dehydration.
abdominal radiographs should be obtained if the patient experiences bloating, severe pain,
or obstructive symptoms or if perforation is suggested.
When a stool examination is nondiagnostic, performing sigmoidoscopy/colonoscopy with
biopsy and esophagogastroduodenoscopy (EGD) with duodenal aspirate and biopsy may be
Consider sigmoidoscopy in patients with bloody diarrhea. It can be useful in diagnosing
inflammatory bowel disease, antibiotic-associated diarrhea, shigellosis, and amebic
Prevention and Control of Food
Wash hands thoroughly before handling food
always cook by your self. Reduce take outside food.
Keep food preparation surfaces and utensils clean and disinfected (e.g. anti-bacterial)
Prepare and store raw meat and 'ready-to-eat' food separately
Always keep raw and defrosting meat at the base of the refrigerator, below everything else
Ensure that refrigerator and freezer are operating properly. The refrigerator should operate at 5 degrees C or lower and the freezer at -18 degrees C
Check the 'Use by' dates on food and ensure that you use the food before the date expires
Always store eggs in the refrigerator and do not eat food containing uncooked eggs
Keep pets away from food and food preparation surfaces
Defrost food, particularly meat and poultry thoroughly before cooking
Cook food thoroughly. Follow the manufacturers' guidelines and ensure that food is piping hot throughout before consumption
Appropriate training for preventative control
Food handlers have a major role in the prevention of food poisoning during
food preparation since they may cross contaminate raw and cooked foodstuffs
as well as inadequately cook and store foods.
The Ministry of Health in Malaysia launched the Food Handlers’ Training
Programme in 1996 to ensure hygienic practices during handling, preparation
and sale of food.
Adoption of food safety management systems and risk models
Hazard Analysis Critical Control Point (HACCP) in food service establishments
system that helps food business operators look at how they handle food and
introduces procedures to make sure the food produced is safe to eat.
Wash hands after contact with the sick person, and before handling food
Do not use the same towel or face cloth as someone who is suffering with food borne illness
Clear up soiling accidents straightaway, wash with hot soapy water and disinfect with a disinfectant or bleach
Disinfect door and toilet handles, taps and the toilet seat after use and disinfect the toilet bowl frequently
Drink plenty of fluids while you are ill to prevent dehydration
Surveillance and monitoring
A Food Safety Information System of Malaysia (FoSIM) was launched in 2003 to assist in the management of food
safety surveillance to ensure imported foods sold in Malaysia are safe for human consumption .
Food premises inspection and closures were carried out intensively if not follow certain criteria