This document summarizes several types of food poisoning, including those caused by Salmonella, Clostridium botulinum, Staphylococcus aureus, ciguatoxin, scombroid, parasites that can be found in raw fish, and monosodium glutamate. It describes the organisms that cause each type of poisoning, their signs and symptoms, treatments, and other relevant details.

1. Food Poisoning
Richard S. Weisman, Pharm.D.
Director, Florida Poison Center – Miami
Research Associate Professor of Pediatrics
University of Miami, School of Medicine

3. Overview
 Salmonella
 Clostridium
 Staphylococcus
 Ciguatera
 Scombroid
 Japanese Restaurant Syndrome
 Chinese Restaurant Syndrome

4. Salmonella enteritidis
 Outbrakes associated with grade A eggs
 Preparation of Poultry
 Sources
 Chocolate mousse
 Ceasar salad
 Chicken
 Gram - rod
 Killed by high temperatures

5. Salmonella
 Signs and symptoms
 5-72 hours
 low grade fever
 abdominal pain
 diarrhea
 chills

6. Salmonella
 Diagnosis
 patient history
 stool culture
 Microscopic examination
 leukocytes
 occult blood

7. Salmonella
 Treatment
 Supportive
 fluid and electrolyte
 NO antibiotics
 does not alter the severity
 prolongs the carrier state
 Do NOT give anti-motility drugs
 lead to intestinal perforation

8. BOTULISMBOTULISM

9. Clostridium botulinum
 Four different types
 food borne
 infant
 wound
 undetermined
 Resistant
 heating, freezing, ionizing radiation

10. Clostridium Botulinum
 Destroyed by
 boiling >120 degrees for >20 min
 Botulinum toxin
 Very powerful
 0.5 nanograms (lethal)
 Heat sensitive
 80 degrees for 30 min

11. Clostridium Botulinum
 Signs and Symptoms
 12-48 hrs (14 days)
 N/V/D
 abdominal distention
 constipation (as disease progresses)
 Neurologic disturbances
 dysarthria, dysphagia, dry mouth

12. Clostridium
 With disease progression
 descending paralysis
 respiratory weakness
 respiratory failure
 oculobulbar symptoms

13. Clostridium Botulinum
 Treatment
 stabilization of airway
 history
 upper and lower GI decontamination
 trivalent antitoxin
 (ABE)
 watch for hypersensitivity
 call CDC

17. Botulism:
Differential Diagnoses
 Neuromuscular disorders
 Stroke syndrome
 Myasthenia gravis
 Guillain-Barre syndrome (Miller-Fisher variant)
 Tick paralysis
 Atropine poisoning
 Paralytic shellfish/puffer fish poisoning
 Diagnosis based on clinical presentation with
subsequent laboratory confirmation

18. Botulism: Treatment/Prophylaxis
 Ventilatory assistance and supportive care
 Botulinum antitoxin
 Trivalent equine product against types A,B, and E
available from CDC
 Most effective if given early
 Antibiotics for wound botulism
 Penicillin
 Recovery may be prolonged with supportive care
necessary
 Vaccine investigational
 not available

19. 1
1
1
1
1
1
2
1
1
1
1
1
1
1
12
1
Laboratory Capacity for
Botulinum Toxin Testing

20. Arnon SS et al, JAMA 2001:285:1059-70

21. Staphylococcus aureus
 Enterotoxins
 found
 protein rich foods
 ham, poultry, fish, milk and other dairy
 improper food handling

22. Staphylococcus
 Mechanism
 entrotoxin acts as a superantigen
 stimulates intense cytokine production
 toxic shock like syndrome
 Signs and Symptoms
 2-6 hrs
 abdominal pain
 N/V/D

23. Staphylococcus
 Treatment
 mild
 self limiting
 death is rare
 elderly
 debilitated

24. Ciguatera
 Most common reported fish poisoning
 Hawaii and Florida report 90% of all cases

28. Nerve Cell
Ciguatoxic Effects on the Sodium Channel

33. CIGUATERA
Onset of Symptoms
2222
962
110
0
500
1000
1500
2000
2500
< 12 hours 12 - 24 hours > 24 hours
Onset of Symptoms
Am J Trop Med 28:1067, 1979

34. Symptom Course of
Chronic Ciguatera

35. CIGUATERA POISONING
Days of Bed-rest Required
Number of Days of Bed-rest
161
218
91
40
30
13 6
32
0
50
100
150
200
250
1 2 3 4 5 6 7 8
Am J Trop Med Hyg 28:1067-1073, 1979
N= 591

36. Marine & Freshwater Toxin
Diseases : Clinical Epidemiology: Clinical Epidemiology
Ciguatera: ?Clinical Costs
$2470/case in Canada
(Todd 1990)

38. Ciguatera
 Heat stable
 Odorless
 Acid stable
 Tasteless
 Mechanism
 free algae dinoflagellates (ciguatoxin)
 dinoflagellates eaten by small fish

39. Ciguatera
 Diagnosis
 ELISA for ciguatoxin
 high pressure liquid chromatography (HPLC)
 test fish
 dipstick immuno assay

40. Ciguatera
 Treatment
 Mannitol 1g/kg IV over 45 minutes
 activated charcoal
 electrolyte repletion

43. SCROMBOID
“Mahimahi Flush”
 This poisoning is entirely preventable with
adequate refrigeration soon after it is caught.
 Bacteria found under the fish’s scales are converted
from histadine to histamine.
Morganella morganli
Escherichia Coli
Kiebsiella pneumonia
 Cooking the fish will not destroy the histamine
 Poisoning was once attributed to the toxin Saurine

44. SCROMBOID POISONING
Symptoms
 The onset of symptoms is usually within minutes of
the ingestion
 Headache
 Flush
 Diarrhea
 Diaphoresis
 Abdominal Cramps
 Pruritis &Urticaria

45. SCROMBOID POISONING
Laboratory & Treatment
 Histamine levels in the fish correlate with toxicity
0.1
mg/100mg = Non-toxic 1.0
mg/100 mg = Toxic
 Intravenous Diphenhydramine
 Intravenous Cimetidine
 Rehydration
 Once treated, symptoms do not reappear

46. Japanese Restaurant Syndrome
 From eating raw fish
 mackerel
 cod
 flounder
 Round worms
 eustronsylids

47. Japanese Restaurant Syndrome
 Prevention
 freezing (-4 degrees F x 60 hours)
 cooking (140 degrees F x 5 min)
 Signs and Symptoms
 Stomach
 1-12hrs
 N/V
 severe abdominal cramping (like gastric ulcer)

48. Japanese Restaurant Syndrome
 Signs and Symptoms (con’t)
 lower intestinal
 abdominal cramping
 localized abdominal pain
 mimics an acute appendicitis

49. Japanese Restaurant Syndrome
 Diagnosis
 without adequate history difficult to diagnose
 endoscopy
 see pink or red larvae
 pathologic examination
 Treatment
 Riclosamide
 Praziquantel

50. Chinese Restaurant Syndrome
 Monosodium glutamate
 l-sodium glutamate (MSG)
 Found
 chines restaurants
 flavor enhancer
 sausages
 caned soups

51. Chinese Restaurant Syndrome
 Signs and Symptoms
 10-20 min
 burning
 facial pressure
 headache
 flushing (decreased bp)
 shudder attacks
 seizure like (young children)

52. Chinese Restaurant Syndrome
 Treatment
 oxygen
 beta 2 inhalers
 IV fluids