From Big Medical Encyclopedia

FOOD POISONINGS — the acute (seldom chronic) not contagious diseases arising at the use of the food massivno inseminated by certain species of microorganisms or containing substances of the microbic or not microbic nature, toxic for an organism.

The diseases resulting from receipt in an organism of excess amounts of feedstuffs do not enter into group P. of the lake (Hypervitaminoses, a fluorosis, etc.); caused by deliberate introduction to food of any poison for the purpose of suicide or murder; arising owing to alcoholic intoxication; the poisonings which are a consequence of wrong use in life of any toxic agent instead of food and also the diseases developing owing to food allergy (see).

According to P.'s classification by the lake approved by M3 of the USSR in July, 1981 are subdivided on microbic (toxicoinfections, toxicoses and poisonings of the mixed etiology), not microbic (poisonings with noxious plants and tissues of animals or products of plant and animal origin, poisonous under certain conditions; poisonings with impurity of chemical substances) and poisonings of an unspecified etiology.

Toxicoinfections — the acute diseases arising at the use of the food containing massive amounts of living cells of the specific activator (105 — 106 and more on 1 g) and their toxins emitted at reproduction and death of microorganisms. Food toxicoinfections (see. Toxicoinfections food ) can be connected with the most various food stuffs. So, for the toxicoinfections caused by Cl. perfringens type Ah, is characteristic communication with substandard meat products, especially meat of animals of forced slaughter. For the food toxicoinfections caused you. cereus, are more characteristic products of the vegetable and mixed origin (salads, vinaigrettes etc.), however they can arise also at the use of the meat, fish and dairy products inseminated by this species of microorganisms. The listed products at their pollution of PR. vulgaris, E. coli, Str. faecalis can also serve as the reason of food toxicoinfections. The poisonings caused by V. parahaemo-lyticus arise at the use of fish and other seafood, and also the salty vegetables contaminated by this microorganism.

Microbic toxicoses — acute or hron, the diseases arising at the use of the food containing the toxin which collected in it as a result of development of the specific activator. The live microbic culture at the same time in a product can be absent or be found in small amounts. Microbic toxicoses are subdivided into two groups — bacterial toxicoses and mikotoksikoza. C1, botulinum and enterotoxigenic strains of St belong to causative agents of bacterial toxicoses. aureus.

The poisonings caused by Cl. botulinum, arise at the use of products (most often mushrooms of house preparation, fish of cold smoking, canned food of vegetable products) in which in connection with violation of the rules of production favorable conditions for development of anaerobe bacterias (are created see. Botulism ). The items of the lake caused by St. aureus, are connected with enterotoxin of this microbe. Toxin termoustoychiv, maintains long boiling, autoclaving, does not collapse during the freezing of products.

Infection of food stafilokokkam (see) can happen at contact of the persons having pustulous diseases to food stuffs or a drop way — at cough of patients with quinsy.

It serves frequent the reason of infection of milk mastitis at cows. Mikotoksikoza are subdivided into the diseases caused by toxins of fungi of the sorts Fusarium, Aspergillus, Penicillium, and also a type of Claviceps purpurea, etc. All these toxins have extremely high resistance to influence physical. and chemical factors (see Mikotoksikoza).

Not microbic Items of the lake are subdivided into three groups — poisonings noxious plants (see) and tissues of animals; poisonings with products of plant and animal origin, poisonous under certain conditions, and poisonings with impurity of the chemical nature. Typical examples of diseases of the first group — poisoning with the poisonous mushrooms and conditionally edible mushrooms which are not subjected to the correct culinary processing (see. Mushrooms, poisonings with mushrooms ). Poisonings with noxious plants concern to the same group, to-rye arise preferential in warm season, is more often among the children or tourists eating unfamiliar plants. These poisonings can have mass character. The leading symptom at poisoning with many plants is defeat of a nervous system. Depending on character of the poisonous beginning in a wedge, a picture signs of dysfunction of c prevail. N of page (excitement or oppression) with the expressed cholinolytic (atropinopodobny) syndrome (at poisoning with a belladonna, henbane) or with a nicotinosimilar syndrome (at poisoning with poppy, a horsetail, to milestones, monk's-hood).

At the use ranks of a sowing campaign damage of a spinal cord with spastic paralysis of the lower extremities develops (see. Lathyrism ).

Poisons of many plants have the expressed effect on a mucous membrane of a digestive tract, causing dispeptic frustration, abdominal pains, and in hard cases — bystry dehydration of an organism. The autumn crocus, a spurge, a castor-bean tree, an euphorbia, a buckthorn concern to this group of plants. For an organism seeds of some weeds getting to grain during the harvesting are poisonous. So, consumption of flour from the grain containing impurity of a weed of a trikhodesma gray-haired (see. Noxious plants ), leads to development of a trikhodesmotoksikoz who meets in Uzbekistan and became history under the name «dzhalangar-sky encephalitis». Seeds of a trikhodesma contain alkaloids inkanin, N-oksidinkanin, trikhodesmin. Dispeptic frustration, headaches, the general weakness, twitching of face muscles, constraint of movements, disturbance of gait, defeat of pyramidal system, gemi-and tetraparesis, disturbance of mentality are characteristic of poisoning with seeds of a trikhodesma. From the first days the phenomena of a capillary toxicosis are noted (see. Shenleyna — Genokh a disease ), hypochromia anemia (see. Iron deficiency anemia ).

In hard cases the long current, up to 2 — 3 years, with dominance of symptoms of damage of a liver and c is observed. N of page. Consumption of the grain contaminated by seeds of a heliotrope an opushenno-fruit-nogo (Heliotropium lasiocarpum) causes the disease caused by hepatotropic effect of the poisons which are contained in these seeds — - a gelio-trina and a laziokarpina. The disease can end letalno as a result of development of a hepatic coma (see. Heliotropic toxicosis ).

Poisonings with poisonous animal products (see. Poisonous animals ) in our country meet seldom. Poisonings with caviar and milts of some species of fish belong to these diseases: marinka, Sevan hromula, man with a big mustache. The clinic of a toxic gastroenteritis is characteristic of these diseases. In the southern countries of P. of the lake poisonous fishes meet more often. In the world it is known apprx. 500 poisonous fishes, annually the quantity of poisonings during the use of these fishes in food makes apprx. 20 thousand, of them from the death — apprx. 300. Are most dangerous to the person of a dog fish (more than 90 types are known). The liver, calves, milts, intestines and skin at these fishes contains the most poisonous animal neurotoxin — tetrodotoksinony the Incubation interval of 10 min. to the 3rd hour. The clinic of poisoning is characterized by a parasthesia of lips, language, an ataxy, hypersalivation, lowering of blood pressure, dispeptic frustration. Paralysis of muscles of a throat (an aphonia, a dysphagy), extremities, sometimes spasms is possible. Consciousness is more often kept. Deaths are possible in the first 6 hours, is more rare in 24 hours, from paralysis of respiratory muscles; a lethality to 59,4%. Nek-ry representatives of dogs fishes (fish the fugue) are eaten after removal of all poisonous bodies and are considered in Japan as a delicacy.

Sigvatera — poisonings, to-rye can arise at the use of the most various tropical sea reef and coastal fishes. As a source of poisoning it is described apprx. 300 species of sea fishes including edible, to-rye gain toxicity of hl. obr. in summer hot months. The reason of development of this poisoning known also under the name of an ikhtiosar-kotoksizm, is connected with conditions of food of fishes. Sigvatoksin consists of several fat-soluble and water-soluble fractions. Symptoms of poisoning develop through 1 — 6, is more rare in the 30th hour. Metal taste in a mouth, nausea, vomiting, diarrhea, the progressing muscular weakness, a mialgiya are observed. Often visual disturbances in the form of not clear vision, a photophobia, a passing blindness develop. Pupils are expanded. Skin manifestations — an itch, an erythema. At a serious poisoning muscular paralyzes, kloniko-tonic spasms, a dysphonia, a dysphagy, a coma develop. Deaths come against the background of paralysis of breath. A lethality to 12%. In hard cases a gradual return to health (up to several years). There are poisonous fishes at whom blood has toxic properties (sea eels, moray eels). Ikhtiokri-notoksichesky fishes (lampreys, sea eels) emit toxins with skin glands. Among other marine animals the liver of sharks, especially tropical, a liver of sea turtles, the seal living in the Arctic Ocean is poisonous.

The second group of not microbic P. of the lake is presented by the edible products gaining toxic properties under certain conditions or as a result of the wrong culinary processing. Among products of plant origin it is necessary to call first of all kernels of drupaceous fruits (a peach, an apricot, cherry, almonds, etc.) which part dl-mandelonitrile gentiobioside — the substance forming cyanhydric acid during the splitting is. Most often the use of infusion from these fruits and stones of fruits in a large number which separate grades at a certain stage of vegetation can contain significant amounts of an effective agent is a cause of illness.

Toxicant fagin, easily collapsing during the heating is a part of beechen nuts. Therefore fried beechen nuts are harmless. However consumption of crude nuts can lead to easily proceeding poisonings which are characterized by the phenomena of a toxic gastroenteritis.

At non-compliance with rules of storage toxic can appear wintered sprouted and become green potatoes (see), in Krom a large amount of alkaloid of solanine contains. In 15 — 30 min. after food of such potatoes there is a short-term burning sensation in a throat, dispeptic frustration. At the use of crude haricot, hl. obr. white, the poisoning proceeding or benign (nausea, vomiting, weakness, dizziness) or in heavy — with development of hemolysis, a gemoglubinuriya, jaundice, anemia can develop in the period of 30 min. to 2 hours (see. Favism ). Also the crude haricot containing toxicant fazin can be the reason of poisoning. At heat treatment of a product this substance collapses. Products can be the reason of diseases, in to-rye bean flour is added, and their production is not followed by long heat treatment.

Among animal products for an organism the liver and nek-ry bodies of separate species of fish (a burbot, a pike, etc.) during spawning can become temporarily toxic. The chemical nature of the toxicant which is formed at the same time is not studied.

Poisonings with mollusks (mussels, oysters) as a result of accumulation of toxicants in them are possible at food poisonous the simplest of group of the dinoflagellya-t causing «blossoming» of the sea: during inflows water is painted in red color (in the Far East, in the tropical seas). Most hard the paralytic form of poisoning caused saksitoksiny proceeds. In 30 min. after the use of mollusks paresthesias in the field of language, lips, persons, necks, extremities, appear in hard cases — an ataxy, a dysphagy, a dysarthtia, mialgiya, spasms, paralyzes of extremities, paralysis of the vasculomotor and respiratory centers is possible. Consciousness usually remains. Deaths can develop in the first 12 hours, the lethality makes up to 23%. Forms of these poisonings are known also gastrointestinal and erythematic (petekhialny hemorrhages, damage of a liver, anemia). At the wrong storage of some species of skumbriyevy fishes (a tuna, a horse-mackerel, a jack mackerel, a mackerel) owing to decarboxylation of the histidine which is contained in meat of this fish histamine-like substance zaurin can collect; the lake caused by it P. is characterized by dispeptic frustration, the complicated swallowing, tachycardia, rashes on a body.

Not microbic P. of the lake can be caused and by various impurity to foodstuff of chemical substances (pesticides, salts of heavy metals, the connections migrating in foodstuff from stock, the equipment, a container, packing materials, etc.). A serious poisoning for orthotricresyl phosphate, diverse is known pesticides (see), lead, copper, zinc, mercury, etc.

Acute P. of the lake heavy metals meet seldom. E.g., P. by the lake cadmium as a result of storage of food in kadmirovanny containers is described. P.'s flash by the lake cadmium is described in Japan under the name of an itai-itaa. It was caused by intake of cadmium in food chains from waste of the industry through marine organisms. The symptomatology of these poisonings is similar to that at acceptance in salts of heavy metals (see. Poisonings ). At hron, impact on an organism of salts of heavy metals the toxic phenomena caused by interaction of these metals with sulphhydryl groups of proteins of an organism are noted (see. Cadmium , Lead ). Pollution of the sea mercury (see) brought in Japan to emergence of a disease of Minamata. In marine organisms mercury turns into alkyl derivatives (e.g., methylmercury) and becomes especially dangerous to the person since these derivatives are easier soaked up in intestines and get through barriers of an organism — a placenta and hematoencephalic, damaging a germ and a nervous system.

It is alimentarno necessary to distinguish from poisonings of an unspecified etiology - paroksizmalno - a toxic myoglobinuria, or I geff-will hold down, yuksovsko- Sartlan disease (see). This disease is connected with consumption of small lake fish (a perch, a ruff, a ryapushka), and also pikes, a pike perch, a burbot from the basin of the Baltic coast, Western Siberia. The disease has no constant character in these areas, and it is noted only in separate years and is followed by sudden attacks of the acute muscular pains causing an immovability of the person. Urine of patients gains brown color owing to contents in large numbers of a myoglobin. Duration of an attack is 2 — 4 days; they repeat 3 — 7 times through uncertain terms. Death comes from asphyxia owing to damage of muscles of a diaphragm and intercostal muscles; at separate flashes the lethality reaches 2%. The chemical structure of the poisonous beginning causing a disease is not established, though its high resistance to temperature and other factors is known.

First aid at food poisonings

First aid at food poisonings consists first of all at a distance the poison which came to an organism. In all cases are necessary a gastric lavage water via the probe, introduction to a stomach of active coal, purpose of purgatives, cleansing enemas. For the purpose of desintoxication at the expressed clinic of poisoning forcing of a diuresis, hemosorption is carried out (see. Poisonings ). According to indications carry out specific and antidotal therapy, e.g., administration of atropine at poisoning with a foxglove, antihistaminic drugs — at poisoning with skumbriyevy fishes. In all cases the symptomatic therapy directed to recovery (maintenance) of the broken function of bodies depending on selective toxicity of poison is shown.

Prevention of food poisonings

Prevention of food poisonings of the microbic nature comes down to the prevention of infection of foodstuff with microbes — activators P. of the lake, to the prevention of reproduction in food of microorganisms and to destruction of the got microbes by method of thermal treatment. It is for this purpose carried out sanitary inspection (see) and veterinary sanitary inspection (see) for a dignity. conditions of slaughter of animals, catching and processing of large fishes, receiving and processings of milk, production of sausages, canned food, and also control of production of confectionery, processing, storage and implementation of ready dishes in table, food blocks of child care facilities, buffets and other catering establishments.

The meat and meat products coming to the market shall be followed by the certificate of wellbeing of the area concerning zoonotic diseases of animals, and also the reference from the local veterinarian on the state of health of the slaughtered animal.

Preventive actions for prevention of developing of the food toxicoses caused by staphylococcal enterotoxin include a package of measures, the causes to some extent promoting planting of a stafilokokkama of raw materials, foodstuff and food and to provide creation of such conditions of production, storage and implementation of foodstuff during which enterotoxigenic strains of stafilokokk especially important cannot be formed enterotoksinony For protection of foodstuff from hit in them not to allow to processing of raw materials, foodstuff and production of food of persons with furuncles, felons, abscesses, inflammations after burns, the suppurated cuts and other defeats, and also the workers having quinsy allowing to remove. They are discharged of work before recovery. Along with it for decrease in a staphylococcal carriage among personnel of the food enterprises measures for the prevention catarrhal and elimination of pustulous diseases shall be carried out systematically.

Stafilokokki well breed and produce enterotoxin at long-term storage at the room temperature of thermally processed products. Therefore to store foodstuff and ready food it is necessary at a temperature from 2 to 4 °.

Cows, sheep, goats> sick with mastitis can be a source of planting of a stafilokokkama of milk and dairy products. The milk received from such animals shall not be used for the food purposes. Reduction of bacterial contamination of milk, including staphylococcus, requires observance of sanitary conditions during the receiving, processing, transportation and implementation.

For the prevention of the toxicoses connected with the use of cream products it is necessary to use cream for cakes and cakes no later than 6 hours after its production. For implementation cakes and cream cakes need to be stored at a temperature not over 6 °. At catering establishments and in the shops which do not have refrigeration units, sale of confectionery is forbidden.

For the purpose of prevention of the staphylococcal intoxications connected with the use of fish canned food in oil it is necessary to meet the conditions of their correct production excluding a possibility of planting of a stafilokokkama of oil and the fish going for preparation of canned food. For this purpose timely reveal and discharge of work to an absolute recovery of persons with pustulous diseases of skin, quinsies and acute katara of upper respiratory tracts. Sterilization of fish canned food in oil is made at a temperature of 120 ° within 35 min.

At catering establishments for cutting of meat, fish, vegetables and other products finishing tables and boards mark on a side surface depending on appointment: «CM» — crude meat, «VM» — boiled meat etc.

Food objects shall be provided with special transport, it is forbidden to use accidental vehicles for these purposes.

Events for increase a dignity are systematically held. cultures of employees of the food enterprises. For this purpose all going to work hand over a dignity. - those. at least, and further every 2 year — examination on a dignity. to a minimum.

Prevention of mikotoksikoz is provided with screening of seed grain, its timely cleaning and the correct storage. The suspicious grain (which wintered of late cleaning, is long stored in unfavorable conditions) is subject to a complex research on mycotoxins with the subsequent solution of a question of a possibility of its use for the food or technical purposes.

Prevention of poisonings of not microbic nature comes down first of all to a dignity. - a gleam, work among the population, and also to implementation of a number of organizational actions which aim not to allow receipt of dangerous products for food to the population.

For P.'s prevention by the lake heavy metals in the USSR and some other countries accepted marginal levels of content of metals in foodstuff. WHO established the following general marginal week receipts of heavy metals in a human body weighing 60 kg (with food, water and air): cadmium of 0,4 — 0,5 mg, mercury of 0,3 mg (including methyl-mercury of 0,2 mg), lead of 3 mg.

Food poisonings in the medicolegal relation

Forensic medical examination is carried out for detection of proofs of relationship of cause and effect between the use of foodstuff and the disorder of health which arose after that or approach of death. As the concept P. of the lake is collective, court. - the medical expert, concretizing their origin, shall mean P.'s division of the lake accepted in judicial toxicology on true and indirect, carrying out their differentiation from patol, the processes similar on a wedge, to a current and a thanatogenesis. Lakes carry those to true P., to-rye develop from the use of products, constantly poisonous by the nature (e.g., such mushrooms as a death angel, a strochok; parts of some plants, especially kernels of drupaceous fruits; internals of the Sevan hromula, marinka and other fishes or animals), and also temporarily gaining toxic properties — edible, but old mushrooms, it is long or incorrectly stored foodstuff. At indirect P. of the lake toxicity of products is caused by the impurity which are contained in them: vegetable (heliotrope, gorgan, corn cockle, etc.) or chemical character (salts of heavy metals, toxic chemicals, bacterial toxins, etc.). The most frequent conditions of emergence of P. of the lake are ignorance of toxic properties of some vegetable and animal products, lack of information on possible toxic impurity to products, disturbance of storage of initial products and their processing, and also terms of use of the cooked food; infection of foodstuff in a process of manufacture, storages, transportations and cookings.

At P. of the lake from the death in the course of inspection of the scene court. - the medical expert shall find and withdraw food or its remains and ware in which it was, and also various allocations (the emetic masses, urine, excrements), to find out character of the means applied to assistance.

At court. - a medical research of a corpse if P. is suspected by the lake, it must be kept in mind features of early changes of a corpse (very bystry or slowed-down their development, intensity, etc.), character patol, changes of internals; existence in a stomach of the remains of undigested food (mushrooms, parts of plants, seeds etc.); obligatory withdrawal of objects for a lab. analyses, and withdrawal of objects for bacterial, and biol, researches shall be made sterilely.

Are applied to clarification of character of the substance which caused P. of the lake judicial and chemical, microscopic, spectral, botanical, bacterial, and biol, methods of researches.

See also Foodstuff .

Bibliography: Hygiene of food, under the editorship of. K. S. Petrovsky, t. 1, page 339, M., 1971; At with ynin I. A. Toksikologiya of noxious plants, M., 1962, bibliogr.; Luzhniki E-A. and and ev V. N. of ifirs of H. H. Fundamentals of resuscitation at acute poisonings, M., 1977, bibliogr.; P and at l of e in with to and y S. V. Poisonous animals, L., 1975; Food toxicoinfections, under the editorship of V. I. Pokrovsky, Saratov, 1979; The Guide to forensic medical examination of poisonings, under the editorship of R. V. Berezhny, etc., M., 1980, bibliogr.; Food-borne infections and intoxications, ed-by H. Riemann a, F. L. Bryan, N. Y., 1979; The microbiological safety of food, ed. by B. C. Hobbs a. J. H. Christian, L. — N. Y., 1973; Toxicology, The basic science of poisons, ed. by L. J. Casarett a. J. Doull, N. Y., 1975; T of of i with-k e 11 J. The prevention of food poisoning, Cheltenham, 1978.

Yu. P. Pivovarov; E. A. Luzhnikov (wedge.), V. M. Smolyaninov (court.).