TOXICOINFECTIONS FOOD (Greek toxikos the employee for greasing of arrows, i.e. poisonous + an infection) — the group of the acute intestinal infections resulting from consumption of products in to-rykh bred these or those microorganisms and their toxins collected; are characterized by the sudden beginning, rapid development, intoxication, a gastroenteritis, disturbance of a water salt metabolism, quite often have group character (flashes Other).
Etc. are presented by actually food toxicoinfections and food intoxications (toxicoses, bakteriotoksikoza) — botulism (see) and staphylococcal food intoxication.
Before opening of bacteria all food poisonings were explained by hit in an organism of poisonous putrilages of food — so-called ptomaines. Quite often such diseases connected with consumption of substandard sausage from where there was a name «botulism» (Latin of botulus sausage). Bollinger (O. of Bollinger, 1876) revealed communication of meat of the animals, Other with consumption, who had the diseases which are followed by a septicopyemia. In investigating the role of salmonellas, shigellas and a number of opportunistic microorganisms in development of the acute intestinal infections proceeding as Other was proved. Staphylococcal food intoxications in Russia are described at the beginning of the 20th century by P. N. Lashchenkov (1901) and V. I. Yakovlev (1906).
Etc. are widespread everywhere. The greatest incidence is registered in economically developed countries that, apparently, has a talk, on the one hand, broader development of the food industry and public catering, and with another — fuller registration of incidence.
T. and. can be caused by Proteus (Proteus vulgaris, R. mirabilis), enterococci, sporous aerobes (you. cereus), sporous anaerobe bacterias (Clostridium perfringens), hemophilic vibrioes (Vibrio parahae-molyticus), streptococcus (Streptococcus faecalis), bacteria of the sorts Citrobacter, Campylobacter, Hafnia, Klebsiella, Pseudomonas, etc. Pathogenic activators of intestinal group (a salmonella, a shigella, enteropathogenic iyersiniya, strains of colibacillus) at consumption of products, in to-rykh they collected in a significant amount, can also cause the diseases proceeding as Etc. At allocation from excrements or the emetic mass of the patient or from the remains of food of these activators eaten by it the preliminary diagnosis — food toxicoinfection remove and make the diagnosis of the corresponding nosological form (salmonellosis, dysentery, iyersinioz if - an infection, etc.).
The causative agent of staphylococcal food intoxication is the microorganism from the sort Staphylococcus producing enterotoxin of botulism — Clostridium botulinum, type A, B, E, F.
Emergence Other requires preliminary reproduction of the activator in foodstuff, accumulation in it ekzo-or endotoxin (as a rule, simultaneous action of that and other factor takes place). A certain significance should be attached to the third factor — education in foodstuff under the influence of microbic enzymes toxic for the person amines (see) — toksamin (tyramine, a histamine, pentamethylenediamine and a putrestsin at decarboxylation according to threonine, a histidine, a lysine and ornithine).
Actually food toxicoinfections. Epidemiology. A source of activators Other are people and animals, both patients, and the bacillicarriers allocating the activator with excrements and by that the infecting soils, objects of the environment, vegetables and especially root crops, water of open reservoirs. Way of transfer Other always only alimentary. Diseases of people arise at pollution of food (meat, milk, jellies, forcemeat, pastes, cutlets, fish, vinaigrettes, salads etc.) in the course of production, transportation, storage and implementation of finished goods, and also in the absence of due a dignity. control of the persons working at the food enterprises (see. Sanitary inspection ). Possibly and endogenous infection of meat at a face and processing of carcasses of sick animals. The disease Other is always connected or with the infected product, not a past of sufficient heat treatment, or with the ready food infected after its preparation, stored out of the refrigerator before distribution or distributed without repeated heat treatment. Practice shows that the overwhelming number of flashes Other is connected with such disturbances of norms and rules of preparation, storage and distribution of food.
Cases to Other thicket are observed in warm season. Diseases have sudden explosive character, but usually do not leave behind a so-called epidemic tail (the single, registered a long time new cases of diseases). T. and. can cover many hundreds of people, but «family» or «picnic» flashes are more often observed.
emergence of Other insufficiently simple infection of a product, requires also massive accumulation of the activator and its toxins in food, and the last has the leading value. Many activators Other are capable to produce toxins both in foodstuff, and in a human body. At destruction of activators in went. - kish. a path different additional portions of toxicants are formed. In went for hit. - kish. the path of the person of a large number of activators and toxic products an organism answers with stereotypic reaction. Specific properties of the activator affect features of a pathogeny and a clinical picture a little.
Under the influence of a complex of toxins develop as local changes from outside went. - kish. path (inflammatory process, change of synthesis various biol. substances, disturbance of motility went. - kish. path, intestinal dysbiosis), and all-toxic syndrome (headache, fervescence, disturbance of activity of cardiovascular and nervous systems, etc.). Under the influence of toxins and bacterial enzymes there is a disturbance of synthesis of biologically active agents — cyclic 3', 5 '-adenosinemonophosphate (tsAMF) and cyclic 3', 5 '-guanozinmonofosfata (tsGMF), prostaglandii, a histamine, intestinal hormones, etc. therefore in an organism the difficult complex of functional and morphological disturbances develops.
The pathological anatomy
is Most often observed a picture of expressed gastroenterocolitis (see) with preferential damage of a mucous membrane of a stomach and a small bowel, in a cut the hyperemia, hypostasis, multiple punctulate hemorrhages is noted. Group limf, follicles (a peyerova of a plaque) bulk up, increase in volume. Histologically in a mucous membrane went. - kish. a path the necrosis and desquamation of an epithelium come to light, in internals the expressed plethora, quite often symptoms of dystrophy are observed. At Other, caused Cl. perfringens, can be observed sharply expressed hemorrhagic inflammation in a mucous membrane of a small bowel which is followed by multiple ulcerations.
The nature of changes of a mucous membrane went. - kish. a path depends on weight patol. process, duration of a disease, look and type of the activator. Also expressed disturbances of microcirculation in all bodies, dystrophic changes of various degree are usually noted. In some cases the expressed pathological changes are not found and mainly the hyperemia of mucous membranes is noted.
Immunity at actually food toxicoinfections is not studied.
A clinical picture
the Incubation interval — from 2 — 4 to 24 — 48 hour. After short-term discomfort (unpleasant feelings in epigastric area, inflation and abdominal murmur, nausea, a headache, sometimes blackout, the general weakness, feeling of weakness) within the first hour there is usually repeated vomiting against the background of painful feeling of nausea, periodic abdominal pains. In the next few hours liquid fecal, then watery plentiful fetid excrements appear in the beginning (a chair to 10 — 15 times a day) is more often without patol. impurity, is more rare with impurity of slime and blood. Along with dispepsichesky frustration the fever which is followed by temperature increase, tachycardia, hypotension, pallor of skin, unconscious states is noted. Weight of a state is caused by intoxication and degree of dehydration of the organism (see) connected with a fluid loss and salts with excrements and emetic masses. An asthma, a xeroderma, a Crocq's disease, myotonia, an oliguria up to an anury are noted. In blood the leukocytosis, a neutrocytosis, moderate acceleration of ROE, in hard cases acidosis (see), increase in specific weight of plasma, gematokritny number is observed (see). Duration of a disease during the rendering timely medical aid makes usually 1 — 3 day. However after the termination of vomiting and diarrhea it is long dysfunctions remain went. - kish. path: fermental insufficiency, hyper motility, disturbances of the soaking-up and digesting ability of intestines, dysbacteriosis (see), followed by an unstable chair, a meteorism, short-term abdominal pains.
Clip, manifestations of T. and. depend from etiol a little. factor. However at Other, caused Cl. perfringens, a disease begins with megalgias in a stomach of the pricking character, liquid bloody stools at a standard temperature of a body more often. At toxicoinfection food, caused by Proteus, excrements have a pungent fetid smell.
Complications are noted seldom, happen at children and elderly people, patients to serious associated diseases more often. Development of infectious and toxic shock (see) with dominance of the phenomena of intoxication and dehydration, thrombosis of vessels is possible, mesenteries are more often, endocarditis (see), a pyelocystitis (see. Cystitis ), cholecystitis (see).
the Diagnosis is made on the basis of data by a wedge, pictures, epidemiol. the anamnesis (the group nature of incidence, violation of the rules of thermal treatment, shelf-lifes of the food consumed by the diseased, etc.) and laboratory researches.
The main method of laboratory diagnosis Other is: crops of emetic masses, excrements, the remains of food, etc. on dense differential and selection environments (see. the Selection environments ), passing environments of accumulation; use of narrowly targeted specialized environments (see. Differential and diagnostic environments , Synthetic mediums ), and for the bystry and simplified identification of the activator — use of the complex environments allowing definition in one capacity (a test tube, a cup) of several main signs which are reliably revealing accessory of the allocated microorganism — the activator Other to this or that sort or a look. It is necessary to consider that a number of activators Other is quite often allocated from almost healthy people. Therefore recognition of the allocated microbe the activator Other shall be strictly reasoned what it is necessary for: to exclude (taking into account clinical laboratory and epidemiol. data) other intestinal infections; to confirm etiol. a role of the estimated activator by allocation of identical strains of a microbe from material from patients and from foodstuff, to-rye are considered as a factor of transfer of the activator, on the basis of the massive growth of the activator on mediums, and also positive takes of an agglutination test from autoshtamma of activators and increase of a caption of their antibodies in course of disease.
The differential diagnosis should be carried out with salmonellosis (see), dysentery (see), esherikhiozy (see. Kolya infection ), iyersiniozy (see), cholera (see), a rotavirusny gastroenteritis (see), poisonings with salts of heavy metals (see. Poisonings ), organophosphorous connections (see) and poisonous mushrooms (see), and also with acute appendicitis (see), cholecystitis (see), pancreatitis (see), etc.
Hospitalization is made according to clinical indications, as well as at other widespread intestinal infections (see the Salmonellosis). During the first hours diseases the gastric lavage is the most effective. However at nausea and vomiting this procedure can be carried out also in later terms. The stomach is washed out by 2% solution of hydrosodium carbonate or 0,1% solution of potassium permanganate, in case of lack of these solutions — water. The procedure is repeated to an otkhozhdeniye of pure rinsing waters. Best of all for a gastric lavage to use a gastric tube. Further treatment is carried out taking into account degree of dehydration of an organism of the patient. Oral administration of liquid of the following structure is recommended: sodium chloride of 3,5 g, potassium chloride of 1,5 g, hydrosodium carbonate of 2,5 g, glucose of 20 g on 1 l of drinking water. Solution is allowed to drink in the small portions or entered via the nazogastralny probe. Instead of the specified solution patients can give isotonic solution of sodium chloride with glucose, hot tea, mineral water. The amount of the drunk liquid shall correspond to its losses.
In the absence of effect of oral administration of liquid, and also at arrival of the patient under observation of medical staff in a serious condition with the expressed symptoms of dehydration of the III—IV degree (vomiting, a diarrhea, thirst, a xeroderma and mucous membranes, a point of features, etc. — for more details see Cholera) intravenous administration of salt solutions — kvartasol, trisol, etc. is shown. Purpose of causal treatment at Other is inexpedient.
Is important to lay down. food (see. clinical nutrition ). It is necessary to exclude the products rendering irritant action on from a diet went. - kish. path. Mucous soups, not concentrated broths, dishes from the ground or wiped meat, boiled low-fat fish, omelets, porridges, vermicelli, mashed potatoes, cottage cheese, kissels, butter, the dried bread, biscuit, tea are shown. To correction and compensation of digestive insufficiency it is recommended to apply enzymes and fermental complexes — pepsin, Pancreatinum, festal, etc. within 7 — 15 days. For recovery of normal intestinal microflora purpose of a kolibakte-rin, laktobakterin, bifikol, bifidumbacterium, etc. is shown. Observance of a diet in the period of reconvalescence with gradation on usual food is necessary not less than 1 month. The extract of patients from a hospital is carried out later a wedge, recovery.
The forecast is usually favorable, deaths are observed seldom, hl. obr. at development of infectious and toxic shock.
For the prevention of T. and. it is necessary to observe a dignity strictly. norms and rules at preparation, transportation p storage of foodstuff, health and technological regulations of preparation and use of ready food, and also the rule of personal hygiene by personnel of the food enterprises. All perishable goods should be stored in the cold. Meat and fish, crude products and semi-finished products need to be undressed on different tables (boards), different knives. Ready food should be stored and transported in the pure ware scalded by boiled water. Distribution of food is carried out directly after its heat treatment; if food is distributed in several hours after preparation, then it is necessary to store it in the cold, and before distribution to boil (to fry thoroughly, protushit). Full heat treatment of food prevents emergence Other
Staphylococcal food intoxication
the Source of an infection the people who are working at the food enterprises, having purulent infections of a staphylococcal etiology are (furuncles, pustules, felons, quinsy, etc.). and also animals (cows, goats), sick with mastitis.
The products prepared on milk (creams, ice cream, cakes, cakes, etc.) and milk happen factors of transmission of infection more often. Much more rare factors of transfer of staphylococcus are liverwurst, ham, fish canned food in oil, fresh sheep cheese, cottage cheese, sour cream.
The disease of people is connected with consumption of the products stored after their infection at optimum for reproduction of stafilokokk and toksinoobrazovanpya to temperature (36 — 37 °). For accumulation of toxins in the specified conditions 4 — 5 hour are enough. This process goes rather intensively p at the room temperature.
In a pathogeny of staphylococcal food intoxication the leading role belongs to staphylococcal enterotoxin. It influences through a parasympathetic nervous system a cordial .myshtsa and the blood circulatory system, causing hypotensive effect. Enterotoxin activates also motility went. - kish. path.
The incubation interval averages 2 — 4 hours. The disease begins with a fever, short-term nausea, then vomiting, abdominal pains and an anticardium develop, the diarrhea is changeable. Pulse is speeded up, sometimes threadlike. Temperature is usually subfebrile, or normal, but can increase to 39 — 39,5 °. Plentiful vomiting and a diarrhea can cause noticeable dehydration, disturbances of a salt metabolism. In hard cases spasms and a collapse are possible. Usually the disease happens short-term, and in 1 — 2 days there comes the period of reconvalescence.
The diagnosis is based on epidemiol. data (a disease of a group of persons, using the same product), a wedge. a picture and laboratory researches — allocation of the activator with the subsequent identification (see Stafilokokki). The products which served as the reason of poisoning investigate on availability of enterotoxin (see. Toxins ).
The differential diagnosis is carried out with poisonings with chemical substances (see Poisonings), cholera (see), viral diarrhea (see Diarrhea virus), and at single diseases — with a number of somatopathies: preperforativny and a ruptured ulcer of a stomach (see. Peptic ulcer ), appendicitis (see), etc.
Treatment is same, as at actually Etc.
The only effective action for prevention of staphylococcal food intoxication is categorical non-admission to work with foodstuff, to milking of cows of the persons having pustulous diseases of skin, quinsies and other forms of a staphylococcal infection (see. Staphylococcal infection ). It is connected with the fact that staphylococcal endotoxin is steady against thermal influence, and also with the fact that staphylococcus usually infects the products which are not undergoing heat treatment (creams, cakes, cakes, ham) or exposed to the short-term heat treatment insufficient for destruction of endotoxin (dairy products, liverwurst, fish canned food in oil).
Features of food toxicoinfections at children
Children get sick at consumption of the infected milk more often. Also the contact and household way of infection through toys, nipples, objects of leaving, a hand of mother is in addition possible. Diseases can arise in the form of flashes in a maternity home, child care facility, and also in the form of an intrahospital infection (see). In the 70th 20 century among children aged till 1 year incidence of Other staphylococcal etiology considerably increased, to-rye quite often proceed in a severe form. They often gain character of toksiko-septic states from newborns.
In a pathogeny Other from newborns and children of early age owing to lability at them exchange processes major importance is got by disturbances of water and mineral and protein metabolism with development of dehydration of an organism — an eksi-goat (see. Dehydration of an organism ), defeat of c. N of page (neurotoxicosis), disturbance of blood circulation.
Morfol. the picture of damage of intestines is various — from insignificant disturbances of blood circulation to an ulcer and necrotic coloenteritis (in case of staphylococcal Etc. at children of the first months of life at the burdened anamnesis).
Temperature increase, vomiting, vomiting, a frequent chair, excrements liquid, dehydration, in hard cases — neurotoxicosis (concern, excitement, disturbance of consciousness, a spasm) are observed.
From complications occur at children infectious and toxic shock (see), pneumonia (see), otitis (see), stomatitis (see), a pyoderma (see), pyelonephritis (see) etc.
In treatment the dietotherapy including a vodnochayny pause on 6 — 14 hours (tea, broth of a dogrose, broth of raisin) and the subsequent dosed feeding of the child the decanted breast milk or acid mixes (on 10 — 50 ml in 2 hours) and gradual increase in amount of food and intervals between feedings is on the first place.
At toxicosis and an eksikoza the acute management including infusional therapy — introduction of 5% of solutions of glucose and salt solutions taking into account a type of an eksikoz (at isotonic option the ratio of 5% of solution of glucose and salt solutions shall make 1:1, at water scarce — 3:1 and at soledefitsitny — 2:3-4), introduction of Haemodesum, Neocompensanum, reopoliglyukin, and also alkaline solutions for the purpose of correction of a metabolic acidosis, an action for fight against neurotoxicosis and a hyperthermia — purpose of lytic mixes, anticonvulsant drugs, antipyretics is required. In hard cases glucocorticoid therapy is shown: Prednisolonum, a hydrocortisone within 5 — 7 days with a gradual dose decline. An antibioticotherapia is shown only to children of early age. It should be seen off taking into account a type of the activator and its sensitivity to drug. In addition to the antibiotics (ampicillin, levomycetinum succinate, tseporin, erythromycin, etc.) entered enterally or parenterally it is possible to use drugs of a nitrofuran row (furasolidone, furadonin, etc.). The subsequent use biol is of great importance. drugs (bifidumbacterium, bifikol, laktobakterin, etc.).
Etc. most hard proceed at newborns, especially at premature, and also at the weakened children and having various associated diseases. Disease depends as well on type of the activator: proceed Etc. more hard, caused by staphylococcus. In recent years in connection with improvement of methods of treatment the lethality considerably decreased.
Prevention is based on the correct feeding of the children, observance of rules of preparation and storage of food (in particular, milk mixes) guaranteeing against hit of activators in it Etc.; regular medical examinations of employees of milk kitchens and other food enterprises, strict sanitary inspection (see) etc.
Earlier identification of the first cases of a disease is necessary for what children with initial symptoms of an intestinal disease are isolated and inspect, in particular carry out bacterial. research. At suspicion on Other patients hospitalize in diagnostic chambers from where after specification of the diagnosis transfer to special departments. In nek-ry cases at corresponding a dignity. - a gigabyte. conditions and not heavy disease treatment is allowed at home.
The children who transferred Other allow in children's collectives after an absolute recovery, normalization of a chair and in the presence of a negative take bacterial. researches. For the children communicating with patients establish medical observation.
Features of epidemiology and prevention of food toxicoinfections in troops
Specifics of life of staff of army and fleet — close communication, collective food and need of cooking for various conditions (doctrines, marches, fighting, etc.) — cause special value of prevention Other in troops. Other violations of the rules of thermal treatment of products and long-term storage of ready food are the most frequent reason.
Prevention Other in troops is carried out in two directions — veterinary and sanitary and medical actions. Vet. - a dignity. actions (see. Veterinary and sanitary, supervision ) provide control of delivery in troops of meat and other animal products. An inspection of maintenance of the cattle is for this purpose carried out and vt it. service during the prelethal period; supervision of slaughter of the cattle and examination of hulks and bodies; vt. - a dignity. and dignity. supervision of the meat-processing plants, crushing points, field meat-processing plants and other enterprises delivering meat and meat products in troops of transportation of meat and other animal products. These events are held jointly by military and veterinary and military-medical services. Medical sanitary and preventive actions (see) are carried out for the purpose of control of health of workers of food and persons of daily (kitchen) details, observance of rules of personal hygiene by them and implementation of sanitary and technological rules of preparation and storage of ready food. Food shall be ready not earlier than before 20 min. before its distribution. If any division in connection with performance of an office task does not manage to arrive to the dining room by the fixed time, then for it leave a so-called expense. In this case it is possible to store food no more than 11/2 hours at a constant temperature not lower than 80 °. For more long-term storage it shall be placed in the refrigerator where there can be to the 4th an hour. Meat and fish dishes keep separately from a garnish, the second courses made from mincemeat are forbidden to be stored. Just before delivery to staff the left food is subjected surely to repeated thermal treatment.
Actions for elimination of flash Other consist in epidemiological inspection (see), identification of the reasons and conditions of its emergence. The doctor or the paramedic who gave first aid by the victim and established or suspected Other immediately reports on the incident on the commander of a part and the higher medical chief. For a lab. researches collect the emetic masses (rinsing waters of a stomach), excrements and urine of the diseased, and in the presence of indications take blood on a hemoculture and for a research on botulinic toksinony
In process epidemiol. inspections survey of all victims for identification of the main symptoms of a disease and establishment of a dish (product) which served as a factor of transfer of the activator Other is conducted.
For clarification of ways of infection of foodstuff the dignity is studied. the condition of kitchen and the dining room, is specified the time spent of meat and fish for various stages of processing, and also shelf-life of ready dishes in kitchen from the moment of readiness to distribution of the last portions. Examination of employees of kitchen, the dining room for identification of the bacillicarriers sick with pustulous or intestinal diseases is at the same time conducted. By results of investigation of flash the statement is drawn up, in Krom data on time and the scene, number of victims, about a wedge are stated, to a picture of a disease, about results of laboratory researches, about data a dignity. - a gigabyte. inspections of subjects to food and food appointment.
For elimination of flash the use of the foodstuff which caused its emergence is forbidden; are immediately discharged of work on food and food objects of the person, to-rye could be a source of an infection; disinfection of catering department will be organized and its carrying out is controlled, are isolated, and on a wedge, to indications and the diseased is hospitalized.
Bibliography: V. D's white hares. Military epidemiology, JI., 1976; B and r of e r O. G. Food poisonings and food toxicoinfections, M., 1942, bibliogr.; B. P. mantises and Rounds with-to and I am V. A. Klinika and diagnosis of the food toxicoinfections caused by associations of opportunistic pathogenic bacteriums Rubbed. arkh., t. 52, No. I, page 9, 1980; Bunin K. V. Diagnosis of infectious diseases, M., 1965; Burgasov P. N. and Rumyantsev S. N. Evolution of klostridioz, M., 1974; G. P Guelder-rose. The third factor of an etiopathogenesis of food toxicoinfections — the state-of-the-art review and justification of a problem, Zhurn. mikr., epid. and immun., No. 2, page 23, 1982; Intestinal infections, under the editorship of Yu. E. Birkovsky, etc., century 6, page 145, Kiev, 1973; Clinic, treatment and diagnosis of a salmonellosis at adults, sost. V. I. Pokrovsky, etc., M., 1981; Methods of indication of bacteria and viruses in objects of the environment, under the editorship of A. P. Shits-kova, page 76, M., 1982; The multivolume guide to microbiology, clinic and epidemiology of infectious diseases, under the editorship of H. N. Zhukova-Verezhnikov, t. 7, page 673, M., 1966; The Multivolume guide to pathological anatomy, under the editorship of A. I. Strukova, t. 9, page 276, 477, M., 1964; Papayan A. V. and Tsybul-k and E. K N. Acute toxicoses at early children's age, L., 1979, bibliogr.; Post V. A Vit. Food toxicoinfections, JI., 1978, bibliogr.; Romanenko E. E., Raginskaya V. P. and Kostikova V. N. Identification of bacteria of the sort Proteus, Laborat. business, No. 2, page 96, 1974; The Guide to gastrointestinal diseases at children, under the editorship of N. I. Nisevich, M., 1969; Sidorenko G. I., etc. The food toxicoinfections caused by C1. perfringens, Zhurn. mikr., epid. and immun., No. 3, page 75, 1967; Multi-infections at children, under the editorship of G. A. Timofeeva and L. B. Bystrya-kova, L., 1980; H and l and with about in I. A. and Hazanov A. T. Guide to pathoanatomical diagnosis of the major infectious diseases of the person, L., 1980; Sh at r I. V. Diseases of a sal-monellezny etiology, M., 1970.
B. I. Pokrovsky, V. M. Rozhdestvensky, N. D. Yushchuk; V. P. Volgin (soldier.), M. O. Gasparyan (ped.), G. P. Kalina (etiol., laboratory diagnosis).