Independent intervention in the treatment of foodborne illness. Case history - food poisoning, pti. Diagnosis of food poisoning

Food poisoning (PTI)- This is a disease caused by infection not by bacteria itself, but by toxins that are formed as a result of the vital activity of bacteria outside the human body - mainly in food. There are a large number of bacteria capable of producing toxins. Many toxins can persist in contaminated food for a long time, and some can withstand various types of processing, including boiling for several minutes. A characteristic feature of food toxic infections are outbreaks of morbidity, when a large number of people fall ill in a short period of time. This is usually associated with the joint use of an infected product. At the same time, absolutely all people who eat the contaminated product become infected.

The main causative agents of food poisoning

The main bacteria whose toxins can cause food poisoning:

• Staphylococcus aureus - Staphylococcus aureus - is capable of producing a toxin that affects the intestines. Staphylococcus aureus is widely distributed in the environment and is perfectly preserved and multiplies in food products, which are its nutrient medium. If dishes are left at room temperature after cooking (especially salads with mayonnaise, cream cakes, etc.), then they create the most favorable conditions for the reproduction of staphylococci and the production of toxin.
• Bacillus cereus - the disease is usually associated with the use of rice dishes (raw rice is often contaminated with Bacillus cereus). The pathogen multiplies in dishes left after cooking at room temperature. Bacillus cereus toxin is heat-stable, and repeated boiling of the dish does not destroy it.
• Clostridium perfringens. This food poisoning is associated with the consumption of dishes from undercooked meat, poultry and legumes. The disease usually lasts no more than a day and goes away without treatment.

Symptoms of food poisoning

It takes several hours, sometimes minutes, for the toxin to enter the bloodstream. Therefore, the incubation period (the time from the onset of infection to the first manifestations of the disease) is extremely short - no more than 16 hours.

Food poisoning is characterized by an increase in body temperature up to 38-39 ° C, accompanied by chills, weakness, headache. However, such a pronounced intoxication does not always occur - sometimes the temperature rises slightly or remains normal.

The most characteristic manifestations of food poisoning are vomiting and diarrhea. These symptoms may appear separately from each other or at the same time. Vomiting is usually accompanied by nausea and usually brings relief. Abundant watery diarrhea - up to 10-15 times a day, accompanied by cramping pains in the umbilical region.

Then signs of dehydration join the general picture of the disease. The initial sign of fluid loss is dry mouth; with a more severe course of the disease, the pulse quickens, blood pressure decreases, hoarseness of the voice appears, convulsions of the hands and feet. If seizures occur, an ambulance should be called immediately.

Prevention of food poisoning

Prevention consists in observing the rules of personal hygiene: we must not forget about the "golden" rule - wash your hands before eating. It is not recommended to eat food that has expired, even if stored in the refrigerator, since many toxins can be stored at low temperatures. Wash fruits and vegetables thoroughly. You should be especially careful when traveling to developing countries, where acute intestinal infections (including food poisoning) are extremely common. On such trips, it is recommended to eat only freshly prepared hot meals, avoid raw vegetables, salads, unpeeled fruits, drink only boiled or disinfected water, and do not drink drinks with ice.

Desmol (bismuth subsalicylate) is an effective treatment for travelers' diarrhea. The drug is taken orally at 524 mg (2 tablets) 4 times a day. It is safe to take it for 3 weeks.

Dehydration due to food poisoning

Perhaps the most dangerous consequence of PTI is dehydration, which occurs as a result of significant loss of fluid during diarrhea and vomiting.

There are 4 degrees of dehydration.

Grade 1: fluid loss is 1-3% of body weight.

There is only dryness in the mouth, skin and mucous membranes with normal humidity. Hospitalization is usually not required. However, we should not forget about the need to replenish the lost volume by drinking plenty of water. In the presence of severe nausea and vomiting, it is necessary to drink liquid in a tablespoon every 2-3 minutes.

Grade 2: fluid loss is 4-6% of body weight.

With 2 degrees of dehydration, the following symptoms are observed:

• Strong thirst;
• Mucous membranes of the mouth, nose - dry;
• There may be some blueness of the lips, fingertips;
• Hoarseness of voice;
• Convulsive twitching of hands and feet.

The appearance of seizures is due to the loss of electrolytes - substances that play an important role in many processes in the body, including the process of muscle contraction and relaxation.

• There is also a slight decrease in turgor.

Turgor – This is the degree of elasticity of the skin, it depends on the amount of fluid in the tissues. Turgor is determined as follows: two fingers form a skin fold - most often on the back of the hand, the front of the abdomen or on the back of the shoulder; then let go and watch the expansion time. Normally and at the first degree of dehydration, the fold straightens instantly. With 2 degrees of dehydration, the fold can straighten out in 1-2 seconds.

• The amount of urine excreted is slightly reduced.

You can replenish the lost fluid with 2 degrees of dehydration through the mouth. However, in the event of seizures, urgent medical attention should be sought.

Grade 3: fluid loss - 7-9% of body weight.

• The patient's condition is grave.
• Turgor is significantly reduced - the fold straightens out in 3-5 seconds.
• Wrinkled skin.
• Convulsive contractions of the muscles of the arms and legs.
• The amount of urine excreted is significantly reduced.

Grade 3 dehydration requires immediate hospitalization.

Grade 4: loss of 10% or more fluid. In fact, it is a terminal state. It is very rare - mainly with cholera.

At food poisoning dehydration of 3 and 4 degrees does not occur.

Dysbacteriosis with food poisoning

Abundant loose stools for several days can lead to a violation of the quantitative and qualitative composition of bacteria living in the intestine - dysbactriasis. Most often, dysbacteriosis is manifested by chronic diarrhea and requires special treatment.

Diet for food poisoning

An important component of treatment is diet. If diarrhea persists, a therapeutic diet No. 4 is recommended, which is characterized by a reduced content of fats and carbohydrates with a normal protein content and a sharp restriction of any gastrointestinal tract irritants. Foods that can cause flatulence (increased formation of gases in the intestines) are also excluded.

• wheat rusks, thinly sliced ​​and not toasted;
• soups on low-fat meat or fish broth with the addition of cereals: rice, semolina or egg flakes; as well as finely mashed boiled meat;
• lean soft meat, poultry, or boiled fish;
• low-fat freshly prepared cottage cheese;
• no more than 2 eggs per day in the form of soft-boiled or steam omelet;
• cereals on the water: oatmeal, buckwheat, rice;
• vegetables only in boiled form when added to soup.

Foods to Avoid:

• bakery and flour products;
• soups with vegetables, on a strong fatty broth;
• fatty meat, piece of meat, sausages;
• fatty, salted fish, canned food;
• whole milk and other dairy products;
• hard-boiled eggs, scrambled eggs;
• millet, barley, barley porridge; pasta;
• legumes;
• vegetables, fruits, raw berries; as well as compotes, jam, honey and other sweets;
• coffee and cocoa with milk, carbonated and cold drinks.

After the normalization of the stool, you can switch to a therapeutic diet No. 2. It is somewhat softer than diet number 4. At the same time, the following are added to the diet:

• bread baked yesterday or dried. Unsavory bakery products, cookies;
• meat and fish can be cooked in pieces;
• dairy products, including cheese;
• eggs other than hard-boiled eggs;
• vegetables: potatoes, zucchini, cauliflower, carrots, beets, pumpkin;
• ripe fruits and pureed berries;
• creamy caramel, marmalade, marshmallow, marshmallow, jam, honey>.

Treatment of food poisoning

Treatment is mainly to replace the lost fluid. It must be understood that with diarrhea and vomiting, not only water is lost, but also the necessary trace elements, so it is wrong to replenish the liquid with water. For this, the drug "Regidron" is suitable - a powder containing all the necessary substances. The contents of the package are dissolved in 1 liter of boiled water, it is necessary to start drinking the solution as soon as possible.

With 1 degree of dehydration, the volume of fluid administered is 30-50 ml/kg of body weight. At 2nd degree - 40-80 ml / kg of body weight. The rate of fluid replenishment should be at least 1-1.5 liters per hour; drink slowly in small sips.

In the presence of vomiting, you should try to drink a tablespoon in 2-3 minutes. If indomitable vomiting does not allow you to drink liquid, you need to call a doctor.

In addition to the liquid, sorbent preparations are used - substances that bind toxic toxins and remove them from the body. Activated carbon, Smecta, Enterosgel, Polyfepam, etc. are suitable for this. Sorbents are taken 3 times a day.

NB! Antibiotics for food poisoning are not prescribed, since the cause is not a bacterium, but a toxin.

It is very important to remember that you should not take imodium (loperamide) in case of food poisoning. This drug causes a significant delay in the excretion of intestinal contents, which can lead to more poisoning with toxins and worsening of the disease.

FOOD TOXIC INFECTIONS - a group of acute infectious diseases caused by the use of contaminated food products and characterized by the phenomena of acute gastritis, gastroenteritis or gastroenterocolitis, short-term chills, fever, intoxication and dehydration of the body.
Food poisoning infections (FTI) are polyetiological diseases caused by the ingestion of microorganisms or pathogenic products of their vital activity (toxins, enzymes) into the human body with food. The most common causative agents of PTI are Clostridium perfringens, Proteus vulgaris and Pr. mirabilis, Bacillus cereus, bacteria of the genera Klebsiella, Salmonella, Enterobacter, Citrobacter, Pseudomonas, Aeromonas, Staphilococcus aureus.
A feature of PTI is the absence of direct transmission of infection from a sick person to a healthy one. With group morbidity, the source of infection is a person, farm animals and birds, patients or bacteria carriers. The source of PTI of staphylococcal etiology are persons suffering from purulent infections, and animals (more often cows, sheep) with mastitis. With PTI caused by Proteus, enterococci, B. cereus, CI. perfringens, etc., the source of infection can be significantly distant in time and geographically from the time and place of the disease. In these cases, pathogens excreted with the feces of people and animals can persist for a long time in the soil, open water bodies, and plant products.
The mechanism of transmission of the pathogen is fecal-oral, the route of distribution is food; transmission factors are most often meat and meat products, eggs and culinary products using raw eggs, less often milk, sour cream, fish, vegetables. PTI caused by staphylococcal enterotoxin is most often associated with the use of cakes, creams, ice cream, jelly. Especially dangerous is the contamination of products that are not subjected to heat treatment, as well as re-infected before use (salads, jelly, sausages, canned food, confectionery creams). A necessary condition for the occurrence of PTI is the storage of food contaminated with microbes from 2-3 to 24 hours or more at 20-40 ° C, which leads to active reproduction and accumulation of microorganisms and their toxins in it in large quantities. In most cases, neither taste, neither the appearance of the food product nor the presence of microbial contamination can be detected only with special studies.
PTIs are caused by the intake of microorganisms and their toxins with food, which can form and accumulate in food products, as well as be excreted in the gastrointestinal tract by living or dead pathogens.
Toxins can both be absorbed into the blood, affecting the cardiovascular and nervous systems, and damage the epithelium of the small intestine, causing an increased release of water and salts and, as a result, dehydration of the body.

Symptoms. PTI is characterized by a cyclic course with a short incubation period, an acute period of illness and a period of convalescence. The duration of the incubation period ranges from 1-6 hours to 2-3 days. The shortest incubation period (less than 1 hour) is characteristic of staphylococcal PTI, it is longer with salmonellosis, proteus toxicoinfection.
PTI is characterized by an acute onset of the disease, most often by the type of acute gastroenteritis. Nausea, vomiting and loose stools are observed. In a significant number of patients, bloating and rumbling in the abdomen are detected. When examining a patient, a dry tongue, densely coated with bloom, attracts attention. Along with
symptoms of acute gastroenteritis in some patients by the end of 1-2 days of illness, symptoms of colitis appear. As the disease progresses, the symptoms of gastrointestinal lesions usually recede into the background, and the clinical picture of the disease is determined by general syndromes, among which intoxication is the leading one.
Violations of water-salt metabolism in PTI, unlike cholera, rarely come to the fore. However, in some cases they become dominant and become crucial for the outcome of the disease; usually with PTI, I-II degree of dehydration is observed. With developed dehydration, patients complain of thirst, painful cramps of the calf muscles; the voice becomes hoarse up to aphonia. When examining a patient, cyanosis, a decrease in skin turgor, retraction of the eyeballs, sharpening of facial features, a drop in blood pressure, as well as tachycardia, shortness of breath, and a decrease in diuresis are noted; hyperthermia with progressive dehydration may be replaced by hypothermia.
The diagnosis of PTI is established based on the results of a comprehensive assessment of clinical symptoms, epidemiological and laboratory data; The material for bacteriological examination is suspected food products, vomit, gastric lavage, feces of patients. The proof of the etiological role of this microorganism is the identity of strains isolated from several patients who fell ill at the same time.
In the differential diagnosis of PTI, it should be taken into account that many diseases have similar clinical signs, including surgical (acute appendicitis, thrombosis of mesenteric vessels, intestinal obstruction, perforation of a stomach ulcer), gynecological (ectopic pregnancy, toxicosis of pregnant women, pelvic peritonitis), neurological (acute and transient disorders of cerebral circulation, neurocirculatory dystonia, subarachnoid hemorrhage), therapeutic (croupous and focal pneumonia, hypertensive crises, myocardial infarction), urological (pyelonephritis, renal failure). A number of acute intestinal infections are diagnosed as PTI until the results of special studies are obtained due to the similarity of early clinical symptoms (cholera, acute dysentery, gastrointestinal form of yersiniosis, rotavirus gastroenteritis, campylobacteriosis, dyspeptic variant of the prodromal period of viral hepatitis, etc.). It is necessary to take into account the presence of food poisoning caused by poisonous and conditionally edible mushrooms, heavy metal salts, phosphorus and organochlorine compounds, some varieties of fish and stone fruits.

Treatment. Usually begin with gastric lavage with a probe; the volume of washing liquid (t = 18/20 ° C) is initially determined for an adult equal to 3 liters, however, if necessary, it can be increased, since the procedure must be carried out until clean washing water appears. Gastric lavage is contraindicated in case of suspected myocardial infarction, in ischemic heart disease with symptoms of angina pectoris, in stage III hypertension, peptic ulcer of the stomach and duodenum. At the second stage, oral rehydration therapy is performed (see Salmonellosis). All patients with PTI should be given a light diet.
Prevention is reduced to compliance with the rules of preparation, storage and processing of food.

Food poisoning (PTI, food bacterial poisoning; lat. toxicoinfectiones alimentariae) is a polyetiological group of acute intestinal infections that occur after eating foods contaminated with opportunistic bacteria, in which the microbial mass of pathogens and their toxins accumulated.

ICD codes -10 A05. Other bacterial food poisonings.

A05.0. Staphylococcal food poisoning.
A05.2. Food poisoning caused by Clostridium perfringens (Clostridium welchii).
A05.3. Food poisoning caused by Vibrio Parahaemolyticus.
A05.4. Food poisoning caused by Bacillus cereus.
A05.8. Other specified bacterial food poisonings.
A05.9. Bacterial food poisoning, unspecified.

Etiology (causes) of food poisoning

Combine a large number of etiologically different, but pathogenetically and clinically similar diseases.

Combining food toxic infections into a separate nosological form is caused by the need to unify measures to combat their spread and the effectiveness of the syndromic approach to treatment.

The most frequently recorded food toxic infections caused by the following opportunistic microorganisms:

family Enterobacteriaceae genus Сitrobacter, Klebsiella, Enterobacter, Hafnia, Serratia, Proteus, Edwardsiella, Erwinia;
family Micrococcaceae genus Staphilococcus;
the family Bacillaceae, the genus Clostridium, the genus Bacillus (including the species B. cereus);
the family Pseudomonaceae, the genus Pseudomonas (including the species Aeruginosa);
· family Vibrionaceae, genus Vibrio, species NAG-vibrios (non-agglutinating vibrios), V. parahaemoliticus.

Most of the above bacteria live in the intestines of practically healthy people and many representatives of the animal world. Pathogens are resistant to the action of physical and chemical environmental factors; capable of reproduction both in the conditions of a living organism and outside it, for example, in food products (in a wide temperature range).

Epidemiology of food poisoning

Sources of pathogens can be people and animals (patients, carriers), as well as environmental objects (soil, water). According to the ecological and epidemiological classification, food toxic infections caused by opportunistic microflora are classified as anthroponoses (staphylococcosis, enterococcosis) and sapronoses - water (aeromonosis, plesiomonosis, NAH infection, parahemolytic and albinolytic infections, edwardsiellosis) and soil (cereus infection, clostridium, pseudomonosis, klebsiellosis, proteosis, morganellosis, enterobacteriosis, erviniosis, hafnia- and providence-infections).

Pathogen transmission mechanism- fecal-oral; transmission route - food. Transmission factors are varied. Usually, the disease occurs after eating food contaminated with microorganisms brought in by dirty hands during the cooking process; undisinfected water; finished products (in case of violation of the rules for storage and sale in conditions conducive to the reproduction of pathogens and the accumulation of their toxins). Proteus and clostridia are capable of active reproduction in protein products (jelly, jellied dishes), B. cereus - in vegetable soups, meat and fish products. In milk, mashed potatoes, cutlets, enterococci rapidly accumulate.

Halophilic and parahemolytic vibrios that survive in marine sediment infect many marine fish and molluscs. Staphylococcus gets into confectionery, dairy products, meat, vegetable and fish dishes from people with pyoderma, tonsillitis, chronic tonsillitis, respiratory diseases, periodontal disease, and those working in public catering establishments. Zoonotic source of staphylococcus - animals with mastitis.

Practice has shown that, despite the diverse etiology of intestinal infections, the food factor is important in maintaining a high level of morbidity. Food poisoning is a "dirty food" disease.

Outbreaks of food poisoning have a group, explosive nature, when most people (90–100%) who have consumed an infected product fall ill within a short time. Frequent family outbreaks, group diseases of passengers of ships, tourists, members of children's and adult organized groups.

In waterborne outbreaks associated with faecal contamination, pathogenic flora causing other acute intestinal infections are present in the water; cases of mixed infection are possible. Diseases are most often recorded in the warm season.

The natural susceptibility of people is high. Newborns are more susceptible; patients after surgical interventions receiving antibiotics for a long time; patients suffering from disorders of gastric secretion.

The main preventive and anti-epidemic measure is sanitary and hygienic monitoring of epidemiologically significant objects: sources of water supply, water supply and sewerage networks, treatment facilities; enterprises associated with the procurement, storage, transportation and sale of food products. It is necessary to introduce modern methods of processing and storing products; strengthening sanitary control over compliance with the technology of preparation (from processing to sale), the terms and conditions of storage of perishable products, medical control over the health of public catering workers. Particular attention should be paid to sanitary and veterinary control at the enterprises of the meat and dairy industry.

In the focus of food poisoning, to identify the source of infection, it is imperative to conduct bacteriological and serological studies in persons of decreed professions.

The pathogenesis of food poisoning

For the occurrence of the disease is important:
· infectious dose - not less than 105-106 microbial bodies per 1 g of the substrate;
Virulence and toxigenicity of strains of microorganisms.

Of primary importance is intoxication with bacterial exo- and endotoxins of pathogens contained in the product.

With the destruction of bacteria in food products and the gastrointestinal tract, endotoxin is released, which, by stimulating the production of cytokines, activates the hypothalamic center, contributes to the onset of fever, impaired vascular tone, and changes in the microcirculation system.

The complex effect of microorganisms and their toxins leads to the appearance of local (gastritis, gastroenteritis) and general (fever, vomiting, etc.) signs of the disease. The excitation of the chemoreceptor zone and the vomiting center, located in the lower part of the bottom of the IV ventricle, by impulses from the vagus and sympathetic nerves matters. Vomiting is a defensive reaction aimed at removing toxic substances from the stomach. With prolonged vomiting, the development of hypochloremic alkalosis is possible.

Enterotoxins are caused by enterotoxins secreted by the following bacteria: Proteus, B. cereus, Klebsiella, Enterobacter, Aeromonas, Edwardsiella, Vibrio. Due to a violation of the synthesis and balance of biologically active substances in enterocytes, an increase in the activity of adenylate cyclase, an increase in the synthesis of cAMP occurs.

The energy released at the same time stimulates the secreting function of enterocytes, as a result, the release of isotonic, protein-poor fluid into the lumen of the small intestine is enhanced. Profuse diarrhea occurs, leading to disturbances in water and electrolyte balance, isotonic dehydration. In severe cases, dehydration (hypovolemic) shock may develop.

The colitis syndrome usually appears with mixed infections involving pathogenic flora.

In the pathogenesis of staphylococcal food poisoning, the action of enterotoxins A, B, C1, C2, D and E is important.

The similarity of pathogenetic mechanisms in foodborne toxic infections of various etiologies determines the commonality of clinical symptoms and determines the scheme of therapeutic measures.

Clinical picture (symptoms) of food poisoning

Incubation period- from 2 hours to 1 day; with food poisoning of staphylococcal etiology - up to 30 minutes. Acute period of illness- from 12 hours to 5 days, after which a period of convalescence begins. In the clinical picture, general intoxication, dehydration and gastrointestinal syndrome come to the fore.

Classification of food poisoning

According to the prevalence of the lesion:
- gastric variant;
- gastroenteric variant;
- gastroenterocolitic variant.

According to the severity of the flow:
- easy;
- medium-heavy;
- hard.

For complications:
- uncomplicated;
- complicated PTI.

The first symptoms of food poisoning are abdominal pain, nausea, vomiting, chills, fever, loose stools. The development of acute gastritis is evidenced by a white-coated tongue; vomiting (sometimes indomitable) of food eaten the day before, then - mucus mixed with bile; heaviness and pain in the epigastric region.

In 4-5% of patients, only signs of acute gastritis are found. Abdominal pain can be diffuse in nature, be cramping, less often - constant. The development of enteritis is evidenced by diarrhea that occurs in 95% of patients. Stools profuse, watery, offensive, light yellow or brown; have the appearance of swamp mud. The abdomen is soft on palpation, painful not only in the epigastric region, but also in the umbilical region. The frequency of bowel movements reflects the severity of the disease. Signs of colitis: excruciating cramping pain in the lower abdomen (usually on the left), an admixture of mucus, blood in the stool - found in 5-6% of patients. In the gastroenterocolitic variant of food poisoning, a consistent involvement of the stomach, small and large intestines in the pathological process is observed.

Fever is expressed in 60-70% of patients. She may be subfebrile; in some patients it reaches 38–39 °C, sometimes - 40 °C. The duration of the fever is from several hours to 2-4 days. Sometimes (with staphylococcal intoxication) hypothermia is observed. Clinical signs of intoxication - pallor of the skin, shortness of breath, muscle weakness, chills, headache, pain in the joints and bones, tachycardia, arterial hypotension. According to the severity of these symptoms, a conclusion is made about the severity of the course of food poisoning.

The development of dehydration is indicated by thirst, dryness of the skin and mucous membranes, decreased skin turgor, sharpness of facial features, retraction of the eyeballs, pallor, cyanosis (acrocyanosis), tachycardia, arterial hypotension, decreased diuresis, muscle cramps of the extremities.

On the part of the cardiovascular system, deafness of heart tones, tachycardia (less often - bradycardia), arterial hypotension, diffuse changes of a dystrophic nature on the ECG (decrease in the T wave and depression of the ST segment) are noted.

Changes in the kidneys during food poisoning are due to both toxic damage to them and hypovolemia. In severe cases, prerenal acute renal failure may develop with oligoanuria, azotemia, hyperkalemia, and metabolic acidosis.

Changes in hematocrit and specific gravity of plasma make it possible to assess the degree of dehydration.

Intoxication and dehydration lead to severe dysfunction of internal organs and exacerbation of concomitant diseases: the development of hypertensive crisis, mesenteric thrombosis, acute cerebrovascular accident in patients with hypertension, myocardial infarction (MI) in patients with coronary artery disease, withdrawal syndrome or alcoholic psychosis in patients with chronic alcoholism.

Staphylococcal food poisoning cause enterotoxigenic strains of pathogenic staphylococci. They are resistant to environmental factors, tolerate high concentrations of salt and sugar, but die when heated to 80 ° C. Staphylococcus enterotoxins withstand heating up to 100 °C for 1–2 hours. In appearance, taste and smell, products contaminated with staphylococcus are indistinguishable from benign ones. Enterotoxin is resistant to the action of digestive enzymes, which makes it possible to absorb it in the stomach. It affects the parasympathetic nervous system, contributes to a significant decrease in blood pressure, activates the motility of the stomach and intestines.

The onset of the disease is acute, stormy. The incubation period is from 30 minutes to 4-6 hours.

Intoxication is pronounced, body temperature is usually elevated to 38-39 ° C, but may be normal or low. Characterized by intense pain in the abdomen, localized in the epigastric region. Weakness, dizziness, nausea are also noted. In 50% of patients, repeated vomiting (within 1–2 days), diarrhea (within 1–3 days) is observed. In severe cases, acute gastroenteritis (acute gastroenterocolitis) occurs. Tachycardia, deafness of heart sounds, arterial hypotension, oliguria are characteristic. A short-term loss of consciousness is possible.

In the vast majority of patients, the disease ends in recovery, but debilitated patients and elderly people may develop pseudomembranous colitis and staphylococcal sepsis. The most severe complication is TSS.

Food poisoning with clostridial toxin occurs after eating foods contaminated with clostridia and containing their toxins. Clostridium is found in soil, human and animal feces. Poisoning is caused by the use of contaminated home-cooked meat products, canned meat and fish. The disease is characterized by a severe course, high mortality. Toxins damage the intestinal mucosa, disrupt absorption. When released into the blood, toxins bind to the mitochondria of the cells of the liver, kidneys, spleen, lungs, the vascular wall is damaged and hemorrhages develop.

Clostridium proceeds in the form of acute gastroenterocolitis with signs of intoxication and dehydration. The incubation period is 2-24 hours. The disease begins with intense, stabbing pains in the abdomen. In mild and moderate cases, an increase in body temperature, repeated vomiting, loose stools (up to 10-15 times) with an admixture of mucus and blood, abdominal pain on palpation are noted. The duration of the disease is 2–5 days.

The following severe cases are possible:
Acute gastroenterocolitis: pronounced signs of intoxication; yellowness of the skin; vomiting, diarrhea (more than 20 times a day), an admixture of mucus and blood in the stool; sharp pain in the abdomen on palpation, enlargement of the liver and spleen; a decrease in the number of red blood cells and hemoglobin content, an increase in the concentration of free bilirubin.

With the progression of the disease - tachycardia, arterial hypotension, anaerobic sepsis, ITSH;
cholera-like course - acute gastroenterocolitis in combination with dehydration of I-III degree;
Development of necrotic processes in the small intestine, peritonitis against the background of acute gastroenterocolitis with a characteristic stool such as meat slops.

Cereosis in most patients it is mild. The clinical picture is dominated by symptoms of gastroenteritis. A severe course is possible in the elderly and in immunodeficiency states. Isolated cases of TTS with a fatal outcome are known.

Klebsiella an acute onset is characteristic with an increase in body temperature (within 3 days) and signs of intoxication. The clinical picture is dominated by acute gastroenterocolitis, less often by colitis. The duration of diarrhea is up to 3 days.

The moderate course of the disease prevails. It is most severe in people with concomitant diseases (sepsis, meningitis, pneumonia, pyelonephritis).

Proteosis in most cases proceeds easily. The incubation period is from 3 hours to 2 days. The main symptoms are weakness, intense, unbearable pain in the abdomen, sharp pain and loud rumbling, fetid stools.

Cholera-like and shigellosis-like variants of the course of the disease are possible, leading to the development of TSS.

Streptococcal food poisoning tend to have a mild flow. The main symptoms are diarrhea and abdominal pain.

A little-studied group of food toxic infections - aeromonosis, pseudomonosis, citrobacteriosis.

The main symptom is gastroenteritis of varying severity.

Complications of food poisoning

Regional circulatory disorders:
- coronary (myocardial infarction);
- mesenteric (thrombosis of mesenteric vessels);
- cerebral (acute and transient disorders of cerebral circulation).

Pneumonia.

The main causes of deaths (Yushchuk N.D., Brodov L.E., 2000) are myocardial infarction and acute coronary insufficiency (23.5%), thrombosis of mesenteric vessels (23.5%), acute cerebrovascular accidents (7, 8%), pneumonia (16.6%), ITSH (14.7%).

Diagnosis of food poisoning

It is based on the clinical picture of the disease, the group nature of the disease, the connection with the use of a certain product in violation of the rules for its preparation, storage or sale (Table 17-7).

Table 17-7. Standard for examination of patients with suspected food poisoning

The decision to hospitalize the patient is made on the basis of epidemiological and clinical data. In all cases, a bacteriological examination should be carried out to exclude shigellosis, salmonellosis, yersiniosis, escherichiosis and other acute intestinal infections. An urgent need for bacteriological and serological studies arises when cholera is suspected, with group cases of the disease and the occurrence of nosocomial outbreaks.

To confirm the diagnosis of food poisoning, it is necessary to isolate the same microorganism from the patient's feces and the remains of a suspicious product. This takes into account the massiveness of growth, phage and antigenic uniformity, antibodies to the isolated strain of microorganisms found in convalescents.

The diagnostic value is the statement of RA with an autostrain in paired sera and a 4-fold increase in titer (with proteosis, cereosis, enterococcosis).

If staphylococcosis and clostridium are suspected, toxins are identified in vomit, feces, and suspicious products.

The enterotoxic properties of the isolated culture of staphylococcus are determined in animal experiments.

Bacteriological confirmation requires 2–3 days. Serological diagnosis is carried out in paired sera to determine the etiology of PTI retrospectively (from the 7th–8th day). General analysis of blood, urine, instrumental diagnostics (recto- and colonoscopy) are uninformative.

Differential diagnosis of food poisoning

Differential diagnosis is carried out with acute diarrheal infections, poisoning with chemicals, poisons and fungi, acute diseases of the abdominal organs, and therapeutic diseases.

In the differential diagnosis of food poisoning with acute appendicitis, difficulties arise from the first hours of the disease, when Kocher's symptom (pain in the epigastric region) is observed for 8–12 hours. Then the pain shifts to the right iliac region; with an atypical location of the process, the localization of pain may be uncertain. Possible dyspeptic symptoms: vomiting, diarrhea of ​​varying severity. In acute appendicitis, pain precedes an increase in body temperature, is permanent; patients note an increase in pain when coughing, walking, changing body position.

Diarrheal syndrome in acute appendicitis is less pronounced: stools are mushy, fecal in nature. On palpation of the abdomen, local pain is possible, corresponding to the location of the appendix. In the general analysis of blood - neutrophilic leukocytosis. Acute appendicitis is characterized by a short period of "calm", after which, after 2-3 days, destruction of the process occurs and peritonitis develops.

Mesenteric thrombosis is a complication of ischemic bowel disease. Its occurrence is preceded by ischemic colitis: colicky abdominal pain, sometimes vomiting, alternating constipation and diarrhea, flatulence. With thrombosis of large branches of the mesenteric arteries, intestinal gangrene occurs: fever, intoxication, intense pain, repeated vomiting, loose stools mixed with blood, bloating, weakening and disappearance of peristaltic noises. The pain in the abdomen is diffuse, constant. On examination, symptoms of peritoneal irritation are found; at colonoscopy - erosive and ulcerative defects of the mucous membrane of an irregular, sometimes annular shape. The final diagnosis is established by selective angiography.

Strangulation obstruction is characterized by a triad of symptoms: cramping abdominal pain, vomiting, and cessation of fecal discharge and gases.

Diarrhea is absent. Typical bloating, increased peristaltic noises.

Fever and intoxication occur later (with the development of intestinal gangrene and peritonitis).

Acute cholecystitis or cholecystopancreatitis begins with an attack of intense colicky pain, vomiting. Unlike food poisoning, the pain is shifted to the right hypochondrium, radiating to the back. Diarrhea is usually absent. The attack is followed by chills, fever, dark urine, and discoloration of the stool; scleral icterus, jaundice; bloating. On palpation - pain in the right hypochondrium, a positive symptom of Ortner and phrenicus symptom. The patient complains of pain during breathing, pain to the left of the navel (pancreatitis). In the study of blood - neutrophilic leukocytosis with a shift to the left, an increase in ESR; increased activity of amylase and lipase.

Differential diagnosis of food poisoning with myocardial infarction in elderly patients with coronary artery disease presents great difficulties, since food poisoning may be complicated by myocardial infarction. With food poisoning, the pain does not radiate beyond the abdominal cavity, it is paroxysmal, colicky in nature, while with MI the pain is dull, pressing, constant, with characteristic irradiation. With food poisoning, body temperature rises from the first day (in combination with other signs of intoxication syndrome), and with MI - on the 2nd-3rd day of illness. In persons with a burdened cardiac history with food poisoning in the acute period of the disease, ischemia, rhythm disturbances in the form of extrasystole, atrial fibrillation may occur (polytopic extrasystole, paroxysmal tachycardia, ST interval shift on the ECG are not typical). In doubtful cases, the activity of cardiospecific enzymes is examined, an ECG is performed in dynamics, EchoCG. In shock, patients with food poisoning always show dehydration, therefore, signs of stagnation in the pulmonary circulation (pulmonary edema) characteristic of cardiogenic shock are absent before the start of infusion therapy.

Hypercoagulability, hemodynamic disturbances and microcirculatory disorders due to damage to the vascular endothelium by toxins during food poisoning contribute to the development of MI in patients with chronic coronary artery disease. It usually occurs during the period of subsiding food poisoning. In this case, there is a recurrence of pain in the epigastric region with characteristic irradiation, hemodynamic disturbances (arterial hypotension, tachycardia, arrhythmia). In this situation, it is necessary to conduct the entire complex of studies for the diagnosis of MI.

Atypical pneumonia, pneumonia in children of the first year of life, as well as in persons suffering from disorders of the secretory function of the stomach and intestines, alcoholism, cirrhosis of the liver, can occur under the guise of food poisoning. The main symptom is watery stools; less often - vomiting, abdominal pain. Characterized by a sharp increase in body temperature, chills, cough, chest pain during breathing, shortness of breath, cyanosis. X-ray examination (in a standing or sitting position, since basal pneumonias are difficult to detect in the supine position) helps to confirm the diagnosis of pneumonia.

Hypertensive crisis is accompanied by repeated vomiting, fever, high blood pressure, headache, dizziness, pain in the heart. Diagnostic errors are usually associated with fixing the doctor's attention on the dominant symptom, which is vomiting.

In the differential diagnosis of food poisoning and alcoholic enteropathy, it is necessary to take into account the relationship of the disease with alcohol consumption, the presence of a period of abstinence from alcohol, the long duration of the disease, and the ineffectiveness of rehydration therapy.

A clinical picture similar to food poisoning can be observed in people suffering from drug addiction (with withdrawal or overdose of a narcotic substance), but with the latter, the anamnesis is important, the diarrheal syndrome is less pronounced and the prevalence of neurovegetative disorders over dyspeptic ones.

Food poisoning and decompensated diabetes mellitus have a number of common symptoms (nausea, vomiting, diarrhea, chills, fever). As a rule, a similar situation is observed in young people with latent type 1 diabetes mellitus.

In both conditions, there are disorders of water-electrolyte metabolism and acid-base state, hemodynamic disturbances in severe cases.

Due to the refusal to take hypoglycemic drugs and food, which is observed with food poisoning, the condition quickly worsens and ketoacidosis develops in diabetic patients. Diarrheal syndrome in diabetic patients is less pronounced or absent. The decisive role is played by the determination of the level of glucose in the blood serum and acetone in the urine. The anamnesis matters: the patient's complaints about dry mouth that arose a few weeks or months before the disease; weight loss, weakness, skin itching, increased thirst and diuresis.

With idiopathic (acetonemic) ketosis, the main symptom is severe (10–20 times a day) vomiting. The disease is more likely to affect young women aged 16–24 who have suffered mental trauma and emotional overstrain. The smell of acetone from the mouth, acetonuria are characteristic. Diarrhea is absent.

The positive effect of intravenous administration of 5-10% glucose solution confirms the diagnosis of idiopathic (acetonemic) ketosis.

The main symptoms that make it possible to distinguish a disturbed tubal pregnancy from food poisoning are pallor of the skin, cyanosis of the lips, cold sweat, dizziness, agitation, dilated pupils, tachycardia, hypotension, vomiting, diarrhea, acute pain in the lower abdomen with irradiation to the rectum, brownish vaginal discharge, Shchetkin's symptom; history of delayed menstruation. In the general analysis of blood - a decrease in hemoglobin.

Unlike food poisoning, cholera does not have fever or abdominal pain; diarrhea precedes vomiting; stools do not have a specific smell and quickly lose their fecal character.

In patients with acute shigellosis, intoxication syndrome dominates, dehydration is rarely observed. Typical cramping pain in the lower abdomen, "rectal spitting", tenesmus, spasm and tenderness of the sigmoid colon.

Rapid cessation of vomiting is characteristic.

With salmonellosis, signs of intoxication and dehydration are more pronounced.

The stool is loose, copious, often greenish in color. The duration of fever and diarrheal syndrome is over 3 days.

Rotavirus gastroenteritis is characterized by an acute onset, pain in the epigastric region, vomiting, diarrhea, loud rumbling in the abdomen, fever. Perhaps a combination with catarrhal syndrome.

Escherichiosis occurs in various clinical variants and may resemble cholera, salmonellosis, shigellosis. The most severe course, often complicated by hemolytic-uremic syndrome, is characteristic of the enterohemorrhagic form caused by Escherichia coli 0-157.

The final diagnosis in the above cases is possible only after bacteriological examination.

In case of poisoning with chemical compounds (dichloroethane, organophosphorus compounds), loose stools and vomiting also occur, but these symptoms are preceded by dizziness, headache, ataxia, and psychomotor agitation. Clinical signs appear a few minutes after ingestion of the poisonous substance. Sweating, hypersalivation, bronchorrhea, bradypnea, pathological types of breathing are characteristic. Perhaps the development of coma. In case of poisoning with dichloroethane, the development of toxic hepatitis (up to acute liver dystrophy) and acute renal failure is likely.

In case of poisoning with alcohol surrogates, methyl alcohol, poisonous mushrooms, a shorter incubation period and a predominance of gastritis syndrome at the onset of the disease are characteristic. In all these cases, consultation with a toxicologist is necessary.

Indications for consulting other specialists

For differential diagnosis and identification of possible complications of food poisoning, consultations are needed:
surgeon (acute inflammatory diseases of the abdominal organs, mesenteric thrombosis);
Therapist (MI, pneumonia);
gynecologist (disturbed tubal pregnancy);
Neurologist (acute cerebrovascular accident);
Toxicologist (acute chemical poisoning);
endocrinologist (diabetes mellitus, ketoacidosis);
resuscitator (shock, acute renal failure).

Diagnosis example

A05.9. Bacterial food poisoning, unspecified. Gastroenteric form, course of moderate severity.

Treatment of food poisoning

Patients with severe and moderate course, socially unsettled persons with PTI of any severity (Table 17-8) are shown hospitalization in an infectious diseases hospital.

Table 17-8. Standard of care for patients with food poisoning

Note. Pathogenetic therapy depends on the degree of dehydration and body weight of the patient, is carried out in two stages: I - elimination of dehydration, II - correction of ongoing losses.

Treatment begins with gastric lavage with warm 2% sodium bicarbonate solution or water. The procedure is carried out until clean wash water is discharged.

Gastric lavage is contraindicated in high blood pressure; persons suffering from ischemic heart disease, gastric ulcer; in the presence of symptoms of shock, suspected MI, chemical poisoning.

The basis for the treatment of patients with food poisoning is rehydration therapy, which promotes detoxification, normalization of water-electrolyte metabolism and acid-base status, restoration of disturbed microcirculation and hemodynamics, elimination of hypoxia.

Rehydration therapy to eliminate existing and correct ongoing fluid losses is carried out in two stages.

For oral rehydration (with I-II degree of dehydration and absence of vomiting) apply:
glucosolan (oralite);
citroglucosolan;
Regidron® and its analogues.

The presence of glucose in solutions is necessary to activate the absorption of electrolytes and water in the intestine.

The use of second-generation solutions made with the addition of cereals, amino acids, dipeptides, maltodextran, and rice base is promising.

The amount of fluid administered orally depends on the degree of dehydration and the patient's body weight. The volumetric rate of administration of oral rehydration solutions is 1–1.5 l/h; solution temperature - 37 °C.

The first stage of oral rehydration therapy continues for 1.5-3 hours (enough to obtain a clinical effect in 80% of patients). For example, a patient with IPT with II degree dehydration and a body weight of 70 kg should drink 3-5 liters of rehydration solution in 3 hours (the first stage of rehydration), since with II degree of dehydration, fluid loss is 5% of the patient's body weight.

In the second step, the amount of fluid injected is determined by the amount of continuing loss.

In case of III-IV degree dehydration and contraindications to oral rehydration, intravenous rehydration therapy is carried out with isotonic polyionic solutions: trisol, quartasol, chlosol, acesol.

Intravenous rehydration therapy is also carried out in two stages.

The amount of fluid administered depends on the degree of dehydration and the patient's body weight.

The volumetric rate of administration in severe PTI is 70-90 ml / min, with moderate - 60-80 ml / min. The temperature of the injected solutions is 37 °C.

At an injection rate of less than 50 ml / min and an injection volume of less than 60 ml / kg, symptoms of dehydration and intoxication persist for a long time, secondary complications develop (ARF, disseminated intravascular coagulation, pneumonia).

Calculation example. A patient with PTI has III degree of dehydration, body weight is 80 kg. The percentage of losses is on average 8% of body weight. 6400 ml of solution should be administered intravenously. This volume of liquid is administered at the first stage of rehydration therapy.

For the purpose of detoxification (only after the elimination of dehydration), you can use a colloidal solution - reopoliglyukin.

Drug therapy for food poisoning

Astringents: Kassirsky powder (Bismuti subnitrici - 0.5 g, Dermatoli - 0.3 g, calcium carbonici - 1.0 g) one powder three times a day; bismuth subsalicylate - two tablets four times a day.

Preparations that protect the intestinal mucosa: dioctahedral smectite - 9-12 g / day (dissolve in water).

Sorbents: hydrolysis lignin - 1 tbsp. three times per day; activated charcoal - 1.2-2 g (in water) 3-4 times a day; smecta® 3 g in 100 ml of water three times a day, etc.

Prostaglandin synthesis inhibitors: indomethacin (stops secretory diarrhea) - 50 mg three times a day with an interval of 3 hours.

Means that increase the rate of absorption of water and electrolytes in the small intestine: octreotide - 0.05-0.1 mg subcutaneously 1-2 times a day.

Calcium preparations (activate phosphodiesterase and inhibit the formation of cAMP): calcium gluconate 5 g orally twice a day after 12 hours.

Probiotics: acipol®, linex®, acilact®, bifidumbacterin-forte®, florin forte®, probifor®.

Enzymes: orase®, pancreatin, abomin®.

With severe diarrheal syndrome - intestinal antiseptics for 5-7 days: intestopan (1-2 tablets 4-6 times a day), intetrix® (1-2 capsules three times a day).

Antibiotics are not used to treat patients with food poisoning.

Etiotropic and symptomatic agents are prescribed taking into account concomitant diseases of the digestive system. Treatment of patients with hypovolemic, TSS is carried out in the ICU.

Forecast

The causes of rare deaths are shock and acute renal failure.

Complications of food poisoning

Mesenteric thrombosis, MI, acute cerebrovascular accident.

The prognosis is favorable with timely medical care.

Approximate periods of incapacity for work

Hospital stay - 12-20 days. If it is necessary to extend the deadlines - justification. In the absence of clinical manifestations and a negative bacteriological analysis - an extract for work and study. In the presence of residual effects - observation of the clinic.

Clinical examination

Not provided.

Reminder for the patient

Taking eubiotics and following a diet with the exception of alcohol, spicy, fatty, fried, smoked foods, raw vegetables and fruits (except bananas) from the diet for 2-5 weeks. Treatment of chronic diseases of the gastrointestinal tract is carried out in the clinic.

Food poisoning is not a rare occurrence. Especially often cases of foodpoisoning occurs in the summer or during the holidays (for example, during the New Year holidays), when a large amount of cooked food is stored for a long time, various microorganisms that produce bacterial toxins (for example, staphylococcal enterotoxin and hematoxin) multiply in the products. Also, food poisoning can be caused by eating foods containing substances toxic to the body (watermelons stuffed with herbicides, chicken meat treated with formaldehyde).

There have been cases in history when children ate corn straight from the field, freshly treated for pests, and died.

But still, food poisoning caused by pathogenic microorganisms is more common than food intoxication with chemical toxins.

Staphylococcal poisoning is often associated with eating spoiled meat and dairy products, vegetable dishes, pastries, cakes, canned fish in oil. Purely externally, they may not differ from benign products. Moreover, enterotoxin withstands temperatures of 100 degrees for 1.5 - 2 hours. That is, if such products are boiled, the staphylococci themselves will die, and the enterotoxin contained in them will still cause food poisoning. Botulinum toxin is destroyed by heating, but clostridia spores do not die during home canning of products (for example, when pickling mushrooms).

Food poisoning: symptoms

Toxins that cause food poisoning are not broken down by digestive enzymes and can be absorbed into the bloodstream through the stomach lining. Children are especially sensitive to them. Symptoms of food poisoning appear already in the first two hours after eating low-quality foods (in case of poisoning with Clostridium toxins - from six to 24 hours).

A patient with food poisoning is concerned about:

1. Vomit.
2. Cutting pain in the upper abdomen (in the epigastric region), rumbling of the abdomen, its swelling.
3. Body temperature can be normal or subfebrile (not higher than 37.5).
4. Short-term stool disorder occurs in half of the cases of food poisoning.
5. For food poisoning, weakness, pale skin, cold hands and feet, and a drop in blood pressure (BP) are typical.
6. The development of a collaptoid state is possible.

Symptoms of food poisoning caused by Clostridia exotoxins are much more severe, with the development of necrotic enteritis, anaerobic sepsis. The death of patients with botulism occurs in 30% of cases.

Treatment for food poisoning

Before you start treating food poisoning on your own, you must absolutely be sure that this is it, and not the first signs or intestinal infection (salmonellosis, dysentery, gastroenteric form of enterovirus infection, rotavirus gastroenteritis, and so on).

Food poisoning is indicated by:

1. Association with the consumption of a particular product. Usually, when collecting an anamnesis, patients themselves indicate: "I ate (a) something wrong."
2. The group nature of the disease.

What to do first in case of food poisoning:

1. Rinse the stomach with water or 5% sodium bicarbonate (soda).
2. After that, in order to delay the absorption of the poison and its entry into the bloodstream, as well as to cleanse the intestines, a saline laxative can be prescribed once (magnesium or sodium sulfate is given to children at the rate of 1 g per 1 year of life, they cannot be drunk with kidney failure).
3. Then give the patient any sorbent: activated carbon, smectite, polyphepan, enterosgel.
4. To prevent dehydration, solder the patient with mineral water, tea (regular, ginger, green), a decoction of dill seeds. To restore the balance of electrolytes, it is necessary to drink a solution of rehydron.
5. Of the drugs, they help a lot with food poisoning romazulan,aloe gastric juice (increases the secretion of the gastrointestinal tract, has bactericidal activity and laxative effect), marshmallow root (contains up to 35% of plant mucus, has an anti-inflammatory effect). Hilak forte (it has many effects, you need to read the instructions, in addition, it tastes slightly sour, and patients drink it willingly).

Should antibiotics be given for food poisoning?
The decision to prescribe antibiotics and sulfonamides is made only by a doctor. In most cases, with food poisoning, they are useless, moreover, they can be harmful in the form of intestinal dysbacteriosis.

Should I take Imodium (Loperamide) for diarrhea?

No. Let the body cleanse itself of toxins. Otherwise, they will be absorbed into the blood, the lymph nodes of the abdominal cavity may react to this with lymphadenitis, and then it will be difficult to distinguish food poisoning from an acute surgical pathology requiring surgical intervention.

Diet after poisoning

Before the appearance of appetite, the diet should be sparing. It is not recommended to eat anything fried and smoked. Everything is just boiled. From the diet it is necessary to exclude all products that cause the processes of decay and fermentation: milk, eggs, black bread. The enzymatic system of the digestive tract after poisoning is weakened, and he is not able to digest heavy food. You can drink compotes, kissels, eat crackers. The daily amount of calories must be reduced to 2,000 kcal.

Forecast

Even with a pronounced symptomatology of the initial period, recovery occurs already at the end of the day from the onset of the disease. And only in some patients weakness persists for two or three days. In the presence of chronic diseases of the gastrointestinal tract, food poisoning can cause their exacerbation.

With botulism, the prognosis is serious.

When should you call an ambulance for food poisoning?
If there is no certainty that this is food poisoning, with a severe course of the disease, with suspicion of botulism, if food poisoning is in a small child, then you should urgently seek medical help. But first aid must be provided even before the arrival of doctors.

Prevention

You can prevent food poisoning. To do this, you need to properly store food (not exceeding their shelf life), do not defrost meat (especially minced meat) at room temperature. You can not drink unboiled milk that has stood for a day in the refrigerator in an open pack.

Observe the rules of hygiene when preparing food. Do not allow persons with a pustular infection on the skin to this process. Buy products only in places that are trustworthy and from trusted manufacturers. Look carefully at the expiration dates of products.

Food poisoning- acute infectious diseases caused by opportunistic bacteria that produce exotoxins. When microorganisms enter food products, toxins accumulate in them, which can cause human poisoning.

Brief historical information
For many centuries, mankind has known that eating poor-quality products, especially meat, can lead to the development of vomiting and diarrhea. After describing P.N. Lashchenkov (1901) of the clinical picture of staphylococcal food intoxication, it was found that diseases with diarrhea and intoxication syndromes can be caused by opportunistic bacteria. As a result of the work of domestic researchers, these diseases are classified as food toxic infections.

What provokes / Causes of food poisoning:

Food poisoning is caused by a large group of bacteria.; the main pathogens are Staphylococcus aureus, Proteus vulgaris, Bacillus cereus, Clostridium perfringens, Clostridium difficile, representatives of the genera Klebsiella, Enterobacter, Citrobacter, Serratia, Enterococcus, etc. Pathogens are widespread in nature, have a pronounced resistance and are able to multiply in environmental objects. All of them are permanent representatives of the normal intestinal microflora of humans and animals. Often, it is not possible to isolate the pathogen from the sick, since the clinical picture of food toxic infections is mainly determined by the action of microbial toxic substances. Under the influence of various environmental factors, opportunistic microorganisms change such biological properties as virulence and resistance to antibacterial drugs.

Epidemiology
Source of infection- various animals and people. Most often these are persons suffering from purulent diseases (panaritiums, tonsillitis, furunculosis, etc.); among animals - cows and sheep suffering from mastitis. All of them secrete pathogens (usually staphylococci) that enter food products during their processing, where bacteria multiply and accumulate. Both patients and carriers of pathogens pose an epidemiological danger. The period of contagiousness of patients is small; concerning terms of a bacteriocarrier data are inconsistent.

The causative agents of other toxicoinfections (C. perfringens, B. cereus, etc.) are excreted by people and animals into the external environment with feces. The reservoir of a number of pathogens can be soil, water and other environmental objects contaminated with animal and human feces.

Transfer mechanism- fecal-oral, the main route of transmission is food. For the occurrence of food toxic infections caused by opportunistic bacteria, a massive dose of pathogens is required or a certain time for its reproduction in food products. Most often, food toxic infections are associated with the contamination of milk, dairy products, canned fish in oil, meat, fish and vegetable dishes, as well as confectionery products containing cream (cakes, pastries). The main product involved in the transmission of clostridia is meat (beef, pork, chicken, etc.). The preparation of some meat dishes and products (slow cooling, repeated heating, etc.), the conditions for their implementation contribute to the germination of spores and the reproduction of vegetative forms. Various objects of the external environment participate in the relay-race transmission of the pathogen: water, soil, plants, household items and patient care. Products containing staphylococcal and other enterotoxins do not differ from benign in appearance, smell and taste. Diseases occur in the form of sporadic cases and outbreaks. They are more often recorded in the warm season, when favorable conditions are created for the reproduction of pathogens and the accumulation of their toxins.

Natural susceptibility of people high. Usually, most of the people who eat contaminated food get sick. In addition to the properties of the pathogen (sufficient dose, high virulence), the development of the disease requires a number of contributing factors from both the microorganism and the macroorganism (reduced resistance, the presence of concomitant diseases, etc.). Individuals from the risk group are more susceptible: newborns, debilitated individuals, patients after surgical interventions or who have received antibiotics for a long time, etc.

Main epidemiological signs. Diseases caused by opportunistic pathogens are ubiquitous. Outbreaks are familial or when food is contaminated in catering establishments, diseases can be dispersed throughout the population. The number of cases determines the number of people who consumed the contaminated food product and can vary significantly. In particular, group diseases among passengers of ships, tourists and members of children's and adult organized groups are very characteristic. Flashes are usually explosive. There were no differences in the socio-age and gender composition. Diseases are more often recorded in the summer. Depending on the type of food product, children or adults predominate among the sick. In addition to food, household outbreaks are also possible, in most cases occurring in a hospital setting. Outbreaks of nosocomial infections caused by C. difficile are associated with prolonged use of antibiotics. During water outbreaks, as a result of fecal contamination, other pathogens of acute intestinal infections are also isolated along with opportunistic pathogens.

Pathogenesis (what happens?) During food poisoning:

A common property for all causative agents of food poisoning is the ability to produce various types of exotoxins (enterotoxins) and endotoxins (lipopolysaccharide complexes). It is due to the peculiarities of the action of these toxins that a certain originality is noted in the clinical manifestations of foodborne toxic infections caused by various pathogens. The relatively short incubation period of the disease also indicates the extremely important role of bacterial toxins in the development of foodborne infections.

Depending on the types of toxins, they can cause hypersecretion of fluid into the intestinal lumen, clinical manifestations of gastroenteritis and systemic manifestations of the disease in the form of an intoxication syndrome.

Bacterial toxins realize their action through the production of endogenous mediators (cAMP, PG, interleukins, histamine, etc.), which directly regulate the structural and functional changes in organs and systems detected in patients with food poisoning.

The similarity of the pathogenetic mechanisms of food toxic infections of various etiologies determines the commonality of the basic principles in approaches to therapeutic measures for these diseases, as well as for salmonellosis and campylobacteriosis.

Symptoms of food poisoning:

incubation period. It is usually several hours, but in some cases it can be shortened to 30 minutes or, conversely, extended to 24 hours or more.

Despite the polyetiology of food poisoning, the main clinical manifestations of the syndrome of intoxication and water and electrolyte disorders in these diseases are similar to each other and hardly distinguishable from those in salmonellosis. The diseases are characterized by an acute onset with nausea, repeated vomiting, loose stools of an enteric nature from several to 10 times a day or more. Pain in the abdomen and a temperature reaction may be insignificant, however, in some cases, severe cramping pains in the abdomen, a short-term (up to a day) increase in body temperature to 38-39 ° C, chills, general weakness, malaise, headache are observed. When examining patients, note pallor of the skin, sometimes peripheral cyanosis, coldness of the extremities, pain on palpation in the epigastric and umbilical regions, changes in pulse rate and a decrease in blood pressure.The severity of clinical manifestations of dehydration and demineralization depends on the volume of fluid lost by patients with vomiting and diarrhea.The course of the disease is short and in most cases is 1-3 days.

However, the clinical manifestations of food poisoning have some differences depending on the type of pathogen. Staphylococcal infections are characterized by a short incubation period and the rapid development of symptoms of the disease. The clinical picture is dominated by signs of gastritis: repeated vomiting, sharp pains in the epigastric region, resembling gastric colic. The nature of the stool may not change. Body temperature in most cases remains normal or rises briefly. A pronounced decrease in blood pressure, cyanosis and convulsions can be observed already in the first hours of the disease, but in general the course of the disease is short-term and favorable, since changes in cardiohemodynamics do not correspond to the degree of water and electrolyte disorders. In cases of food poisoning caused by Clostridium perfringens, the clinical picture, similar to that of a staphylococcal infection, is supplemented by the development of diarrhea with characteristic loose bloody stools, body temperature remains normal. With food poisoning caused by Proteus vulgaris, the stool becomes fetid.

Complications
Observed extremely rarely; most often - hypovolemic shock, acute cardiovascular insufficiency, sepsis, etc.

Diagnosis of food poisoning:

Differential Diagnosis
Food poisoning should be distinguished from salmonellosis and other acute intestinal infections - viral gastroenteritis, shigellosis, campylobacteriosis, cholera, etc., as well as from chronic gastrointestinal diseases, surgical and gynecological pathologies, myocardial infarction. Since the main pathogenetic mechanisms and clinical manifestations of food toxic infections are little different from those in salmonellosis, in clinical practice a generalized preliminary diagnosis of food toxic infections is often made, and salmonellosis is isolated from this general group if it is bacteriologically or serologically confirmed.

Laboratory diagnostics
The basis is the isolation of the pathogen from vomit, gastric lavage and feces. When sowing the pathogen, it is necessary to study its toxigenic properties. However, in most cases, the excretion is insignificant, and the detection of a specific microorganism in a patient does not yet allow us to consider it the culprit of the disease. At the same time, it is necessary to prove its etiological role either with the help of serological reactions with an autostrain, or by establishing the identity of pathogens isolated from an infected product and from persons who used it.

Treatment of food poisoning:

Treatment of foodborne illnesses similar to that of salmonellosis; gastric lavage, siphon enemas, early appointment of enterosorbents (activated carbon, etc.), vitamins are shown. If necessary, carry out rehydration therapy. Etiotropic treatment for uncomplicated food poisoning is not indicated.

Prevention of food poisoning:

Epidemiological surveillance should be carried out as part of the surveillance of intestinal infections and nosocomial infections.

Prevention of diseases is based on the observance of the sanitary-hygienic and technological regime, norms and rules for the procurement, preparation, storage and sale of food products. It is necessary to ensure veterinary and sanitary control over animals that can contaminate soil, water and surrounding objects with pathogens. To prevent staphylococcal poisoning, measures are taken to reduce the carriage of staphylococci in workers of food enterprises (sanation of staphylococcus carriers in the nasopharynx and on the skin, treatment of chronic inflammatory diseases of the tonsils and upper respiratory tract). It is necessary to remove from work directly related to the processing of food products and their manufacture, persons with pustular skin diseases, pharyngitis, tonsillitis and other manifestations of staphylococcal infection. Of great importance are the control over the observance of the sanitary and hygienic regime at food enterprises and medical institutions, the observance of the rules of personal hygiene, and the constant conduct of sanitary and educational work. It is important to properly store food products, to exclude the reproduction of foodborne pathogens in them. Heat treatment of foodstuffs, boiling of milk and adherence to the deadlines for their implementation are extremely important.

Activities in the epidemic focus
Similar to those for other acute intestinal infections. Dispensary observation of patients who have recovered is not regulated.

Which doctors should you contact if you have food poisoning:

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