Food poisoning is defined as an illness caused by the consumption of food or water contaminated with bacteria and/or their toxins, viruses or chemicals. Although the GI tract is the primary target, autonomic nervous system disturbances and CNS impairment are prominent manifestations in chemical-related, plant-related and seafood-related poisonings and in botulism.
Food poisoning affects the public health and the economy in a negative way. In addition to its negative effects on human health, there are work hour losses related to inefficient working or not being able to work. The health costs can cause bigger economical losses and may result in deaths. It is widely agreed that there has been a genuine increase in food poisoning.
It is likely that a combination of many factors is responsible, changing social patterns, the moves towards shopping less frequently and thus storing food for longer; the increasing use of pre-prepared dishes, which are not always stored or reheated appropriately; the trend towards eating out more often and the increase in international travel. Also, emergence of new diseases as E. coli O157 which was reported in England and Wales in 1982. Moreover, the increasingly globalised food market with the variation in standards of food safety between countries could allow micro-organisms to spread quickly across the globe. This has a great influence on the society in terms of health, economy and culture.
Food borne pathogens are virtually inescapable reaching every aspect of life. Furthermore, microbial contaminants are extremely difficult to pinpoint precision of their presence and role in food systems.
Common Causes of Food Poisoning
Several factors contribute to food poisoning in Egypt, including:
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- Unspecified Food Poisoning: A significant proportion of cases are attributed to unspecified toxins.
- Organophosphate Insecticides: Food contaminated with these insecticides is a notable cause.
- Ciguatera: This food-borne illness is related to the consumption of marine fish contaminated by natural toxins.
- Botulism: A paralytic illness caused by neurotoxins synthesized by Clostridium botulinum.
- Escherichia coli O157: An uncommon but serious cause of gastroenteritis.
Non pathogenic food poisoning as fish borne toxins; scombrotoxin, ciguatoxin, paralytic shellfish; chemicals, heavy metals, monosodium glutamate and plants as poisonous mushrooms represent another cause of food poisoning. Food contamination by chemical substances is also possible. Insecticides, rodenticides, arsenic, lead, or fluoride preparations can be mistaken for a food ingredient. Moreover, the possibility of unintentional acute heavy-metal ingestion must be considered.
This type of poisoning most typically occurs when very acidic fruit punch is served in metal-lined containers. Antimony, zinc, copper, tin, or cadmium in a container may be dissolved by an acid food or juice medium.
Specific Food Poisoning Agents
Scombroid poisoning originally was described with the Scombroidae fish (including the large dark-meat marine tuna, albacore, mackerel and kingfish). However, nonscombroid fish and marine mammals such as mahi mahi (dolphin) and blue fish also have been linked to outbreaks of poisoning. The appearance, taste and smell of the fish usually are unremarkable.
Ciguatera is a food-borne illness in tropical regions related to the consumption of marine fish contaminated by natural toxins consumed through their diets. Globally, ciguatera affects between 25000 and 500 000 people per year. The potent neurotoxins responsible for ciguatera are predominantly ciguatoxins . These toxins enter the food chain when herbivorous fishes consume Gambierdiscus toxicus while grazing on larger reef-colonizing species of red, green and brown algae.
The toxin accumulate in the tissues of the fishes and bioaccumulate in higher predator species of the food chain-with humans at the apex of the trophic pyramid, experiencing the full effects of bio-accumulation. Unfortunately, these toxins are odorless, tasteless and colorless, heat stable and lipid soluble, remaining active after cooking, freezing or smoking and so, passed unnoticed.
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Study on Food Poisoning Patterns in Egypt
A retrospective study was conducted at the Poisoning Control Centre, Ain Shams University, Cairo, Egypt with the aim of evaluating the pattern of food poisoning. Hence, the medical profiles of 1748 food poisoning patients, admitted during the period from January 2010 to June 2010, were carefully reviewed.
The greatest proportion of food poisoning occurred between the ages of 18 and 29 years, with preponderance of male gender. Most cases of poisoning were accidental. The study revealed that the most common cause involved in acute poisoning was unspecified food poisoning, followed by food contaminated with organophosphate insecticides.
Ciguatera and botulism were the third and fourth agents that induced food poisoning. Botulism and organophosphate compounds were the most serious toxicities. All patients had favorable outcome.
The pattern of acute poisoning may be different even within a region or a country. Moreover, food poisoning depends on the nature of the environment, socio-cultural, socio-economic and dietary differences. It affects masses especially in places like schools, hospitals and offices where food is produced in large quantities.
It is therefore essential to increase the number of studies carried on the importance of food poisoning. Moreover, epidemiological surveillance is necessary to assess the magnitude of the problem and the major risk factors so that the preventive measures can be taken.
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In this context, a study was carried out to evaluate the pattern of food poisoning in both adults and children in Poison Control Centre, Ain Shams University, a referral center for poisoning, covering great area of Great Cairo, between January 2010 and June 2010.
Key Findings from the Study
The study revealed several key findings:
- Unspecified Food Poisoning: 96.51% of cases were due to unspecified food poisoning, with young adults (18-29 years) being the most affected (36%).
- Organophosphate (OP) Insecticides: Preschool children were the most vulnerable age group (33.3%).
- Ciguatera: The middle-aged group was the main affected age group (85.7%).
- Botulism: There was a predominant affection of the adult age group (66.6%).
There was higher male to female ratio (59 to 41%) in unspecified food poisoning group. In contrast, ciguatera group showed predominance of females (71.4%) to males (28.6%). Regarding OP and botulism groups non significant difference was observed between both sexes.
In unspecified food poisoning group, the ratio of urban to rural areas was 4:1, while in OP group, the ratio was 2:1. Regarding ciguatera, all cases were from urban area whereas in Botulism groups the ratio of urban to rural area was 5:1.
In groups 1 and 2 (unspecified food poisoning and OP groups), there was predominance of single population to married one, whereas in ciguatera and botulism groups all cases were single.
All cases in groups 1, 3 and 4 (unspecified food poisoning, ciguatera and botulism) were accidental. As regards OP group, 87.5 % of cases were accidental whereas 8.33% of cases were suicidal and 4.17% suspicious of criminal purpose.
Mild clinical manifestations in the form of nausea, vomiting, diarrhea, abdominal colic and hypotension were the main presenting manifestations of unspecified food poisoning. Patients received intravenous fluids with electrolytes, H2 blockers and kept under observation with full recovery within 1 day.
Abdominal colic, vomiting, diarrhea, constricted pupil were the main presenting picture of OP group (2). Other manifestations in the form of muscle fasciculation bronchorrhea, bronchospasm were also reported. Investigations revealed mild to moderate cholinesterase inhibition in all cases.
Patients presented with mild symtoms (75%) recovered rapidly with atropine, IV fluids and spasmolytics, within 1-2 days, those with moderate symptoms (18.7%) required admission for longer period (3-4 days), while those who presented with severe clinical symptoms (6.25%) as pulmonary oedema and those who developed complications as intermediate syndrome were admitted for longer period (5-8 days).
In group (3) (ciguatera) tingling, numbness and motor paresis were the predominant manifestations with only one case of ataxia and vomiting. Arterial blood gases, Na and K levels were normal in sex out of seven patients (85.7%). They were admitted for 1 day, received activated charcoal, intravenous fluids with electrolytes and steroids. One patient (14.3%) developed hypernatremia and hypokalemia and was admitted to intensive care unit for 3 days where he received intravenous fluids, electrolytes and steroids.
Neurological manifestations in the form of diplopia, blurring of vision, dilated pupils, dysphoria and motor paresis were the main presenting features in patients with botulism (group 4). Gastrointestinal manifestations in the form of nausea, vomiting and constipation were also present. Arterial blood gases were normal in all cases except for one case of botulism that developed hypoxemia and respiratory alkalosis. Hypokalemia with normal Na levels were found in all cases of botulism. All cases of botulism (group 4) were admitted to intensive care unit for 4 days where they received anti-botulism antidote, intravenous fluids, electrolytes, H2 blockers and antibiotics.
All patients enrolled in this study were discharged from the poison control centre, with complete recovery with no recorded mortalities.
Acute food poisoning is a major public health problem. Most of the cases are mild and improve without any specific treatment. Some patients have severe disease and require hospitalization, aggressive hydration, and antibiotic treatment.
In the present study, 1748 cases of food poisoning were reported from January to June 2010. 96.51% of the cases were due to unspecified food poisoning with predominance affection of young adult age group (18-29 years) representing 36% followed by school children (6-17...
HOW TO AVOID FOOD POISONING WHILE TRAVELLING (AND TREAT IT)
Microbial Analysis of Fish in Egypt
The microbial analysis of fish is critical for ensuring overall health. Uncooked fish can serve as a conduit for transmitting several types of microbes; the current investigation sought to assess the bacterial levels in various kinds of fish from Nasser Lake, Aswan, Egypt, considered the chief source of potable water in Egypt.
Two hundred and fifty fish samples, including 50 of each Oreochromis niloticus, Sander lucioperca, Lates niloticus, Clarias gariepinus, and Mormyrus kannume, from Nasser Lake, Aswan, Egypt, were collected to detect the bacterial load, isolation, and identification of Aeromonas hydrophila, Pseudomonas aeruginosa, and Vibrio parahaemolyticus and their virulence genes. The findings revealed that Oreochromis niloticus and Clarias gariepinus exhibited higher bacterial loads than other fish species.
Incidences of bacterial contamination among examined fishes were 28.8%, 20.4%, and 16% for Aeromonas hydrophila, Pseudomonas aeruginosa, and Vibrio parahaemolyticus, respectively. Additionally, PCR analysis detected the presence of aerA (60%) and Act (40%) genes in A. hydrophila, rpoB (70%) and LasB (30%) genes in P. aeruginosa, and ToxR (70%) and tdh (50%) genes in V. parahaemolyticus.
The study suggested that the bacterial contamination levels in Oreochromis niloticus and Clarias gariepinus could be notably more significant than in other species that could potentially be harmful to the consumers, especially considering the identification of particular bacteria known to cause foodborne illnesses. Further recommendations emphasized that regular monitoring and assessments are required to preserve their quality.
Traveler's Diarrhea
Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and stomach cramps. It's caused by eating contaminated food or drinking contaminated water. To reduce your risk of traveler's diarrhea, be careful about what you eat and drink while traveling.
Symptoms
Traveler's diarrhea may begin suddenly during your trip or shortly after you return home. Most people improve within 1 to 2 days without treatment and recover completely within a week. Sometimes, people experience moderate to severe dehydration, ongoing vomiting, a high fever, bloody stools, or severe pain in the belly or rectum.
When to See a Doctor
Traveler's diarrhea usually goes away on its own within several days. Symptoms may last longer and be more severe if it's caused by certain bacteria or parasites. Be especially cautious with children because traveler's diarrhea can cause severe dehydration in a short time.
Causes
It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But usually infectious agents â such as bacteria, viruses or parasites â are to blame. So why aren't natives of high-risk countries affected in the same way?
Risk Factors
Each year millions of international travelers experience traveler's diarrhea. Traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, and a few Caribbean islands also poses some risk. Your chances of getting traveler's diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition.
- Young adults: The condition is slightly more common in young adult tourists. Though the reasons why aren't clear, it's possible that young adults lack acquired immunity.
- People with weakened immune systems: People with diabetes, inflammatory bowel disease, or severe kidney, liver or heart disease.
- People who take acid blockers or antacids.
- People who travel during certain seasons: The risk of traveler's diarrhea varies by season in certain parts of the world.
Complications
Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated, especially during the summer months. Dehydration caused by diarrhea can cause serious complications, including organ damage, shock or coma.
Prevention
Watch what you eat. The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Don't drink unsterilized water â from tap, well or stream. If you need to consume local water, boil it for three minutes.
Feel free to drink canned or bottled drinks in their original containers â including water, carbonated beverages, beer or wine â as long as you break the seals on the containers yourself. If it's not possible to buy bottled water or boil your water, bring some means to purify water. You also can chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system.
You can purchase water-disinfecting tablets containing chlorine, iodine tablets or crystals, or other disinfecting agents at camping stores and pharmacies. Wash your hands often and always before eating. Keep children from putting things â including their dirty hands â in their mouths.
Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. As a preventive measure, some doctors suggest taking bismuth subsalicylate, which has been shown to decrease the likelihood of diarrhea. However, don't take this medicine for longer than three weeks, and don't take it at all if you're pregnant or allergic to aspirin. Common harmless side effects of bismuth subsalicylate include a black-colored tongue and dark stools.
Preventive Measures and Recommendations
To achieve a reduction in food poisoning, measures need to be taken across the food chain-from farms to slaughterhouses, food businesses, caterers, consumers and imported foods. Implementation of good hygiene practices and enforcement of legislation are crucial.
In addition, strict rules must be followed regarding the sale of insecticides. Establishing poison information centers in different parts of the country, preparing national treatment guidelines, training healthcare providers and ensuring easy availability of the antidotes are also recommended.
No one should have to fear food poisoning every time they eat or drink, but the reality, even in the 21st century, is that risks remain. An Osaka Metropolitan University-led Egypt-Japan research team found E. Of the 210 samples of raw milk, cheese, and yoghurt, 26.2% were positive for E. coli, with the highest being raw buffalo milk at 68%, and the lowest at 7.5% for rayeb, a type of fermented milk.
The preference for raw milk instead of pasteurized milk and varying hygienic conditions at small dairies and markets could explain these results. The researchers found that one of the E. coli strains they isolated from the samples collected in 2018 in Egypt had the same characteristics as the E. coli that caused food poisoning in Japan's central Toyama Prefecture in 2021. The E. coli discovered in this study has attracted attention as a new pathogenic E. coli that does not fall into any existing category.
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