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LIVING with the EARTH FOODBORNE ILLNESS Objectives

LIVING with the EARTH FOODBORNE ILLNESS Objectives

LIVING WITH THE EARTH FOODBORNE ILLNESS

CHAPTER 8 FOODBORNE ILLNESS

Objectives for this Chapter Objectives for this Chapter

• A student reading this chapter will be able • A student reading this chapter will be able to: to: – 1. Recognize, list, and explain the major – 4. Explain the mechanisms by which these reasons for protection programs. cause foodborne illness , and – 2. List and describe the major categories and describe how the life cycles of these subcategories of agents causing foodborne organisms are important in this illness. of . – 3. Describe the major foodborne pathogens – 5. List and describe the major disease including parasitic,viral, and bacterial symptoms in humans for these foodborne . pathogens.

Objectives for this Chapter FOODBORNE ILLNESS

• A student reading this chapter will be able • Worldwide Distribution of Foodborne to: Pathogens – 6. Describe and explain the HACCP system in – 1.5 billion children under the age of five suffer protecting against foodborne disease. from , and tragically, over 3 million die – 7. Discuss recent regulatory efforts in the area as a consequence. of food potection.

1 Reason for Food Protection FOODBORNE ILLNESS Programs • Reasons for varying among • The implementation of programs to geographic regions minimize foodborne diseases is important – Climate because of the problems associated with – Population demographics morbidity, mortality, and economic loss. – Nutritional status – Cultural aspects

Morbidity and Mortality Due to Morbidity and Mortality Due to Foodborne Disease Foodborne Disease • In the United States there are as many as • The causative agents and modes of 33 million cases of foodborne illness which transmission (means through which an are responsible for an estimated 9 causative agent is spread) are known in thousand annually. less than 1% of the severe cases.

Economic Consequences of Foodborne Illness • Medical Costs Fig. • Loss of Wages 8-1 • Recall • Investigation • Litigation (Fig. 8-1)

2 CAUSATIVE AGENTS OF CAUSATIVE AGENTS OF FOODBORNE DISEASE FOODBORNE DISEASE • Foodborne illness is defined as any illness incurred from the consumption of • Radionuclides contaminated food. • Chemicals • Food Additives • Poisonous Plants and Animals • Pathogens (Table 8-1)

Table 1b

Table 1a

Radionuclides Radionuclides

• Radiation is introduced into the food chain • Radionuclides, which are deposited in the naturally from mineral deposits beneath environment accidentally, or intentionally, the earth’s surface or from the atmosphere as a direct result of human activity are of in the form of ultraviolet and cosmic rays. much greater concern. • Chernobyl • India vs. Pakistan

3 Chemicals Chemicals

• Ironically, man is responsible for many • Chemicals enter the food from packaging chemical contaminants presently found in materials, agricultural applications of food. and fertilizers, by adding • Between 80%-90% of our exposure to or colorings to , or by potentially harmful chemicals is from food the release of industrial chemicals into the consumption. environment (Table 8-2).

Packaging Materials

• Acidic conditions will leach these chemicals from damaged packaging Table 8-2 containers – Antimony – Cadmium – Lead

Symptoms Industrial Processes

• Antimony •Mercury – Complications of the gastrointestinal, – Methyl mercury is an acute which cardiovascular, and hepatic systems causes tremors, neurological complications, • Cadmium kidneyy, failure, and birth defects. – Kidney damage – Fungicides and animal feed – Minamata Bay, Japan • Lead – Neurological, kidney failure, bone integrity

4 Industrial Processes Polychlorinated biphenyls (PCBs) • Polychlorinated biphenyls (PCBs) – Widely used in industry, they are extremely • Rice oil-Japan, 1968 stable compounds that do not degrade easily, – 1000 with Symptoms theyy,y are resistant to heat, and they are also – Swelling of the eyes, rash, and highly toxic. gastrointestinal illness, five deaths.

Pesticides Pesticides

• Organochlorine compounds such as DDT • Many of the chemicals banned from use in and chlordane, organophosphates such as the United States are sold to developing parathion and , and inorganic nations who use them extensively in compounds such as arsenics, have been producing crops for export to the American have all been applied to food in the form of market. a .

Pesticides Food Additives

• The EPA has banned DDT, aldrin, , • Food additives are intentionally added to hepaclor, and kepone, yet traces of these food to alter taste, color, texture, nutritive compounds and their metabolites continue value, appearance, and resistance to to be found in our food. deterioration. • DDT and other chemicals of its class accumulate in the environment.

5 Food Additives Food Additives

• Food additives are considered to be the • Food and Drug Act of 1906 least hazardous source of foodborne • In 1958, the Food Additive Amendment to illness, ranking behind pesticides, the Food Drug and Cosmetic Act required environmental contcontaminantsaminants, natural FDA approval before use. , and microbial toxins. • Color Additive Amendment of 1950

Food Additives Food Additives

• • – Causes bladder cancer in lab animals – Chinese Syndrome (headaches – Not covered under the Delaney clause and possible ), and lesions of the retina. – An allowable daily intake (ADI) of 120mg/kg has been established for individuals over one year of age.

Food Additives Food Additives

• GRAS (Generally Recognized as Safe) • Nitrates and Nitrites – GRAS substances are chemicals that had a – Prevent the growth of spores. history of safe use before the 1958 Food Additive Amendment passed. – In the body, nitrates can be reduced to nitrites which in turn oxidize hemoglobin – There are approximately 700 GRAS and cause anoxia. substances. – In food, nitrites react with amines, to form – Currently, the FDA is reviewing their safety nitrosamines. and reclassifying if necessary. • Have caused cancer of the , kidney, bladder, , and pancreas of laboratory animals.

6 Poisonous Plants and Animals Poisonous Plants and Animals

• Plant Sources • By the process of trial and error, humans – have identified plants that were either • Herbs -the pyrrolizidine group harmful to man, or possessed little • Potatoes- Solanum alkaloids nutritional value, and excluded them from • Caffeine, teas- Xanthine alkaloids our diet. • Some plants and animals known to be harmful to man have a significant nutritional value and are still part of our diet.

Plant Sources Animal Sources

• Lectins • Paralytic Shellfish – Lectins are plant proteins(the Leguminosae – Shellfish become toxic to humans when they family) that agglutinate red cells. feed on dinoflagellates such as Gonyaulax •Saponins catenella in numbers greater than 200/ml of – Saponins are glycosides that hemolyze red water. blood cells. – Symptoms include a tingling or burning – As we are experiencing dietary shift to sensation of the lips and gums, ataxia, and healthier foods such as alfalfa and soy paralysis of the diaphragm. based products, we can also expect an increase of saponin intoxications.

FOODBORNE PATHOGENS

• More than 40 potential foodborne pathogens have been listed by CAST (Table 8-3). Table 8-3

7 FOODBORNE PATHOGENS FOODBORNE PATHOGENS

• Listed below are reasons for the surfacing • Parasitic of new and old pathogens. – The – Decrease in lactic acid • Trichinella spiralis (Fig. 8-2) – Contaminated water applied to food • (Fig. 8-3) – Abuse of • (Fig. 8-4) – Dietary shift – Longer shelf-life, ready-to-eat

Fig. 8-2 Taenia life cycle solium life cycle Fig. 8-3a

Fig. Fig. 8-3b 8-4a Taenia saginata life cycle

Taenia solium life cycle

8 Fig. 8-4b The Protozoans

• (Fig. 8-5 a-b) – Affects about 10% of the worlds population. – Outbreaks occur where sanitation is poor, risky sexual habits are practiced, and in Taenia institutional facilities. saginata – Symptoms Range from mild diarrhea to life cycle amoebic dysentery.

Entamoeba histolytica Fig. 8-5b life cycle

Fig. 8-5a Entamoeba histolytica life cycle

The Protozoans Fig. 8-6

• lamblia – Giardia lamblia is a protozoan flagellate found in areas with poor sanitation, and in unfiltered surface water supplies (Fi g. 8-6). – is most common among those who travel to areas, in homosexuals, and in child day care settings.

9 Giardia lamblia The Protozoans

– Cysts reach the surface water supplies • through the fecal deposits of beaver and – Primarily a waterborne , muskrats Cryptosporidium is transmitted via water – Syypmptoms consist of nausea, ex plosive contaminated with feces from human and diarrhea (up to ten movements per day), and agricultural origins. fatigue. – Milwaukee, 1993

Cryptosporidium

– Foodborne transmission of Cryptosporidium occurs via the fecal-oral route, usually from careless food handlers shedding the hardy Fig. 8-7 oocysts (see life cycle, Fig. 8-7) of the organism. Cryptosporidium life cycle

Cryptosporidium FOODBORNE PATHOGENS

– In healthy individuals, symptoms present as • mild diarrhea, nausea, cramps, and a low – microscopic particles that usually contain a grade fever. single strand of RNA – Immunocompppromised patients such as those – Require a for replication to occur. with AIDS, experience high volume diarrhea, – The two most prominent foodborne viruses of weight loss, and severe abdominal cramps. present day are and Norwalk-like .

10 Viruses Viruses

• Hepatitis A • Norwalk-like Virus – Transmitted via the fecal-oral route, and – In 1982, Norwalk-like viruses were the leading causes liver occasionally cause of reported foodborne illness in the accomppyjanied by . United States,,p responsible for 5000 cases – Contamination occur by infected food workers from two different outbreaks. handling foodstuffs, or from food products that have come in contact with water polluted with fecal matter.

Viruses FOODBORNE PATHOGENS

• Norwalk-like Virus • Fungi – Food products such as creams, cream fillings, – Fungi, such as molds and yeasts are single and salads, are efficient vehicles for viruses and multi-celled plant-like organisms that because theyygy do not undergo any extensive gg,,,g,row on cereals, breads, , vegetables, heating before being served. and cheeses (Fig. 8-8). – Symptoms include diarrhea and nausea

FOODBORNE PATHOGENS

Fig. • Fungi – The majority of molds are aerobes. 8-8 – Yeasts are facultative anaerobes. – are mold metabolites produced on food, which cause illness or when ingested by man or animals.

11 Fungi Penicillium spp. (Fig. 8-9)

• (Fig. 8-9) – Rubratoxin, , and yellow rice toxins are • Turkey X Disease produced by members of the genus • Four primary , B1, B2, G1, and G2, which Penicillium. are found in peanuts, corn, and cotton seed. – Syypmptoms include vomitin g, difficult y • Causes hemorrhaging, anemia, ataxia, hematosis, breathing, low blood pressure and respiratory of the liver, and is a very potent arrest. carcinogen.

Mucor and Rhizopus spp. (Fig. Fig. 8-9 8-9) – Mucormycosis is the disease caused by fungi in the order Mucorales. – common spoilage organisms of bread and . – Symptoms include the invasion of blood vessels, causing embolisms and tissue .

FOODBORNE PATHOGENS FOODBORNE PATHOGENS

•Bacteria •Bacteria – Bacteria are the single-celled organisms – Bacteria exist in the form of coccus, rods, which are responsible for more than 80% of spirillium, spirochete, and appendaged (Fig. foodborne illness. 8-10). – Two broad groups of bacteria classification are: • gram-positive • gram-negative.

12 Fig. 8-10 Bacteria

• Another characteristic useful in identifying bacteria is the ability to grow in the presence or the absence of oxygen (Fig. 8-11). – Aerobic bacteria – Anaerobic – Facultative anaerobe – Microaerophilic

Bacteria

– If the anaerobe is suspected, the investigator might search for Fig. endospores, which are structures produced during the life cycle of certain bacteria (Fig. 8- 8-11 12).

Fig. 8-12 Bacteria

• spp. – Gram-negative, facultative anaerobes. – Estimated 2-4 million cases a year in the U.S. – Three syndromes are caused by Salmonella species, , enteric fever, and gastroenteritis.

13 Bacteria Bacteria

• Salmonella spp. • Staphylococcus spp – The disease is transmitted via food, water, – Staphylococcus food poisoning, caused by and the fecal-oral route the gram-positive cocci, Staphylococcus – These organisms colonize in the small aureus. intestine, causing intestinal inflammation, – Sickness is due to the consumption of the resulting in diarrhea, abdominal cramps, heat stable , and includes nausea, chills, fever, and , which last 1-4 vomiting, and diarrhea. days.

Staphylococcus aureus Bacteria

– Contamination occurs through the preparation • Clostridium spp. of foods by infected food handlers. Foods • and Clostridium such as creams, cream pies, potato salad, and ham have all been implicated in in botulinum are spore-forming anaerobic outbreaks of Staphylococci food poisoning. bacteria found in soils throughout the world.

Clostridium botulinum Clostridium botulinum

– is the illness that results when C. – There are seven types of C. botulinum, A-G, botulinum spores germinate and produce a which are identified by the toxin they produce. toxin in the food to be ingested. – The A toxin is the most common in the United – Byyygp destroying the spores in foods before States, and has been isolated in fruits, canning or storing products, risk of botulism vegetables, fish, condiments, beef, pork, and can be eliminated. .

14 Clostridium botulinum Bacteria

• Symptoms • – At the onset, symptoms such as nausea, – Campylobacter species are part of the normal vomiting and diarrhea, are present, then as flora of the of warm the condition developp,s, fatig ue , blurred vision, blooded animals. difficulty speaking and swallowing are – During , the intestinal tract is experienced. lacerated, allowing feces to contaminate the food.

Campylobacter Bacteria

– Campylobacter can survive for weeks in • at 4°C – Gram negative – Symptoms are usually mild including nausea, – E. coli organisms which are important to vomitinggy, and bloody diarrhea, but in severe foodborne illness can be divided into four infections, Gullian Barre Syndrome develops, groups, enteroinvasive, enterotoxigenic, which causes neuromuscular paralysis. enteropathogenic, and enterohemorrhagic.

Escherichia coli Escherichia coli

– Enteroinvasive E. coli invade the epithelial – Enteropathogenic E. coli are most commonly cells of the intestine, resulting in fever, chills, found among infant nurseries in developing and bloody diarrhea. countries. – Enterotoxigenic E. coli are responsible for – Enterohemorrhagic E. coli, also known as E. traveler’s diarrhea, produce a toxin, and coli O157:H7 is the result of consuming exhibit like symptoms. improperly cooked ground beef, raw , or unpasteurized apple cider.

15 Escherichia coli cholerae

• E. coli O157:H7 – Gram negative vibrio – Symptoms generally include, abdominal – Responsible for the disease cholera which is cramps, watery to bloody diarrhea, vomiting, common among LDCs and international and ppyossibly a fever and ; travelers. – Hemolytic uremic syndrome (HUS), which is – In Peru, in 1991, an outbreak of cholera the primary cause of renal failure in children. spread to 322,562 Peruvians.

Factors Frequently Cited in Foodborne Illness • Vibrio cholerae colonizes on the lining of the intestine and produces the toxin – 1. Improperly refrigerated food. choleragen. – 2. Improperly heated or cooked food. • Symptoms present as abdominal pains, – 3. Food handlers who pppractice poor . dehydration, and a characteristic diarrhea, – 4. Lapse of a day or more between which has been termed “rice water stool.” preparing and serving food.

Factors Frequently Cited in Factors Frequently Cited in Foodborne Illness Foodborne Illness – 7. Failure to properly heat previously cooked – 5. Introducing raw or contaminated foods to temperatures that will kill bacteria. materials to a food that will not – 8. Cross contamination of ready to serve undergo further . foods with raw foods, contaminated utensils – 6. Improper storage of foods at or machinery, or through the mishandling of temperatures ideal for bacterial foods growth.

16 Fig. 8-13

Figure 8-13 illustrates some useful procedures for reducing food contamination.

Hazard Analysis Critical Control Hazard Analysis Critical Control Points Points – In response to this present threat, the federal – There are seven key principles to the HACCP government has mandated the system (Table 8-4). implementation of hazard analysis critical control points (HACCP) strategies in the , poultry, and meat industries.

Table 8-4 United States Regulatory Efforts with Regard to Food Protection

– On December 18, 1997, the FDA required that all seafood processors , domestic and those importing to the United States, carry out a hazard analysis of their products and processes.

17 United States Regulatory Efforts with Regard to Food Surveillance efforts Protection – The Foodborne Diseases Active Surveillance Network (FoodNet) – On January 27, 1997, the USDA required – Since January 1, 1996, it has identified meat and poultry slaughterers and outbreaks of Campylobacter in California, processing facilities have sanitation SOPs Salmonella in Oregon, and two outbreaks of in place, and that they also conduct E. coli O157:H7 in Connecticut. generic E. coli testing.

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