food-borne disease: a thanksgiving special · 2018. 11. 1. · food-borne disease: a thanksgiving...
TRANSCRIPT
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Food-Borne Disease:
A Thanksgiving Special
Thanksgiving 2018
Ted Cieslak MD MPH
University of Nebraska
College of Public Health
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The Menu
• Appetizers• For the Kids• Salads• Entree
– Turkey
• Sides– Stuffing
– Gravy
– Vegetables
– Cranberries
• Beverages• Desserts• Leftovers
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Appetizers (Eggs): Salmonella
• The Salmonellae– S. typhi
– S. paratyphi
– S. enteriditis
• ~2400 serovars
• ~1,000,000 cases/yr in USA• ~5% develop bacteremia
– Neonates
– Persons >50 yo
– Immunosuppressed
– Valvular abnormalities & grafts
• Increasing resistance to antimicrobials
Found only
In humans
Found in
many species
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Appetizers (Ahi Poke): Also Salmonella
Top News
Health Department pulls products tied
to salmonella from seaweed farm
http://www.staradvertiser.com/category/breaking-news/
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Appetizers (Oysters): Vibrio
• Vibrios– V. cholera
• V. cholera O1 (Ganges Delta)
• V. cholera O139 (New World)
– Halophilic vibrios
• V. vulnificus
• V. parahemolyticus
Increase in Vibrio parahaemolyticus
illnesses associated with consumption of
shellfish from several Atlantic coast harvest
areas, United States, 2013
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Appetizers (Chitterlings): Yersinia
• Chittlins’ are pig intestines• Chittlins’ are often served raw• Raw intestines contain feces• Feces is a good source of:
– Protein
– ID Consults
• Pigs are reservoir of Yersinia
• The Yersiniae– Y. pestis (Plague)
– Y. pseudotuberculosis
– Y. enterocolitica
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Appetizers (Cheese Tray): Listeria
• For those who don’t care for Listeria:– Salmonella
– Campylobacter
– Brucellosis
• Especially in Texas:– we have a lot of goats
– Quesa fresca is goat cheese
– Quesa fresca is “fresh” (i.e. unpasteurized)
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For the Kids (Hot Dogs): More Listeria
• Listeria monocytogenes– Grows at refrigerator temperature (40oF)
– Found in:
• Hot dogs
• Deli meat
• Soft cheeses
• Ice Cream
– High-risk groups:
• Pregnant women
• Neonates
• Elderly
• Immunocompromised
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Also for the Kids (Burgers): E. coli O157:H7
• E. coli– Commensals
– ETEC
– EAEC
– EIEC
– EHEC
• Includes O157:H7, O26:H11
• Shiga toxin-producing
• Found in intestines of cattle (& goats)
• Not found in muscle (steaks & roasts pose no risk)
• Causes Hemolytic-Uremic Syndrome
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Steak Tartare: Do as I Say…..
http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj4wsbisqLTAhWE2YMKHfDcAOEQjRwIBw&url=http://www.sergetheconcierge.com/2012/05/raw-pleasures-beef-sirloin-tartare-with-quail-eggs-from-mansion-on-turtle-creek-cookbook.html&bvm=bv.152180690,d.amc&psig=AFQjCNEPcZm1sxzx7gr3ZZI_lst05ljUxA&ust=1492205925265057
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Salads: Hepatitis A
• Additional Salad Bar Items:– Salmonella
– Shigella
– E. coli
– Cyclospora
– Noroviruses
• Extensively-handled foods• Wash it, Boil it, Peel it, or…..• Forget it• Salad items difficult to wash• Boiled salad is unpopular
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Job Security for Peds ID Docs
Day Care Centers
Petting Zoos
Salad Bars
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Morbidity & Mortality: Implicated Foods
Conclusion– salad is a great way to get sick, but if it’s mortality you’re looking
for, you need to move on to the Main Course…….
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Entrée (Turkey): Campylobacter
• For those on a Campylobacter-free diet:– Salmonella
– S. aureus
– C. perfringens
• Most common confirmed agent– ~1,000,000 cases/year in USA
– Although Norovirus is likely far more common
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Side Dishes (Stuffing): Bacillus cereus
• Cereus– Latin: ‘waxy’
– Ceres (God of Agriculture)
• Two Toxins– Emetic (ST)
– Diarrheal (LT)
• Fried Rice Syndrome– allow rice to stand out
– this avoids clumping
– fry it the next day
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Side Dishes (Gravy): C. perfringens
• Risk factors– Prepared in quantity
– Kept warm (but not hot)
• For long periods of time
• Clostridial Diseases– 1. Soft Tissue (Gangrene)
• C. perfringens
– 2. Enteric
• C. perfringens
• C. difficile
– 3. Neurologic
• C. tetani
• C. botulinum
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Vegetables (Green Beans): Botulism
• Aunt Stella cans beans• Aunt Stella doesn’t wash• But she does use good anaerobic technique• Beans sit in cellar for months• Opened at Thanksgiving• Heated thoroughly• Heat kills C. botulinum• Heat doesn’t inactivate toxin• You eat beans• You get Botulism
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Cranberries: Cyclospora?
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Beverages (Eggnog): More Salmonella
CDC estimates Salmonella causes
about 1.2 million illnesses, 23,000
hospitalizations, and 450 deaths in the
United States every year. Food is the
source for about 1 million of these
illnesses.
•Most persons infected with Salmonella
develop diarrhea, fever, and abdominal
cramps 12 to 72 hours after infection.
The illness usually lasts 4 to 7 days, and
most persons recover without treatment.
•However, in some persons, the
diarrhea may be so severe that the
patient needs to be hospitalized.
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On the Other Hand
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Dessert (Pumpkin Pie):Bringing it all Together
• Eggs– Salmonella
• Milk– Salmonella
– Campylobacter
– Yersinia
– E coli O157
• Nutmeg– Myristicin
• Cooling– Staph aureus
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I Couldn’t Eat Another Bite
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Sure You Could!
Leftovers: Staph aureus
• Turkey properly cooked• Everyone enjoys turkey• Turkey sits out all day• Everyone watches Lions lose• Cousin Eddy picks his nose• Cousin Eddy has Staph• Cousin Eddy picks at turkey• Turkey inoculated• You pick at turkey• You get Staph
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Leaving the Cooking to Someone Else:
Norovirus
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31 Major Foodborne Pathogens
Pathogens
Norovirus
Salmonella
C. perfringens
Campylobacter
S. aureus
Shigella
STEC (non-O157)
all others
Estimated Annual US Cases = 9,388,075
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CDC’s Progress Report
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Major Food-Borne Illness Syndromes
• Nausea & Vomiting within 1-6 hours– Staphylococcus aureus, Bacillus cereus
• Cramps & Diarrhea within 8-16 hours– Clostridium perfringens, Bacillus cereus
• Fever, Cramps, and Diarrhea within 16-48 hours– Salmonella, Shigella, Campylobacter, E. coli
• Cramps & Watery Diarrhea within 16-72 hours– Vibrio
• Vomiting & Non-Bloody Diarrhea within 24-48 hours– Noroviruses
• Fever & Abdominal Cramps without Diarrhea– Yersinia
• Bloody Diarrhea without Fever– E. coli O157
• Nausea, Vomiting, Diarrhea, and Paralysis– Clostridium botulinum (Botulism), Camplyobacter (Guillain-Barre)
Toxin-mediated:
rapid onset
abrupt onset
absence of fever
Bacterial & Viral:
subacute
often have fever
Special Cases
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Miscellaneous Syndromes
• Cramps within an hour– Heavy Metals
• Paraesthesias within an hour– Scombroid, PSP, NSP, Niacin, MSG?
• Paraesthesias within 1-6 hours– Ciguatera, PSP
• Mushroom Poisoning Syndromes– Amanita spp.
• Persistent Diarrhea– Cyclospora
• Systemic Invasive Illness– Listeria, Vibrio vulnificus, Toxoplasma
• Water-borne (rather than food-borne) pathogens– Giardia, Cryptosporidium
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I WILL SURVIVE(with apologies to Gloria Gaynor)
I’d listen to the news
And I’d be petrified
Another foodborne outbreak,
I’d be all torn up inside
But then I spent so many nights
Worried about what I just ate
Could I be next?
Did I have poisons on my plate?
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31
“Key recommendations”
for food safety
The 2005 USDA Dietary
Guidelines give five
“Key Recommendations”
for food safety.
Source: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm
http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm
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Clean hands,
food-contact
surfaces, fruits
and vegetables.
Recommendation 1: CLEAN
Do NOT wash or rinse meat and poultry as
this could spread bacteria to other foods.
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Avoid washing raw meat & poultry
Do NOT wash raw meat and
poultry. Washing is not necessary.
Washing increases the danger of
cross-contamination, spreading
bacteria present on the surface of
meat and poultry to ready-to-eat
foods, kitchen utensils, and
counter surfaces.
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Recommendation 2: SEPARATE
Separate raw,
cooked, and
ready-to-eat foods
while shopping,
preparing or
storing foods.
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Recommendation 3: COOK
Cook foods to a safe
temperature to kill
microorganisms.
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Temperature Rules
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Turkey
Thermy™ says: A turkey is done when the
temperature in the inner thigh reaches 180 degrees F.
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Recommendation 4: CHILL
Chill (refrigerate)
perishable foods
promptly and
defrost foods
properly.
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39
DANGER
ZONEBacteria multiply rapidly
between
40 and 140 degrees F.
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The TWO-hour rule
Refrigerate perishable foods so
TOTAL time at room temperature
is less than TWO hours or
only ONE hour when temperature
is above 90 degrees F.
Perishable foods include:
• Meat, poultry, fish, eggs, tofu
• Dairy products
• Pasta, rice, cooked vegetables
• Fresh, peeled/cut fruits and
vegetables
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The THAW LAW
• Plan ahead to defrost foods.
• The best way to thaw
perishable foods is in the
refrigerator.
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Recommendation 5: AVOID...
• Raw (unpasteurized) milk or milk products
• Raw or partially cooked eggs and foods containing raw eggs
• Raw and undercooked meat and poultry
• Unpasteurized juices
• Raw sprouts
Most at risk are infants, young children,
pregnant women, older adults and the
immunocompromised.
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Things Could Always Be Worse:Thanksgiving in Congo
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Happy Thanksgiving