Hygiene can prevent major outbreak of food poisoning:

Thought for food

by Sajitha PREMATUNGE

Food poisoning has become a major health hazard as of late. Mass cooked food spoils fast leading to food poisoning cases by the hundreds. This is most acute especially during hot days. Healthwise spoke to Dr. Karven J. Cooray, Consultant Microbiologist, MRI on food poisoning and how to prevent it.

Food poisoning occurs due to the ingestion of food contaminated by bacteria, bacterial toxins and natural poisons or harmful chemicals.

The Most common bacterial food borne pathogens include Salmonella, Staphylococcus aureus, Clostridium perfringens, Bacillus cereus and Shigella. The recent death in Matale was caused by Shigella food poisoning.

"Signs and symptoms, the type of food and mean incubation period - the time of ingestion to appearance of signs and symptoms - can provide clues as to which of these agents caused a particular type of food poisoning" said Dr. Karven J. Cooray.

Type of food

Food type can provide vital clues to reach a correct diagnosis of the type of food poisoning. "For example Vibrio parhemolyticus food poisoning can be caused by ingestion of raw fish, Staphylococcus aureus by cream bun, Bacillus cereus through fried rice and Salmonella through raw meat."

Salmonella can be found in eggs, poultry, meat and meat products and can survive for long periods in food. Clostridium perfringens can be found mostly in dairy products, pasta, flour, poultry and vegetables. Food poisoning caused by this agent is mild and large numbers of cells have to be ingested to cause illness.

Signs and symptoms

Signs and symptoms can also shed light on the condition patients could be suffering from. "There are two types of bacterial food poisoning" explained Dr. Cooray. "Toxine mediated food poisoning - which occur due to toxins produced by bacteria - and food poisoning caused by the multiplication of bacteria. Bacteria in large amounts can make you sick."

Signs and symptoms can differ according to the type of food poisoning. "Severe vomiting in many patients at once is an indicator of Staphylococcus aureus food poisoning, whereas no vomiting, no fever but slight abdominal pain in patients suggests Clostridium perfringens food poisoning"

The Symptoms of toxin mediated Staphylococcus aureus food poisoning such as severe vomiting, abdominal pain and diarrhoea, occur during one to six hours of ingestion. In toxin mediated Clostridium perfringens food poisoning abdominal pain, diarrhoea and nausea sets in within 10 to 12 hours of ingestion.

Nausea and vomiting occur during one to three hours of ingestion in case of toxin mediated Bacillus cereus Emetic type. The Bacillus cereus diarrhoea type display abdominal pain, diarrhoea, nausea and vomiting.

Symptoms of multiplication type Salmonella food poisoning such as abdominal pain, diarrhoea, nausea, vomiting and fever set in within 12 to 36 hours.

In Vibrio parhemolyticus watery diarrhoea and bleeding can occur within 12 to 24 hours. Symptoms of Clostridium botulinum such as ptosis (drooping of the upper eyelid), weakness, dryness of mouth and even paralysis can occur within 12 to 36 hours.

Incubation period

As Dr. Cooray explained that the incubation period can also be taken into consideration when making a diagnosis as to what type of food poisoning is concerned. If the incubation period is less than 30 minutes, it is likely to be a case of chemical poisoning. "Chemical poisoning can be either intentional or due to a chemical reaction between food and food containers" explained Dr. Cooray. If the incubation period is 30 minutes to six hours it is likely toxin mediated food poisoning and symptoms of food poisoning due to the multiplication of bacterial cells which usually occur from six to 48 hours.

Prevention

As the saying goes prevention is better than cure. "Although there is always a possibility of getting food poisoning, several precautionary measures could limit the susceptibility" said Dr. Cooray.

* Avoid as much as possible from drinking unpasteurised milk or products that contain unpasteurised milk

* Wash raw fruits and vegetables thoroughly before eating

* Keep the refrigerator temperature at 40 F (4.4 C) or lower; the freezer temperature at 0 F (- 17.8 C) or less

* Use precooked, perishable or ready-to-eat food as soon as possible

* Keep raw meat, fish and poultry separate from other food

* Wash hands, knives and cutting boards after handling uncooked food, especially raw meat, fish and poultry

* Cook raw fish thoroughly and meat to a safe internal temperature

Patients should seek immediate medical attention in cases when clear signs of indigestion such as severe vomiting, fever and abdominal pain is displayed.

According to Dr. Cooray a major problem in dealing with food poisoning crises is delays in notification.

"By the time food poisoning cases are reported food samples are unavailable for analysis."

But he also reiterated the fact that, in spite of the common belief that food samples are the most important, in cracking a case of food poisoning patient samples can be more helpful.

Look out for water borne diseases

Water borne diseases viral diarrhoea, dysentery, typhoid and viral hepatitis maybe on the rise these days. Some water borne diseases such as dysentery and typhoid are caused by bacteria, while others such as viral diarrhoea and viral hepatitis are caused by viruses.

According to Dr. Paba Palihawadana, Director Epidemiology Unit, Ministry of Health these diseases show the same symptoms as food poisoning. "The most common type of water borne disease that the public should look out for these days is viral diarrhoea" said Dr. Palihawadana.

Viral diarrhoea symptoms include loose motion, fever and abdominal pain. "If the illness progresses patients may also experience vomiting" said Dr. Palihawadana.

Viral diarrhoea usually settles on its own, "but vaccines are available for the type of diarrhoea caused by the Rota virus." Dr. Palihawadana advises that patients should take in fluids - such as jeevani, lime juice and kanji - as much as possible to prevent dehydration, take easily digestible food without fibre and paracetamol for fever.

"The public should be especially wary of dysentery and typhoid since they can be fatal if misdiagnosed" said Dr. Palihawadana and warned that patients with these symptoms should seek immediate medical advice. Symptoms of dysentery include passing of blood and mucus mixed with stools, abdominal pain and fever. Patients with dysentery are given antibiotics and are advised to take in a lot of fluids."The frontal headache is a distinct symptom indicative of typhoid" explained Dr. Palihawadana. Intermittent fever, loss of appetite and abdominal pain. "Patients with typhoid are given antibiotics."

The defining symptom of viral hepatitis is a yellowish discolouration of the eyes and skin. In addition loss of appetite, fever, vomitting and nausea can also be observed. According to Dr. Palihawadana the risk of contracting viral hepatitis is its effect on the liver. "It causes enlargement of liver" said Dr. Palihawadana and advised a lot of bed rest and a digestible diet.

"Vaccines are available for diarrhoea caused by the Rota virus, typhoid as well as viral hepatitis", said Dr. Palihawadana.

To prevent from contracting not only water borne diseases, but also food poisoning Dr. Palihawadana suggested drinking boiled water, eating properly cooked food, proper use of toilet and washing hands regularly. "Food should be uncontaminated", explained Dr. Palihawadana. Food should be covered at all times to keep away from flies. "Do not buy food that have been exposed for long periods of time", warned Dr. Palihawadana. Fruits and vegetables should be thoroughly washed before use.

-SP

Health News

Gene test 'could prevent ineffective use of Taxol in breast cancer'

by Mark Henderson

A genetic signature that can determine whether breast cancer is likely to respond to a common treatment has been identified, promising more personalised care for patients.

The advance by British scientists could allow doctors to predict which types of chemotherapy were most likely to benefit patients, sparing them toxic and gruelling drug regimes that were unlikely to work.

The study, led by a team at Cancer Research UK's London Research Institute, found that measuring the activity of six particular genes could forecast whether a breast tumour was sensitive to paclitaxel (Taxol), a chemotherapy agent. Paclitaxel is commonly given to patients with breast cancer to shrink their tumours before surgery.

About 15 per cent of such patients receive the drug. It is not always effective and has serious side-effects that include nerve pain, hair loss and a weakened immune system.

If the technique is validated in clinical studies, it could identify that up to half of patients who would currently get the drug are unlikely to benefit.

"A great challenge in cancer medicine is determining which patients will benefit from particular drugs and it is hoped this research is a step towards more rapid developments in personalised medicine," said Charles Swanton, who led the study, which was published in the journal Lancet Oncology.

The findings are the latest to move cancer care towards a new era of personalised therapy, in which the genetic characteristics of patients' tumours are used to select the treatment strategy that is most likely to work.

Several similar DNA tests are already available that determine whether a cancer treatment will work.

Bowel cancer patients, for example, do not benefit from a drug called cetuximab (Erbitux) if their tumours carry mutations in a gene called KRAS.

An international consortium recently began a £600 million project to find all the mutations that drive 50 forms of cancer, to reveal clues to the best approaches to treatment.

The new findings emerged from a study of 829 genes, which the scientists inactivated one by one in breast cancer cells to see whether they had any effect on susceptibility to paclitaxel.

Further studies in patients will be needed to confirm the accuracy of tests based on the technique, and it will be at least three years before it is ready for clinical use, Dr Swanton said.

He added that further research will also be needed to identify suitable alternative treatment for patients whose tumours are not susceptible to paclitaxel.Dr Swanton said: "These could include treatment that is currently deemed too expensive to fund on the NHS - however, in the future, treating only the patients that will benefit from certain treatments will save the NHS money in the long term.

"By identifying which patients do not respond well to certain treatment, doctors are able to consider alternative therapies, within clinical trials, aimed at treating individual patients more effectively."

Timesonline.co.uk

Gut bacteria may be contributing to obesity

By Drucilla DYESS

Certain types of bacteria that naturally reside in the intestine may be causing an increased appetite that promotes obesity as well as other unhealthy symptoms linked to being overweight.

According to a report recently published in the journal Science, certain types of bacteria in the gut cause inflammation that can affect appetite and also lead to inflammatory bowel conditions such as colitis and Crohn's disease.

Senior study author Andrew Gewirtz, an associate professor of pathology and laboratory medicine at Emory University School of Medicine in Atlanta, explained, "Previous research has suggested that bacteria can influence how well energy is absorbed from food, but these findings demonstrate that intestinal bacteria can actually influence appetite." Generally speaking, these germs in the gut make you overeat.

The chance discovery was made by Gewirtz and his research team while conducting a study on mice having colitis to substantiate a suspicion that the colitis is caused by a type of germ. Bacteria and other micro-organisms have been found to settle into baby mice closely following birth, which endure in both the skin and bowels throughout their lifetime. Because these organisms are very similar to those found in their own mothers, the researchers transferred mice embryos to surrogate mothers to prevent possible infection by the biological mothers.

Although the babies of the surrogate mothers showed improvement in the colitis, they grew to be obese and developed a group of symptoms collectively known as metabolic syndrome that are often a precursor of heart disease and diabetes. These symptoms include harmful cholesterol levels, too much belly fat, high blood pressure, and insulin resistance, a condition in which the body is unable to effectively to break down food.

Regarding the findings, Gewirtz said, "It has been assumed that the obesity epidemic in the developed world is driven by an increasingly sedentary lifestyle and the abundance of low-cost, high-calorie foods.

However, our results suggest that excess caloric consumption is not only a result of undisciplined eating but that intestinal bacteria contribute to changes in appetite and metabolism." He also pointed out that the research suggests that the bacteria may be flourishing due to factors of modern life such as access to clean water, and the use of antibiotics which has caused competing organisms to be totally eliminated.

Previous studies have shown that people of normal weight and people who are obese have different types and amounts of microbes that naturally live in the intestine. However Gewirtz and his colleagues found that both increased appetite and insulin resistance can be transferred from one mouse to another through intestinal bacteria.

He said the findings suggest "that it's possible to inherit metabolic syndrome through the environment, rather than genetically. He also asked and answered, "Do obese children get that way because of bad parenting? Maybe bacteria that increase appetite are playing a part." Gewirtz's team is currently working to identify the culprit micro-organisms.

In addition, they are looking to determine whether or not obese people have unique patterns of gut bacteria. A gene called toll-like receptor 5 (TLR5) is known to play an important role in controlling intestinal bacteria. The researchers plan to investigate variations of TLR5 among humans, as well as to determine what impact bacteria in TLR5-deficient mice may have on appetite and metabolism.

As for what measures can be taken to improve the health of the mice, Gewirtz said, "If we limit their food intake they are mostly Okay.

They certainly are no longer obese. They are, however, insulin-resistant." Eating a healthy diet and receiving extended periods of antibiotic therapy are two key factors that have helped to decrease the weight of the obese mice in the study.

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