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Staphylococcal Food Poisoning

Food Poisonings Staphylococcal

One of the most frequent foodborne illnesses worldwide, Staphylococcal food poisoning is a form of gastroenteritis caused by ingestion of thermostable Staphylococcus aureus enterotoxins, originating primarily from improperly handled or inadequately stored food. A majority of cases present with nausea and intense vomiting (potentially causing dehydration) along with abdominal cramps, while diarrhea may or may not be present. The diagnosis is based on clinical presentation and diet history of the patient, while laboratory confirmation is warranted only in a suspected epidemic.


Presentation

Staphylococcal food poisoning (SPF) occurs due to ingestion of food containing enterotoxins produced by Staphylococcus aureus bacteria [1] [2] [3]. The bacterial growth and subsequent toxin synthesis are favored in food cooked or stored at an inadequate temperature and increase with the time during which the food was kept tepid (between 6°C and 46°C) [4].

Following the consumption of contaminated food, the onset of SFP is rapid. Symptoms can occur as soon as 30 minutes after ingestion [5] [6], although the incubation period varies among patients as well as with the toxin exposure level, and may last for up to 8 hours [5] [7]. The most typical symptoms are nausea and profuse, vigorous vomiting. Patients also experience painful abdominal cramps. Diarrhea may be present, but the absence of this symptom does not preclude the diagnosis [4] [5] [6]. Fever is usually mild or absent [5] [6]. Additionally, patients may present with nonspecific signs and symptoms such as dizziness, shivering and general weakness or even headaches, prostration and low blood pressure, depending on illness severity [5]. Excessive vomiting can lead to different levels of dehydration in susceptible patients [6]. In spite of the rapid and severe onset most cases resolve spontaneously and without hospitalization, with the potential exception of children, elderly and patients weakened by another condition [1] [7]. A majority of patients recover after 1 to 3 days, with diarrhea and general weakness being the last symptoms to resolve [5] [6].

Hunting
  • Abstract Staphylococcal contamination of intact, hard-boiled eggs resulted in the food poisoning of an estimated 300 children out of 850 who had participated in an Easter egg hunt.[ncbi.nlm.nih.gov]
  • ., Hunt R. Staphylococcus aureus enterotoxin B challenge of monkeys: Correlation of plasma levels of arachidonic acid cascade products with occurrence of illness. Infect. Immun. 1990; 58 :3494–3499. [ PMC free article ] [ PubMed ] 84.[ncbi.nlm.nih.gov]
Sputum
  • Blood, sputum, vomitus, feces and spinal fluid Contaminated food (usually contaminated are custards, pastries, salads, ham and other foods rich in carbohydrates and protein) Medical Management: Use of Penicillin G – drug of choice; cephalosporin as substitute[nursingcrib.com]
Food Poisoning
  • Staphylococcus aureus produces a wide variety of staphylococcal enterotoxins (SEs, SEA to SEX), which are responsible for staphylococcal food poisoning.[ncbi.nlm.nih.gov]
  • The relevance of newly described enterotoxins in outbreaks of staphylococcal food poisoning is controversially discussed.[ncbi.nlm.nih.gov]
  • An integrated gene-to-protein approach for characterizing staphylococcal food poisoning is advocated. KEYWORDS: enzyme immunoassay; food poisoning; mass spectrometry; molecular tools; staphylococcal enterotoxin[ncbi.nlm.nih.gov]
  • Abstract Staphylococcus aureus coagulase type VII strains have been the strains most frequently isolated from staphylococcal food poisoning outbreaks in Tokyo, Japan.[ncbi.nlm.nih.gov]
  • Staphylococcal food poisoning (SFP) is caused by staphylococcal enterotoxins (SEs) preformed in food materials.[ncbi.nlm.nih.gov]
Vomiting
  • Excessive vomiting can lead to different levels of dehydration in susceptible patients.[symptoma.com]
  • Abstract Two waves of vomiting and/or diarrhoea affected approximately 215 of the 715 passengers on a Caribbean cruise ship. The outbreak was independently associated with eating cream-filled pastries at two separate meals.[ncbi.nlm.nih.gov]
  • A doctor may give a drug, either as an injection or as a suppository, to help control severe nausea and vomiting.[checkorphan.org]
  • The attack rate for vomiting among those who consumed more than one carton was greater (38.3%) than among those who consumed only one carton (31.5%) with the highest attack rate among those who consumed three or more cartons (44.4%).[ncbi.nlm.nih.gov]
  • Public health units should consider toxin-producing pathogens such as S. aureus when investigating outbreaks where vomiting is the predominant symptom and occurs rapidly after consuming food.[ncbi.nlm.nih.gov]
Nausea
  • A majority of cases present with nausea and intense vomiting (potentially causing dehydration) along with abdominal cramps, while diarrhea may or may not be present.[symptoma.com]
  • A doctor may give a drug, either as an injection or as a suppository, to help control severe nausea and vomiting.[checkorphan.org]
  • Of the 22 patients, 19 experienced with nausea, 17 came down with diarrhea, 17 with abdominal pain, 15 with vomiting, 13 with headaches and four with fevered chills.[foodsafetynews.com]
Diarrhea
  • Diarrhea may be present, but the absence of this symptom does not preclude the diagnosis. Fever is usually mild or absent.[symptoma.com]
  • Escherichia coli is a common cause of traveler's diarrhea and usually presents with profuse watery diarrhea.[visualdx.com]
  • Other symptoms may include abdominal cramping, diarrhea, and sometimes headache and fever. Severe fluid and electrolyte loss may cause weakness and very low blood pressure (shock).[checkorphan.org]
  • HPI Symptoms develop 1-6 hrs, sometimes within 30 min Food causing illness not smell bad/spoiled but can produce Enterotoxin Suggest foodborne outbreak Other symptoms Prolonged diarrhea Bloody diarrhea Neurologic symptoms 16.[slideshare.net]
Abdominal Cramps
  • A majority of cases present with nausea and intense vomiting (potentially causing dehydration) along with abdominal cramps, while diarrhea may or may not be present.[symptoma.com]
  • Other symptoms may include abdominal cramping, diarrhea, and sometimes headache and fever. Severe fluid and electrolyte loss may cause weakness and very low blood pressure (shock).[checkorphan.org]
  • Symptoms included vomiting (86%), abdominal cramps (86%), nausea (79%), diarrhea (69%), dizziness or weakness (69%), and fever (14%). The incubation period was 2H-5 hours (mean 3T hours).[cdc.gov]
  • The symptoms of SFP are abdominal cramps, nausea, vomiting, sometimes followed by diarrhea (never diarrhea alone). The onset of symptoms is rapid (from 30 min to 8 h), and usually a spontaneous remission is observed after 24 h [ 1 ].[link.springer.com]
  • Physical Findings: diarrhea abdominal cramping excessive salivation nausea Diagnosis: Physical examination according to presenting signs ans symptoms. Short incubation time characteristic of intoxication.[nursingcrib.com]
Decreased Skin Turgor
  • Physical Assess for dehydration or Hypovolemia Thirst Weight loss Dry mucous membrane Sunken eyes Decreased skin turgor Hypotension Tachycardia 17. Diagnosis Clinical evaluation Laboratory evaluation 18.[slideshare.net]
Suggestibility
  • These results suggest that coa310 is a novel variant of SCT XI. Moreover, we demonstrated that coa310 encodes a functioning coagulase, by confirming the coagulating activity of the recombinant protein expressed from coa310.[ncbi.nlm.nih.gov]
  • The patients' symptoms and culture of snoek samples suggested Staphylococcus aureus as the causative agent.[ncbi.nlm.nih.gov]
  • The case-control study strongly suggested pasta salad with pesto as the vehicle of infection (p 0.001), but this food item could not be tested, because there were no leftovers.[ncbi.nlm.nih.gov]
  • In this study, we provide further evidence suggesting that one of these enterotoxins or a combination of SEG, SEI, SEM, SEN, and SEO cause staphylococcal food poisoning.[ncbi.nlm.nih.gov]
  • Investigations suggested that absence of hand washing and other unhygienic food handling at the implicated restaurant was the likely cause of this outbreak.[ncbi.nlm.nih.gov]
Fear
  • […] the fast food, bad mood,careless i dnt matter if those burgers stay pink inside serving up a storm wit coliform 0157's deadly if it dont get warm microbes tey might kill u x2 sing it microbes tey might kill u x2 we always the targets we evoke lots of fear[slideshare.net]
  • By JEN GUNTER Photo Credit iStock Doctors Treating a Patient With a Nightmarish Condition She had lost all of her skin and I feared I had helped make her last weeks an unrelenting horror show, until our chance reunion. By ALESSANDRA COLAIANNI, M.D.[nytimes.com]
Anuria
  • Symptoms appeared just before landing, about an hour after a meal containing contaminated ham had been served. 143 passengers were admitted to hospital. 1 patient developed acute anuria and 1 had hemiplegia and aphasia; both recovered.[ncbi.nlm.nih.gov]
Aphasia
  • Symptoms appeared just before landing, about an hour after a meal containing contaminated ham had been served. 143 passengers were admitted to hospital. 1 patient developed acute anuria and 1 had hemiplegia and aphasia; both recovered.[ncbi.nlm.nih.gov]

Workup

Clinical presentation and patient history are the starting point of establishing a diagnosis of SFP poisoning. In addition to gastrointestinal symptoms (with special attention to characteristic "projectile" vomiting), the short incubation period can be indicative of SFP. In such cases, anamnesis should include detailed food history.

Food history

Staphylococcal contamination of food originates from several sources, but the common denominator usually is and inadequate temperature of storing the food at some stage. Hence, the pre-cooked food is most frequently associated with SFP. Enterotoxins have been shown to develop in sandwiches, salads, cream-filled desserts, and pastries, as well as egg, dairy, meat (especially poultry) products, and processed meats such as ham [8].

Laboratory diagnostic

Given the short duration and spontaneous recovery of patients, laboratory diagnostics is usually not performed in isolated cases. However, in case, of a suspected epidemic (especially common-source outbreak), laboratory findings are used to confirm the diagnosis [6]. Two approaches can be applied: isolating the bacteria from suitable samples or detecting one of the staphylococcal enterotoxins in suspected food samples [5] [6] [9].

The sources of contamination vary from colonized persons handling the food to unsanitary surfaces or environment and even raw materials (especially milk) used to produce the food [1] [5]. Hence, environmental swabs (including hand and nasal cavities swabs) make a good sample for isolation of Staphylococcus aureus [6]. In addition, food samples and biological material obtained from the patients (stool samples) are used for isolation [6] [10]. However, the bacteria can remain undetected by this method if the food was cooked after the toxin was produced [7]. Due to the thermostability of staphylococcal enterotoxins, they will be present in the food even after high temperature has destroyed the causative agent.

For detection of enterotoxins in contaminated food, immunoassays, bioassays and methods of molecular biology are used [5] [11].

Treatment

  • Egg And Poultry Products Meats Macaroni Potato Chicken Tuna Cream Pies Cream-Filled Pastries Chocolate Eclairs Milk And Dairy Products Sandwich Fillings Custards Topped Desserts Staphylococcal Food Poisoning Treatment staphylococcal food poisoning treatment[howlongdoesfoodpoisoninglast.net]
  • At least four patients were admitted to the hospital and received inpatient treatment, among them a 2-year-old child and a woman in the 4th month of pregnancy.[ncbi.nlm.nih.gov]
  • Treatment - Staphylococcal food poisoning Treatment usually consists of only drinking an adequate amount of fluids. A doctor may give a drug, either as an injection or as a suppository, to help control severe nausea and vomiting.[checkorphan.org]
  • Disabilities Services Services Birth & Marriage Certificates Child Care Child Protection Denali KidCare Food Stamps Immunization Information Medicaid Public Health Centers Temporary "Cash" Assistance Senior Benefits Program Medicare Substance Abuse Treatment[epi.alaska.gov]
  • Treatment usually involves drinking plenty of fluids. The staphylococci bacteria grow in food, in which they produce toxins.[merckmanuals.com]

Prognosis

  • PROGNOSIS • Symptoms may start up to 6 hours and may last up to 3 days. • It may severe in small percentage of patient with low immunity system. 21.  Wash hands and under fingernails with soap and water before handling and preparing food.  Do not prepare[slideshare.net]
  • Prognosis - Staphylococcal food poisoning Not supplied. Treatment - Staphylococcal food poisoning Treatment usually consists of only drinking an adequate amount of fluids.[checkorphan.org]

Etiology

  • (The etiologic agent of the ninth outbreak was unknown.) The effect of USDA intervention cannot be assessed, since production of the specialty ham product was discontinued after investigation of these outbreaks.[cdc.gov]

Epidemiology

  • Staphylocoagulase, an extracellular protein secreted by Staphylococcus aureus, has been used as an epidemiological marker. At least 12 serotypes and 24 genotypes subdivided on the basis of nucleotide sequence have been reported to date.[ncbi.nlm.nih.gov]
  • This study underlines the importance of both laboratory evidence and epidemiological data for outbreak investigation.[ncbi.nlm.nih.gov]
  • A combination of coagulase typing and PFGE typing would provide more detailed information than the former method alone in epidemiologic investigations of staphylococcal food poisoning.[ncbi.nlm.nih.gov]
  • AIMS: To investigate the molecular epidemiological study of Staphylococcus aureus from staphylococcal food poisoning (SFP) incidents in South Korea.[ncbi.nlm.nih.gov]
  • RESULTS: Epidemiological investigations linked the outbreak to a restaurant in the Gold Coast where the suspected food was produced.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Intoxication occurs in one to six hours or days Pathophysiology: Once the toxin has been ingested, it quickly triggers the brain’s vomiting reflex center; abdominal crapms and usually diarrhea then happens.[nursingcrib.com]
  • […] but they may cause significant morbidity. [1, 2] SEB is the toxin most commonly associated with classic food poisoning. [3, 4] It has also been demonstrated to cause a nonmenstrual toxic shock syndrome (TSS). [5] Researchers have implicated SEB in the pathophysiology[emedicine.medscape.com]

Prevention

  • This is the first large outbreak of its type; safeguards can and should be employed to prevent future ones.[ncbi.nlm.nih.gov]
  • Centers for Disease Control and Prevention.[foodsafetynews.com]
  • Staphylococcal Food Poisoning Prevention I think this will be the most important part of the article. The steps which can by which prevent Staphylococcal Food Poisoning.[howlongdoesfoodpoisoninglast.net]
  • Prevention - Staphylococcal food poisoning Careful food preparation can prevent staphylococcal food poisoning. Anyone who has a skin infection should not prepare food for others until the infection heals.[checkorphan.org]

References

Article

  1. Argudín M, Mendoza M, Rodicio M. Food Poisoning and Staphylococcus aureus Enterotoxins. Toxins. 2010;2(7):1751-1773.
  2. Dinges M, Orwin P, Schlievert P. Exotoxins of Staphylococcus aureus. Clinical Microbiology Reviews. 2000;13(1):16-34.
  3. Le Loir Y, Baron F, Gautier M. Staphylococcus aureus and food poisoning. Genetics and Molecular Research. 2003;2:63–76
  4. Bennett S, Walsh K, Gould L. Foodborne Disease Outbreaks Caused by Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus--United States, 1998-2008. Clinical Infectious Diseases. 2013;57(3):425-433.
  5. Hennekinne J, De Buyser M, Dragacci S. Staphylococcus aureus and its food poisoning toxins: characterization and outbreak investigation. FEMS Microbiology Reviews. 2012;36(4):815-836.
  6. Fletcher S, Boonwaat L, Moore T, et al. Investigating an outbreak of staphylococcal food poisoning among travellers across two Australian states. Western Pacific Surveillance and Response Journal. 2015;6(2):17-21.
  7. Murray R. Recognition and management of Staphylococcus aureus toxin-mediated disease. Internal Medicine Journal. 2005;35 (s2):S106-S119.
  8. Wieneke A, Roberts D, Gilbert R. Staphylococcal food poisoning in the United Kingdom, 1969–90. Epidemiology and Infection. 1993;110(03):519-531.
  9. Ostyn A, de Buyser ML, Guillier F et al. First evidence of a food poisoning outbreak due to staphylococcal enterotoxin type E, France, 2009. Euro Surveillance. 2010;15(13)
  10. Food Standards Australia New Zealand. Guidelines For Microbiological Examination Of Ready-To-Eat Foods.. Canberra: Food Standards Australia New Zealand (FSANZ); 2001.
  11. Mclauchlin J, Narayanan GL, Mithani V, O'Neill G.The Detection of Enterotoxins and Toxic Shock Syndrome Toxin Genes in Staphylococcus aureus by Polymerase Chain Reaction. 2000;63(4):479–488

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Last updated: 2019-06-28 09:48