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Food safety
Food Safety 1.svg
Terms
Foodborne illness
HACCP
Critical control point
Critical factors
FAT TOM
pH
Water activity (Wa)
Pathogens
Clostridium botulinum
E. coli
Hepatitis A
Norovirus
Parasitic infections
Blastocystis
Cryptosporidiosis
Trichinosis

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning[1] ) is any illness resulting from the consumption of contaminated food.

There are two types of food poisoning: food infection and food intoxication. Food infection refers to the presence of bacteria or other microbes which infect the body after consumption. Food intoxication refers to the ingestion of toxins contained within the food, including bacterially produced exotoxins, which can happen even when the microbe that produced the toxin is no longer present or able to cause infection. In spite of the common term food poisoning, most cases are caused by a variety of pathogenic bacteria, viruses, prions or parasites that contaminate food,[2] rather than chemical or natural toxins.

Contents

Causes

Badly stored food in a refrigerator

Foodborne illness usually arises from improper handling, preparation, or food storage. Good hygiene practices before, during, and after food preparation can reduce the chances of contracting an illness. There is a general consensus in the public health community that regular hand-washing is one of the most effective defenses against the spread of foodborne illness. The action of monitoring food to ensure that it will not cause foodborne illness is known as food safety. Foodborne disease can also be caused by a large variety of toxins that affect the environment. For foodborne illness caused by chemicals, see Food contaminants.

Foodborne illness can also be caused by pesticides or medicines in food and naturally toxic substances like poisonous mushrooms or reef fish.

Symptoms and mortality

Symptoms typically begin several hours to several days after consumption and depending on the agent involved, can include one or more of the following: nausea, abdominal pain, vomiting, diarrhea, gastroenteritis, fever, headache or fatigue.

In most cases the body is able to permanently recover after a short period of acute discomfort and illness. However, foodborne illness can result in permanent health problems or even death, especially for people at high risk, including babies, young children, pregnant women (and their fetuses), elderly people, sick people and others with weak immune systems.

Foodborne illness due to campylobacter, yersinia, salmonella or shigella infection is a major cause of reactive arthritis, which typically occurs 1–3 weeks after diarrheal illness. Similarly, people with liver disease are especially susceptible to infections from Vibrio vulnificus, which can be found in oysters or crabs.

Tetrodotoxin poisoning from reef fish and other animals manifests rapidly as numbness and shortness of breath, and is often fatal.

Incubation period

The delay between consumption of a contaminated food and appearance of the first symptoms of illness is called the incubation period. This ranges from hours to days (and rarely months or even years, such as in the case of Listeriosis or Creutzfeldt-Jacob disease), depending on the agent, and on how much was consumed. If symptoms occur within 1–6 hours after eating the food, it suggests that it is caused by a bacterial toxin or a chemical rather than live bacteria.

The long incubation period of many foodborne illnesses tends to cause sufferers to attribute their symptoms to "stomach flu".

During the incubation period, microbes pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and begin to multiply there. Some types of microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream, and some can directly invade the deeper body tissues. The symptoms produced depend on the type of microbe.[3]

Infectious dose

The infectious dose is the amount of agent that must be consumed to give rise to symptoms of foodborne illness, and varies according to the agent and the consumer's age and overall health. In the case of Salmonella a relatively large inoculum of 1 million to 1 billion organisms is necessary to produce symptoms in healthy human volunteers[1], as Salmonellae are very sensitive to acid. An unusually high stomach pH level (low acidity) greatly reduces the number of bacteria required to cause symptoms by a factor of between 10 and 100.

Pathogenic agents

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Bacteria

Bacteria are a common cause of foodborne illness. In the United Kingdom during 2000 the individual bacteria involved were as follows: Campylobacter jejuni 77.3%, Salmonella 20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.1%.[4] In the past, bacterial infections were thought to be more prevalent because few places had the capability to test for norovirus and no active surveillance was being done for this particular agent. Symptoms for bacterial infections are delayed because the bacteria need time to multiply. They are usually not seen until 12–72 hours or more after eating contaminated food.

Most common bacterial foodborne pathogens are:

Other common bacterial foodborne pathogens are:

Salmonella

Less common bacterial agents:

Exotoxins

In addition to disease caused by direct bacterial infection, some foodborne illnesses are caused by exotoxins which are excreted by the cell as the bacterium grows. Exotoxins can produce illness even when the microbes that produced them have been killed. Symptoms typically appear after 1–6 hours depending on the amount of toxin ingested.

For example Staphylococcus aureus produces a toxin that causes intense vomiting. The rare but potentially deadly disease botulism occurs when the anaerobic bacterium Clostridium botulinum grows in improperly canned low-acid foods and produces botulin, a powerful paralytic toxin.

Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some other bacteria, produce the lethal tetrodotoxin, which is present in the tissues of some living animal species rather than being a product of decomposition.

Mycotoxins and alimentary mycotoxicoses

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins through food consumption. Mycotoxins have prominently affected on human and animal health such as an outbreak which occurred in the UK in 1960 that caused the death of 100,000 turkeys which had consumed aflatoxin-contaminated peanut meal and the death of 5000 human lives by Alimentary toxic aleukia (ALA) in the USSR in World War II[10]. The common foodborne Mycotoxins include

  • Aflatoxins - originated from Aspergillus parasiticus and Aspergillus flavus. They are frequently found in tree nuts, peanuts, maize, sorghum and other oilseeds, including corn and cottonseeds. The pronounced forms of Aflatoxins are those of B1, B2, G1, and G2, amongst which Aflatoxin B1 predominantly targets the liver, which will result in necrosis, cirrhosis, and carcinoma [11], [12]. In the US, the acceptable level of total aflatoxins in foods is less than 20 μg/kg, except for Aflatoxin M1 in milk, which should be less than 0.5 μg/kg [13]. The official document can be found at FDA's website [14], [15].
  • Altertoxins - are those of Alternariol (AOH), Alternariol methyl ether (AME), Altenuene (ALT), Altertoxin-1 (ATX-1), Tenuazonic acid (TeA) and Radicinin (RAD), originated from Alternaria spp. Some of the toxins can be present in sorghum, ragi, wheat and tomatoes [16], [17], [18]. Some research has shown that the toxins can be easily cross-contaminated between grain commodities, suggesting that manufacturing and storage of grain commodities is a critical practice [19].
  • Citrinin -
  • Citreoviridin -
  • Cyclopiazonic acid -
  • Cytochalasins
  • Ergot alkaloids / Ergopeptine alkaloids - Ergotamine
  • Fumonisins - Crop corn can be easily contaminated by the fungi Fusarium moniliforme, and its Fumonisin B1 will cause Leukoencephalomalacia (LEM) in horses, Pulmonary edema syndrome (PES) in pigs, liver cancer in rats and Esophageal cancer in humans [20], [21]. For human and animal health, both the FDA and the EC have regulated the content levels of toxins in food and animal feed [22], [23].
  • Fusaric acid -
  • Fusarochromanone -
  • Kojic acid -
  • Lolitrem alkaloids -
  • Moniliformin -
  • 3-Nitropropionic acid -
  • Nivalenol -
  • Ochratoxins - In Australia, The Limit of Reporting (LOR) level for Ochratoxin A (OTA) analyses in 20th Australian Total Diet Survey was 1 µg/kg [24], whereas the EC restricts the content of OTA to 5 µg/kg in cereal commodities, 3 µg/kg in processed products and 10 µg/kg in dried vine fruits [25].
  • Oosporeine -
  • Patulin - Currently, this toxin has been advisably regulated on fruit products. The EC and the FDA have limited it to under 50 µg/kg for fruit juice and fruit nectar, while limits of 25 µg/kg for solid-contained fruit products and 10 µg/kg for baby foods were specified by the EC [25], [26]
  • Phomopsins -
  • Sporidesmin A -
  • Sterigmatocystin -
  • Tremorgenic mycotoxins - Five of them have been reported to be associated with molds found in fermented meats. These are Fumitremorgen B, Paxilline, Penitrem A, Verrucosidin, and Verruculogen [27].
  • Trichothecenes - sourced from Cephalosporium, Fusarium, Myrothecium, Stachybotrys and Trichoderma. The toxins are usually found in molded maize, wheat, corn, peanuts and rice, or animal feed of hay and straw [28], [29]. Four trichothecenes, T-2 toxin, HT-2 toxin, diacetoxyscirpenol (DAS) and deoxynivalenol (DON) have been most commonly encountered by humans and animals. The consequences of oral intake of, or dermal exposure to, the toxins will result in Alimentary toxic aleukia, neutropenia, aplastic anemia, thrombocytopenia and/or skin irritation [30], [31], [32]. In 1993, the FDA issued a document for the content limits of DON in food and animal feed at an advisory level [33]. In 2003, US published a patent that is very promising for farmers to produce a trichothecene-resistant crop [34].
  • Zearalenone -
  • Zearalenols -

Emerging foodborne pathogens

Many foodborne illnesses remain poorly understood. Approximately sixty percent of outbreaks are caused by unknown sources.[citation needed]

Preventing bacterial food poisoning

Proper storage and refrigeration of food help in the prevention of food poisoning

Prevention is mainly the role of the state, through the definition of strict rules of hygiene and a public services of veterinary surveying of animal products in the food chain, from farming to the transformation industry and delivery (shops and restaurants). This regulation includes:

  • traceability: in a final product, it must be possible to know the origin of the ingredients (originating farm, identification of the harvesting or of the animal) and where and when it was processed; the origin of the illness can thus be tracked and solved (and possibly penalized), and the final products can be removed from the sale if a problem is detected;
  • enforcement of hygiene procedures like HACCP and the "cold chain";
  • power of control and of law enforcement of veterinarians.

In August 2006, the United States Food and Drug Administration approved Phage therapy which involves spraying meat with viruses that infect bacteria, and thus preventing infection. This has raised concerns, because without mandatory labelling consumers wouldn't be aware that meat and poultry products have been treated with the spray. [2]

At home, prevention mainly consists of good food safety practices. Many forms of bacterial poisoning can be prevented even if food is contaminated by cooking it sufficiently, and either eating it quickly or refrigerating it effectively[citation needed]. Many toxins, however, are not destroyed by heat treatment.

Viruses

Viral infections make up perhaps one third of cases of food poisoning in developed countries. In the US, more than 50% of cases are viral and noroviruses are the most common foodborne illness, causing 57% of outbreaks in 2004. Foodborne viral infection are usually of intermediate (1–3 days) incubation period, causing illnesses which are self-limited in otherwise healthy individuals, and are similar to the bacterial forms described above.

Rotavirus
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines, into the liver. It often induces jaundice, or yellowing of the skin, and rarely leads to chronic liver dysfunction. The virus has been found to cause the infection due to the consumption of fresh-cut produce which has fecal contamination [35], [36].
  • Hepatitis E
  • Norovirus
  • Rotavirus

Parasites

Most foodborne parasites are zoonoses.

Platyhelminthes:

The scolex of Tenia solium

See also: Tapeworm and Flatworm

Nematode:

Protozoa:

Giardia lamblia

Natural toxins

Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants in particular may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal, but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

Some plants contain substances which are toxic in large doses, but have therapeutic properties in appropriate dosages.

Other pathogenic agents

"Ptomaine poisoning"

An early theory on the causes of food poisoning involved ptomaines (from Greek ptōma, "fall, fallen body, corpse"), alkaloids found in decaying animal and vegetable matter. While some alkaloids do cause poisoning, the discovery of bacteria left the ptomaine theory obsolete and the word ptomaine is no longer used scientifically.

Global Impact

In modern times, rapid globalization of food production and trade has increased the potential likelihood of food contamination. Many outbreaks of foodborne diseases that were once contained within a small community may now take place on global dimensions. Food safety authorities all over the world have acknowledged that ensuring food safety must not only be tackled at the national level but also through closer linkages among food safety authorities at the international level. This is important for exchanging routine information on food safety issues and to have rapid access to information in case of food safety emergencies."

It is difficult to estimate the global incidence of foodborne disease, but it has been reported that in the year 2000 about 2.1 million people died from diarrhoeal diseases. Many of these cases have been attributed to contamination of food and drinking water. Additionally, diarrhoea is a major cause of malnutrition in infants and young children.

Even in industrialized countries, up to 30% of the population of people have been reported to suffer from foodborne diseases every year. In the U.S, around 76 million cases of foodborne diseases, which resulted in 325,000 hospitalizations and 5,000 deaths, are estimated to occur each year. Developing countries in particular, are worst affected by foodborne illnesses due to the presence of a wide range of diseases, including those caused by parasites. Foodborne illnesses can and did inflict serious and extensive harm on society. In 1994, an outbreak of salmonellosis due to contaminated ice cream occurred in the USA, affecting an estimated 224,000 persons. In 1988, an outbreak of hepatitis A, resulting from the consumption of contaminated clams, affected some 300,000 individuals in China.

Food contamination creates an enormous social and economic strain on societies. In the U.S., diseases caused by the major pathogens alone are estimated to cost up to US $35 billion annually (1997) in medical costs and lost productivity. The re-emergence of cholera in Peru in 1991 resulted in the loss of US $500 million in fish and fishery product exports that year.

Statistics

Every year there are an estimated 76 million foodborne illnesses in the United States (26,000 cases for 100,000 inhabitants), 2 million in the United Kingdom (3,400 cases for 100,000 inhabitants) and 750,000 in France (1,210 cases for 100,000 inhabitants).

United States

In the United States, using FoodNet data from 1996-1998, the CDCP estimated there were 76 million foodborne illnesses (26,000 cases for 100,000 inhabitants):[37]

  • 325,000 were hospitalized (111 per 100,000 inhabitants);
  • 5,000 people died (1.7 per 100,000 inhabitants.).
  • Major pathogens from foodborne illness in the United States cost upwards of US $35 billion in medical costs and lost productivity (1997)
Causes of foodborne illness in U. S.[37]
Cause Annual cases Rate
(per 100,000 inhabitants)
1 Norwalk-like viruses 20,000 cases 7.3
2 Salmonella 15608 cases 5.7
3 Campylobacter 10539 cases 3.9
4 Toxoplasma gondii 2500 cases 0.9
5 Listeria monocytogenes 2298 cases 0.8
Total 60854 cases 22.3
Causes of death by foodborne illness in U. S.[37]
Cause Annual deaths Rate
(per 100,000 inhabitants)
1 Salmonella 553 cases
2 Listeria 499 cases
3 toxoplasma 374 cases
4 Norwalk-like viruses 124 cases
5 Campylobacter 99 cases
Gastrointestinal illness, unknown eitiology 5100 cases 1.9

France

In France, for 750,000 cases(1,210 per 100,000 inhabitants):

  • 70,000 people consulted in the emergency department of an hospital (113 per 100,000 inhabitants.);
  • 113,000 people were hospitalized (24 per 100,000 inhabitants);
  • 400 people died (0.9 per 100,000 inhabitants).
Causes of foodborne illness in France[38][39]
Cause Annual cases Rate
(per 100,000 inhabitants)
1 Salmonella ~8,000 cases 13
2 Campylobacter ~3,000 cases 4.8
3 Parasites
incl. Toxoplasma
~500 cases
~400 cases
0.8
0.65
4 Listeria ~300 cases 0.5
5 Hepatitis A ~60 cases 0.1
Causes of death by foodborne illness in France
Cause Annual Rate
(per 100,000 inhabitants)
1 Salmonella ~300 cases 0.5
2 Listeria ~80 cases 0.13
3 Parasites ~37 cases 0.06
(95% due to toxoplasma)
4 Campylobacter ~15 cases 0.02
5 Hepatitis A ~2 cases 0.003

Australia

In Australia, there are an estimated 5.4 million cases of food-borne illness every year, causing:[40]

  • 18,000 hospitalisations
  • 120 deaths
  • 2.1 million lost days off work
  • 1.2 million doctor consultations
  • 300,000 prescriptions for antibiotics

Outbreaks

The vast majority of reported cases of foodborne illness occur as individual or sporadic cases. The origin of most sporadic cases is undetermined. In the United States, where people eat outside the home frequently, most outbreaks (58%) originate from commercial food facilities (2004 FoodNet data). An outbreak is defined as occurring when two or more people experience similar illness after consuming food from a common source.

Often, a combination of events contributes to an outbreak, for example, food might be left at room temperature for many hours, allowing bacteria to multiply which is compounded by inadequate cooking which results in a failure to kill the dangerously elevated bacterial levels.

Outbreaks are usually identified when those affected know each other. However, more and more, outbreaks are identified by public health staff from unexpected increases in laboratory results for certain strains of bacteria. Outbreak detection and investigation in the United States is primarily handled by local health jurisdictions and is inconsistent from district to district. It is estimated that 1–2% of outbreaks are detected.

Political issues

United Kingdom

In postwar Aberdeen (1964) a large scale (>400 cases) outbreak of Typhoid occurred, this was caused by contaminated corned beef which had been imported from Argentina[41] The corned beef was placed in cans and because the cooling plant had failed, cold river water from the Plate estuary was used to cool the cans. One of the cans had a defect and the meat inside was contaminated. This meat was then sliced using a meat slicer in a shop in Aberdeen, and a lack of cleaning the machinery lead to spreading the contamination to other meats cut in the slicer. These meats were then eaten by the people of Aberdeen who then became ill.

In the UK serious outbreaks of food-borne illness since the 1970s prompted key changes in UK food safety law. These included the death of 19 patients in the Stanley Royd Hospital outbreak [3] and the bovine spongiform encephalopathy (BSE, mad cow disease) outbreak identified in the 1980s. The death of 17 people in the 1996 Wishaw outbreak of E. coli O157 [4] was a precursor to the establishment of the Food Standards Agency which, according to Tony Blair in the 1998 white paper A Force for Change Cm 3830 "would be powerful, open and dedicated to the interests of consumers".

United States

In 2001, the Center for Science in the Public Interest (CSPI) petitioned the United States Department of Agriculture to require meat packers to remove spinal cords before processing cattle carcasses for human consumption, a measure designed to lessen the risk of infection by variant Creutzfeldt-Jakob disease. The petition was supported by the American Public Health Association, the Consumer Federation of America, the Government Accountability Project, the National Consumers League, and Safe Tables Our Priority. This was opposed by the National Cattlemen's Beef Association, the National Renderers Association, the National Meat Association, the Pork Producers Council, sheep raisers, milk producers, the Turkey Federation, and eight other organizations from the animal-derived food industry. This was part of a larger controversy regarding the United States' violation of World Health Organization proscriptions to lessen the risk of infection by variant Creutzfeldt-Jakob disease.[citation needed]

None of the US Department of Health and Human Services targets [42] regarding incidence of foodborne infections were reached in 2007 [43].

Organizations

World Health Organization Food Safety Department

The WHO provides scientific advice for organizations and the public on issues concerning the safety of food. It serves as a medium linking the food safety systems in countries around the world. Food safety is currently one of WHO's top ten priorities. Food Safety is one of the major issues in our world today, and the Organization calls for more systematic and aggressive steps to be taken to significantly reduce the risk of foodborne diseases.

The Department of Food Safety, Zoonoses and Foodborne Diseases

The Department of Food Safety, Zoonoses and Foodborne Diseases is a department under the WHO. Its mission is to: to reduce the serious negative impact of foodborne diseases worldwide. According to the WHO website, food and waterborne diarrhoeal diseases are leading causes of illness and death in less developed countries, killing approximately 3.8 million people annually, most of whom are children.

WHO works closely with the Food and Agriculture Organization of the United Nations (FAO) to address food safety issues along the entire food production chain--from production to consumption--using new methods of risk analysis. These methods provide efficient, science-based tools to improve food safety, thereby benefiting both public health and economic development.
The International Food Safety Authorities Network (INFOSAN)

This network is intended to complement and support the existing WHO Global Outbreak Alert and Response Network (GOARN) which includes a Chemical Alert and Response component.

Academic resources

Periodicals

Books

  • Advances in Food Mycology (Advances in Experimental Medicine and Biology) (2006) by A.D. Hocking et al., ISBN 978-0387283913 (electronic) 978-0387283852 (paper), Springer
  • Foodborne Infections and Intoxications (2006) by Hans P. Riemann and Dean O. Cliver, ISBN 012588365X, Elsevier
  • Foodborne Pathogens: Microbiology And Molecular Biology (2005) by Pina M. Fratamico et al., ISBN 190445500X ISBN 978-1904455004, Caister Academic Press

See also

References

  1. ^ food poisoning at Dorland's Medical Dictionary
  2. ^ US CDC food poisoning guide
  3. ^ "Food-Related Diseases". http://www.cdc.gov/ncidod/diseases/food/index.htm. 
  4. ^ Food Standards Agency
  5. ^ Humphrey, Tom et al.; O'Brien, S; Madsen, M (2007). "Campylobacters as zoonotic pathogens: A food production perspective <internet>". International Journal of Food Microbiology 117 (3): 237. doi:10.1016/j.ijfoodmicro.2007.01.006. PMID 17368847. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4N0PPRG-1&_user=10&_coverDate=07%2F15%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=74b7c07635a1873ca815b3139b56d2e0. 
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  18. ^ da Motta, Silvana; Lucia M. Valente Soares. "Survey of Brazilian tomato products for alternariol, alternariol monomethyl ether, tenuazonic acid and cyclopiazonic acid <internet>". http://www.informaworld.com/smpp/content~content=a713810863~db=all. Retrieved 13 August 2007. 
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  31. ^ Joffe, A. Z.; B. Yagen. "Comparative study of the yield of T-2 toxic produced by Fusarium poae, F. sporotrichioides and F. sporotrichioides var. tricinctum strains from different sources <internet>". SAGE Publications. http://het.sagepub.com/cgi/content/abstract/20/2/84. Retrieved 12 August 2007. 
  32. ^ Hay, Rod J.; B. Yagen. "Fusarium infections of the skin <internet>". http://www.co-infectiousdiseases.com/pt/re/coinfdis/abstract.00001432-200704000-00002.htm;jsessionid=G2JGL27MSRdb4TS82LyckCgxLH2zJLX3ynBfjz5kjMyfh4WpVkLg!1152499061!181195629!8091!-1. Retrieved 12 August 2007. 
  33. ^ Food and Drug Administration. "Guidance for Industry and FDA - Letter to State Agricultural Directors, State Feed Control Officials, and Food, Feed, and Grain Trade Organizations <internet>". http://www.cfsan.fda.gov/~dms/graingui.html. Retrieved 13 August 2007. 
  34. ^ Hohn, Thomas M.. "Trichothecene-resistant transgenic plants <internet>". http://www.patentstorm.us/patents/6646184.html. Retrieved 13 August 2007. 
  35. ^ Dubois, Eric et al.. "Intra-laboratory validation of a concentration method adapted for the enumeration of infectious F-specific RNA coliphage, enterovirus, and hepatitis A virus from inoculated leaves of salad vegetables spt on from mexican migrant workers. <internet>". http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4HYMVXK-4&_user=10&_coverDate=04%2F25%2F2006&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=29d010eafc89179a9a66fd24a4b44e21. Retrieved 11 August 2007. 
  36. ^ Schmidt, Heather Martin. "Improving the microbilological quality and safety of fresh-cut tomatoes by low dose dlectron beam irradiation - Master thesis <internet>" (PDF). http://txspace.tamu.edu/bitstream/1969.1/2767/1/etd-tamu-2004B-FSTC-Schmidt.pdf. Retrieved 11 August 2007. 
  37. ^ a b c Mead PS et al. (1999). "Food-related illness and death in the United States". Emerg Infect Dis 5 (5): 607–25. doi:10.3201/eid0505.990502. PMID 10511517. PMC 2627714. http://www.cdc.gov/ncidod/EID/vol5no5/mead.htm.  10.3201/eid0505.990502
  38. ^ "Report of the French sanitary agencies" (in French) (PDF). INVS/Afssa. http://www.invs.sante.fr/publications/2004/inf_origine_alimentaire/inf_origine_alimentaire.pdf. 
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External links

 This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention.


Food poisoning
Classification and external resources
ICD-10 A05.9
ICD-9 005
eMedicine med/807 
MeSH D005517

Food poisoning refers to acute illness due to the ingestion of food.[1] It can lead to infectious diarrhea.

The term usually includes:

  • The consequences of ingested enterotoxin.
  • The consequences of ingested bacteria that produce toxins, but do not invade the mucosa, and are usually quickly cleared by the immune system.

The term usually does not include the consequences of invasive organisms acquired via the food supply. (The broader term foodborne illness includes these conditions.)

Onset of food poisoning following the consumption of the tainted food or drink can last from one to ten days.[clarification needed]

Food poisoning can be a notifiable disease in some jurisdictions.[2] An alarming number of people are affected annually by food poisoning.[3] Food poisoning endangers between sixty and eighty million people throughout the world each year and results in between six and eight million deaths.[4]

Common causes of food poisoning: If the incubation period is less than six hours, a possible cause is Staphylococcus aureus toxin ingestion. Symptoms include vomiting, nausea, and diarrhea. Another is Bacillus cereus toxin ingestion. Symptoms include vomiting, and nausea (the "emetic syndrome").[citation needed]

If the incubation period is more than ten hours, a possible cause is B. cereus toxin ingestion. Symptoms include diarrhea and cramps (the "diarrheal syndrome"). Another is ingestion of Clostridium perfringens bacteria, which release a toxin in the gastrointestinal tract. Symptoms include diarrhea and cramps.[citation needed]

E. coli may also cause food poisoning with symptoms varying with the serotype.[citation needed]

References


Travel guide

Up to date as of January 14, 2010

From Wikitravel

This article is a travel topic.

Food poisoning – and its main symptom diarrhea – is undoubtedly the most common traveller's illness. In many ways it's unavoidable: no matter how fanatical you are about food preparation, it's still liberally sprinkled with millions of airborne bacteria. At home, due to this constant exposure to the local germs, odds are very high that you're already immune to them. But in other parts of the world, where the bacteriological fauna are new to you, you're far more likely to run into problems. Thus the scourges of Delhi Belly, the Pharaoh's Curse, Montezuma's Revenge, and their many friends.

Prevent

There's an old adage for eating in the Third World:

Boil it, cook it, peel it, or forget it.

This seems simple, but in practice it's a tough road to follow, the problem being not so much the risk of accident as the risk of temptation. For example, the following items are highly likely to cause problems:

  • tap water
  • ice
  • milk
  • fresh fruits and vegetables

Test: It's another sweltering hot day in Delhi and that curry you just ate is still scorching your throat, so how about a nice strawberry shake to cool you down? If you said "Sure!", you may just have passed an intestinal death sentence on yourself: that shake contains every single one of the four high-risk items. The ice that makes it cold has either been made from tap water or, worse yet, comes from the factory in huge blocks that are often literally dragged down the street. Milk spoils very quickly in the tropics. And those yummy leafy veggies and unpeeled fruits have been washed in that same parasite-laden tap water... if at all.

Having read this, your instinctive reaction will be to panic and to head for the nearest expensive, air-conditioned tourist restaurant. Bad move. They're still using the same ingredients, stored with the same levels of hygiene or lack thereof, but because it's a tourist restaurant their business model relies on catching a couple of tourists a day, instead of feeding a crowd of locals. This, in turn, means that those same ingredients have, more probably than not, been sitting around a long time waiting for you.

What to do then? It's a numbers game, but here are a few guidelines to improve your odds of escaping unscathed:

  • Choose a popular restaurant (or street stall). Many people (especially locals!) means that the food isn't left sitting around, and more likely than not, it also means the chow is good and the price is right.
  • Choose cooked dishes that are made on demand. Things like fried rice and fried noodles are popular in the tropics for a reason. Buffet-style meals, on the other hand, may appear cheap but (unless extremely popular) are very risky indeed.
  • Dishes that are kept boiling hot – in practice this means hot drinks and soup – are also a pretty good option. Fiery curries and the like are not quite as good, but they're usually OK largely thanks to the disinfectant properties of most spices. On the flip side, excessive spices alone may be enough to upset your stomach's balance, so it's best to avoid these at least for the first few days.
  • Avoid meat, fish, and especially shellfish; go visit the market to find out why. Eating ground meat (meatballs etc) or anything not well-done is especially risky, not only due to food poisoning but because of the risk of things like trichinosis. Additionally, things like barbecues and roast chicken have to be prepared in advance, and who knows how long they have been sitting there?
  • Drink only beverages from untampered bottles and cans, and check the seals first! Don't let waiters pour stuff in the kitchen, because you won't be getting what you expect. Reputable restaurants will open their drinks in front of you for this very reason.
  • Boil fresh milk thoroughly before drinking it, or use powdered or condensed milk instead.

The good news is that in a couple of days you'll start to acclimatize to the local bacteria and your odds of getting sick will start to decrease. The bad news is that it only takes one fly in the wrong place at the wrong time to foil all your precautions, and that if you stick around for a while, a run-in with food poisoning is, alas, more or less inevitable.

Treat

So one day your luck runs out, and you find yourself feeling distinctly queasy. Runny bowels or simple diarrhea don't really qualify for food poisoning, but if you...

  • feel sick and dizzy
  • get a fever
  • start to feel like you need to throw up

...then, well, you're reading the right article. The first thing to do is to get the acute phase over with: head for the toilet, kneel in front of the bowl and let go. You won't start to feel better until you start throwing up, and you won't get this over with until your stomach is empty, so just do it. Do not attempt to eat anything, and do not drink anything other than water yet. When there's nothing left, wash your mouth, brush your teeth and go to bed. You'll feel more alive in the morning. If, however...

  • the acute symptoms persist for more than two days, or
  • there is blood or pus in your feces, or
  • you are getting chills as well as fever, or
  • the pain evolves beyond a nauseous kind of sick, or
  • other weird symptoms show up, eg. skin marks

...you may have something worse and should see a doctor. Do not try to just fight it off.

Drink

Your main priority with any form of regular food poisoning has to be re-hydration. You're losing fluids constantly from any number of orifices, and your symptoms will become worse if you start to dry out. Feelings of thirst are the important early sign of dehydration, others are headache, difficulty with or inability to urinate, and falling blood pressure and associated signs (dizziness). Check the colour of your urine; the lower your body is on water, the darker it gets. Not urinating at all is also a warning sign that you're low on water.

In order to maintain hydration, drink lots and lots of water. If you are losing a great deal of water you also need to replace electrolytes. The medical rehydration recipe is:

  • 1 liter of water (boiled or bottled) to:
  • 8 teaspoons of sugar;
  • 1 teaspoon of salt; and
  • (optionally) half a cup of orange juice or mashed banana to add flavour and help replace potassium

You can get oral re-hydration solutions or sachets from a pharmacy but they are essentially the same as a flavoured version of the above.

"Saudi champagne", a 50-50 mixture of soda water and apple juice, is fairly palatable and reasonably close to the right mix for rehydration.

For mild cases of dehydration, weak tea (sweetened), flat soda, and some diluted fruit juices are all good (but avoid vitamin C). Drinking a glass or two an hour till everything stops running out the other end should stop you becoming too dehydrated. Aim for drinks at room temperature.

Do not drink caffeinated drinks or alcohol.

If you are vomiting intermittantly, you should drink in regular sips rather than one big glass or more of water. Start sipping about half an hour after each vomiting episode.

Eat

For the next few days, you will find that your appetite has all but disappeared. Don't force yourself to eat. If you feel like eating something, stick to bland, stomach-friendly foods like rice, porridge, crackers, bread. But be aware that food for you is also food for any bug that has made you sick, so take it slowly and stop if things get worse. Eat to match your appetite: Don't chuck down large quantities of food to make up for the last few days, instead eat small portions spread out over the day.

Avoid dairy products and oily food.

Some people find that — as a preventative or in treating mild cases — yoghurt helps. It is a bacterial culture; the hope is that the benign yoghurt bacteria will overwhelm the nasty ones. Do not try this if you are acutely ill; you will just heave up the yoghurt and feel even worse.

Medicate

Do not, repeat, do not take any antidiarrheal or antiemetic drugs. These will just block up the nasty stuff in your system and you'll risk turning (relatively) harmless food poisoning into something much worse. A doctor may prescribe antibiotics in severe cases, but this is usually overkill. Don't take aspirin to calm things down — aspirin requires a healthy stomach.

Treat others

If your travelling companions are down for the count, the best thing you can do for them is supply them with water and rehydration solution, and, alas, possibly clean up after them. Wash your hands with very warm water and soap after cleaning, touching the sufferer, handling their clothes or bedding, and of course before eating.

Some groups of people are very vulnerable to dehydration after developing diarrhea. In particular, because of their small bodies, toddlers and babies dehydrate extremely quickly; elderly people also dehydrate more quickly than young adults, and any illness is serious in someone immunocompromised (eg, by AIDS or chemotherapy). A baby with diarrhea should be taken to the doctor immediately if it is under 3 months old, and also if it is older and is either vomiting, has a fever or has stopped wetting its nappy regularly, as this means it is dehydrated.

Don't share

Once sick with vomiting and/or diarrhea do not, if at all possible, prepare or handle food that other people intend to eat as you may infect them with your illness. Continue not to handle others' food for at least 2 days after the symptoms are gone. Sufferers should be extra vigilant about washing their hands thoroughly with warm water and soap before meals and after using (or cleaning) the toilet.

Avoid using the same toilet with an infected person if you can. Reserve and quarantine one toilet for the use of the infected person (it still has to be kept clean, though) and use another one for yourself (or make sure the others use it if you are the one who is sick). If this is not possible, you (or someone else) have to use the same toilet with someone sick, disinfecting the toilet with household bleach after each and any use (defecating, urinating, throwing up, you name what else) by the infected person is a wise precaution. Although not very environmentally friendly, household bleach is generally the cheapest and most common option available (it has different names in different countries (for example eau de Javel in French-speaking countries, after the name of the town which it was first produced), if you don’t know the local name, check the label, it will state that it contains “sodium hypochlorite” (substitute “natrium” for “sodium” in some of the Germanic-, and Slavic-speaking countries), sometimes with the percentage: up to 5%). Pour the bleach on every part of the toilet bowl that was possibly in contact with the bodily wastes after all the solid dirt is removed (solid material hinders disinfecting properties of bleach). Don’t flush bleach down immediately, let it sit for at least 5-10 minutes so it has enough time to kill the nasty bugs. An important thing to remember: Never mix or use bleach together with acid toilet cleaners which contain hydrochloric acid or sulphuric acid and are commonly found in parts of Asia, especially in Indian subcontinent. The chemical reaction causes the release of very dangerous chlorine gas which burns your lungs (in the best case) or kills you (in the worst case). As common sense requires, don’t let any of these strong chemicals come in touch with your skin and keep them away from children or other people who may mistake them as a drink.

Some food related illnesses can spread rapidly through groups of people particularly where the group is regularly gathering for meals. If you are travelling in a group of people (particularly in a closed environment like a cruise ship) or attending a conference or similar gathering it is good to inform the organisers or medical staff if any of your illness so that they are alert to a possible problem for everyone else.

Complicate

Sometimes ordinary food poisoning turns into (or is) something worse. If you have reason to suspect any of these, see a doctor, as any of the following conditions require medical care.

Cholera

Cholera is an extreme form of diarrhea caused by the Vibrio cholerae bacterium, identifiable by torrents of liquid stool with white flecks of mucus ("rice water stools"), up to 20 liters (20% of body weight) in a single day. The skin and lips may turns black and blue and eyes sink. If untreated, death can occur within 24 hours, but with proper hydration the fatality rate is under 1%. The disease is rare, but endemic to the Indian subcontinent and typically occurs in epidemics.

An injected vaccine has been available for some decades, but is not very effective. Recently several oral vaccines [1] have been developed. None are 100% effective against cholera either. Some also provide partial immunity against some other stomach infections.

Dysentery

Dysentery is an inflammation of the intestines resulting in severe diarrhea with blood or pus in the feces, often accompanied by fever or painful stomach cramps. Mostly found in the tropics and closely linked to poor hygiene, it remains a devastatingly lethal illness in much of the Third World, but can be easily treated with modern medicine. There are two major causes:

  • Bacillary dysentery (or shigellosis), caused by Shigella bacteria. Transmitted through fecal-oral contact, incubation period 12-50 hours.
  • Amoebic dysentery (or amoebiasis), caused by the Entamoeba histolytica amoeba. Transmitted through contaminated water, can remain dormant for a long time and only appears after a period of weeks or months.

Dysentery can be confirmed by a stool test, but differentiating the bacillary and amoebic types takes at least 48 hours, so medication for both is often started simultaneously. The condition can usually be cured with five days of treatment with antibiotics (for bacillary) or metronidazole (for amoebic), and hospitalization is usually only necessary if fluid loss is extreme. The stool of dysentery patients can be highly contagious, so frequent handwashing for caregivers is essential.

Gastroenteritis

Also known as stomach flu, this is a viral infection of the stomach tissue (gastritis) or the small bowel (enteritis) that causes stomach pain and frequent watery stools. The diseases is passed through contaminated water, including shellfish in that water, and typical causes include rotaviruses, noroviruses, adenoviruses, sapoviruses, and astroviruses. The main treatment is rehydration and most cases resolve on their own. Antibiotics do not work, but may be used in severe cases to prevent complications.

Giardiasis

Also known as beaver fever, this can be identified by explosive diarrhea, foul-smelling flatulence and vomiting, often starting 1-2 weeks after infection and recurring in cycles. The cause is the Giardia lamblia protozoan, which is transmitted by the fecal-oral route, and often strikes people consuming untreated water in the wilderness and also in countries with poor hygiene. (It's endemic to the tap water systems of some places, like St. Petersburg in Russia.) Two-thirds of the people affected are silent carriers, and the condition often resolves itself with time. However, once identified, giardiasis can be cured a single dose of tinidazole. Metronidazole is a common alternative in poorer countries, and is often available from pharmacies.

Typhoid fever

Characterized by slow buildup, up to a week, to high fever (40°C) with heavy sweating and, in later stages, delirium. Diarrhea is green and bloodless; however, some patients have constipation instead. Caused by the Salmonella bacterium, identified by blood or stool test, and usually easily cured with antibiotics. Untreated cases have 10-30% fatality rates and may take up to a month to cure. Vaccination is available.

This is a usable article. It touches on all the major areas of the topic. An adventurous person could use this article, but please plunge forward and help it grow!

Simple English

[[File:|thumb|People can be sick from eating poorly stored food, as in this picture.]] Food poisoning is when someone gets sick from eating food or drink that has gone bad or is contaminated.[1] There are two kinds of food poisoning: poisoning by toxic agent or by infectious agent. Food infection is when the food contains bacteria or other microbes which infect the body after it is eaten. Food intoxication is when the food contains toxins, including bacterially produced exotoxins, which can happen even when the microbe that produced the toxin is no longer present or able to cause infection. Even though it is commonly called "food poisoning", most cases are caused by a variety of pathogenic bacteria, viruses, prions or parasites that contaminate food,[2] rather than chemical or natural toxins which are what we usually call poison. According to the Centers for Disease Control and Prevention, about 76 million people in the United States become ill from the food they eat, and about 5,000 of them die every year.[3]

Signs and symptoms

[[File:|thumb|left|upright|Campylobacter, a bacteria that is a major cause of food poisoning.]] Symptoms start many hours to many days after eating. Depending on what the cause of the poisoning was, they can include one or more of the following: nausea, abdominal pain, vomiting, diarrhea, gastroenteritis, fever, pain in the head or fatigue.

In most cases the body is able to permanently get better after a short period of acute discomfort and illness. Foodborne illnesses can result in permanent health problems or even death, especially for people at high risk, including babies, young children, pregnant women (and their fetuses), elderly people, sick people and others with weak immune systems.

Foodborne illness due to campylobacter, yersinia, salmonella or shigella infection is a major cause of reactive arthritis, which typically occurs 1–3 weeks after diarrheal illness. Similarly, people with liver disease are especially susceptible to infections from Vibrio vulnificus, which can be found in oysters or crabs.

Tetrodotoxin poisoning from reef fish and other animals shows up very quickly in symptoms such as numbness and shortness of breath, and is often fatal.


References

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