Foodborne Illness causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

See also: Pathogen

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% . 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 organism. 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:

• Campylobacter jejuni which can lead to secondary Guillain-Barré syndrome and periodontitis
• Salmonella spp. - its S. Typhimurium infection is caused by consumption of eggs that are not adequately cooked or by other interactive human-animal pathogens ^{, ,} .
• Escherichia coli O157:H7 enterohemorrhagic (EHEC) which causes hemolytic-uremic syndrome

Other common bacterial foodborne pathogens are:

• Bacillus cereus
• Escherichia coli, other virulence properties, such as enteroinvasive (EIEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroaggregative (EAEC or EAgEC)

Salmonella

• Listeria monocytogenes
• Shigella spp.
• Staphylococcus aureus
• Streptococcus
• Vibrio cholerae, including O1 and non-O1
• Vibrio parahaemolyticus
• Vibrio vulnificus
• Yersinia enterocolitica and Yersinia pseudotuberculosis

Less common bacterial agents:

• Brucella spp.
• Corynebacterium ulcerans
• Coxiella burnetii or Q fever
• Plesiomonas shigelloides

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.

• Clostridium botulinum
• Clostridium perfringens
• Staphylococcus aureus
• Bacillus cereus

For example Staphylococcus aureus produces a toxin that causes intense vomiting. The rare but potentially deadly disease botulismoccurs when the anaerobic bacterium Clostridium botulinum grows in improperly canned low-acid foods and producesbotulin, 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 & 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 consumedaflatoxin-contaminated peanut meal and the death of 5000 human lives by Alimentary toxic aleukia (ALA) in the USSR in World War II. 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 ^, . 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 . The official document can be found at FDA's website ^, .

• 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 ^{, ,} . 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 .

• 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 ^, . For human and animal health, both the FDA and the EC have regulated the content levels of toxins in food and animal feed ^, .

• 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 , 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 .

• 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 ^,

• 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 .

• 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 ^,. 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 irritaion ^{, ,} . In 1993, the FDA issued a document for the content limits of DON in food and animal feed at an advisory level . In 2003, US published a patent that is very promising for farmers to produce a trichothecene-resistant crop .

• Zearalenone -

• Zearalenols -

Emerging foodborne pathogens

Much is still not known about foodborne illness. Approximately sixty percent of outbreaks are still caused by unknown sources.

• Aeromonas hydrophila, Aeromonas caviae, Aeromonas sobria

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 ^,.
• Hepatitis E
• Norovirus
• Rotavirus

Parasites

Most foodborne parasites are zoonoses.

Platyhelminthes:

• Diphyllobothrium sp.

The scolex of Tenia solium

• Nanophyetus sp.
• Taenia saginata
• Taenia solium
• Fasciola hepatica

See also: Tapeworm and Flatworm

Nematode:

• Anisakis sp.
• Ascaris lumbricoides
• Eustrongylides sp.
• Trichinella spiralis
• Trichuris trichiura

Protozoa:

Giardia lamblia

• Acanthamoeba and other free-living amoebae
• Cryptosporidium parvum
• Cyclospora cayetanensis
• Entamoeba histolytica
• Giardia lamblia
• Sarcocystis hominis
• Sarcocystis suihominis
• Toxoplasma gondii

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 defences such as poisons and distasteful substances, for example capsaicin in chilis and pungent sulphur 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.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloid
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning and ciguatera fish poisoning
• Scombrotoxin

• Tetrodotoxin (fugu fish poisoning)

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

• The foxglove contains belladonna.
• Poisonous hemlock (conium) has medicinal uses.

Other pathogenic agents

• Prions, resulting in Creutzfeldt-Jakob disease

"Ptomaine poisoning"

An early theory on the causes of food poisoning involved ptomaines, 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.