Toxic shock syndrome

Toxic shock syndrome was an outbreak when it was first recognized. Toxic shock syndrome is an acute –onset illness characterized by early onset of multi-organ involvement and shock. It causes by gram-positive bacteria that rapidly progresses ro chock with multi-organ failure. Toxic shock syndrome most commonly presents in healthy individuals with intact immune system.

Staphylococcal toxic shock syndrome, STSS, was the first type of toxic shock syndrome diagnosed and consequently has the most thorough epidemiological database.

The following criteria must be made in order to confirm Toxic shock syndrome:
*Fever – temperature higher than 102 °F
*Rash - diffuse, sunburnlike rash
*Skin peeling – usually 0-2 weeks after onset of illness, primarily on palms and soles.
*Low blood pressure
*Involvement in three or more of the following systems
*Laboratory tests to differentiate Toxic shock syndrome from other infectious diseases

Toxic shock syndrome is associated with three etiological agents:
*Staphylococcus aureus infection
*Streptococcus pyogenes infection
*Clostridium sordellii – soft tissue infections

Staphylococcal toxic shock syndrome became well known in the late 1970s when it was described in menstruating women using tampons.
Toxic shock syndrome

Foodborne Disease Caused by Micro-organisms

Foodborne Disease Caused by Micro-organisms
Foodborne disease is a public health problem which comprises a broad group of illnesses.

Among them, gastroenteritis is the most frequent clinical syndrome which can be attributed to a wide range of micro-organisms, including bacteria viruses and parasites.

Usually, the incubation period is short, from 1-2 days to 7 days.

Different degrees in severity are observed, for a mild disease which does not require medical treatment at the more serious illness requiring hospitalization, long term disability and /or death.

The outcome of exposure to foodborne diarrheal pathogens depends on a number of host factors including preexisting immunity, the ability to elicit an immune response, nutrition, age, and non specific host factors.

As a result, the incidence the severity and the lethality of foodborne diarrhea is much higher in some particularly vulnerable segments of the population, including children under five years of age, pregnant women, immuno-compromised people and elderly.

In addition to these well known predisposing conditions, new ones are regularly identified (liver disease for paraheamoliticus septicemia, thalassemia for Yersinia enterocolitica infections).

Serious complications may result from these illnesses including intestinal as well as systemic manifestations, like hemolytic uremic syndrome for 10% of Escherichia coli 0157:H7 infections with bloody diarrhea, Guillain-Barre syndrome (nerve degeneration, slow recovery and severe residual disability) after Campylobacter jejuni infection, reactive arthritis after salmonellosis and chronic toxoplasmic encephalitis.

While diarrhea is the most common syndrome following the consumption of a contaminated food some disease are more serious.

Clinical manifestations of listeriosis include bacteriemia and central nervous system infections, especially in patients with an impairment of T-cell mediated immunity and abortion in pregnant women, with an overall case fatality rate of 25%.

Food borne botulism is a result from the potent toxin by Clostridium botulinum that cause a paralysis of skeletal and respiratory muscles which, when severe may result in death in 8% of cases.

Toxoplasma gondii is also the most frequent cause of lesion in the central nervous system in patients with AIDS.

Hepatitis A is an infectious disease for which age is the most important determinant of morbidity and mortality, with severity of illness and its complications increasing with age.

The durations of illness vary but most cases are symptomatic for three weeks.

Complications during the acute illness phase are unusual, with fulminant hepatitis and death being uncommon.
Foodborne Disease Caused by Micro-organisms

Salmonella: significance as a pathogen

Salmonella: significance as a pathogen
Two clinical entities cause by Salmonella are recognized: enteric fever (a severe, life threatening illness) and the more common food poisoning syndrome. In both cases, the organisms enter the body via oral route.

Enteric fever, commonly referred to as typhoid fever, is primarily caused by the one species Salmonella typhi, but other salmonella are potentially capable of producing this syndrome. The symptoms of enteric fever are generally not elicited through the intestinal tract, although the route of entry into the body is primarily oral. However, a short period of vomiting and diarrhea sometimes occurs in the first day or two in typhoid fever. The onset times vary considerably between typhoid and paratyphoid enteric fevers. Onset times for typhoid are usually 8 – 15 days, seldom as short as 30 – 35 days: while onset time for paratyphoid fever tends to be shorter, and may be so short as to suggest food poisoning. The usual symptoms of salmonellosis are headache, malaise, anorexia, and congestion of the mucous membranes, especially of the upper respiratory tract. Bacteremia generally occurs on the first week of illness.

The food poisoning syndrome is characterized by a self-limiting acute gastroenteritis. Contaminated food or water is the usual, but not the only, vehicle. The incubation period varies from 6 to 48 hours and generally falls within a range of 12 – 36 hrs. Variation in the incubation time may be attributed to the size of the infecting dose, the virulence (degree of pathogenicity) of the organisms, the susceptibility of the host, and the physicochemical composition of the transmitting food. Symptoms include diarrhea, abdominal cramps, vomiting and fever which generally last from 1 - 7 days. However, the organisms may be excreted in the feces for many weeks after symptoms subside.

Salmonellosis may be confused clinically with staphylococcal intoxications, but there are important distinctions. Salmonella has a longer incubation period than staphylococci and is usually accompanied by fever, which is absent in staphylococcal intoxication. And, unlike Salmonella food poisoning, the acute symptoms of staphylococcal food poisoning normally disappear within 24 hrs.

In some case, the gastroenteritis may be followed by extraintestinal invasion resulting in enteric fever, which is more, likely to occur in the very young, the aged and debilitated patients.
Salmonella: significance as a pathogen