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Vibrios are an important cause of human food-borne illness associated with the consumption of seafood worldwide, and contaminated food and drinking water in developing countries. Clinical syndromes induced by vibrios such as Vibrio cholerae, V. parahaemolyticus, V. vulnificus, and others range from mild, self-limiting gastroenteritis to life-threatening primary septicemia. As natural inhabitants of the aquatic environment, these bacteria pose a continual threat to food safety.

Objective: To report two epidemic outbreaks of scombroid food poisoning and their emergency medical services (EMS) response and emergency department (ED) treatment, analyzing the impact of early physician involvement and on-line medical control., Methods: Retrospective case series of two multiple-casualty incidents (MCIs) involving scombroid food poisoning., Results: A total 57 patients were treated from two separate incidents, with 30 patients transported to area hospitals. One patient required treatment with a cardiac medication in the field and another patient eventually required hospital admission. On-scene medical control (incident 1) and early identification of the index case (incident 2) were instrumental to out-of-hospital care interventions and conservation of resources. Patient triage, field treatment, and hospital transport were expedited, with some patients treated and released from the scene., Conclusions: Immediate diagnosis of a food-borne illness in the out-of-hospital setting allows rapid treatment at the scene and allows for the efficient transport of multiple patients to a single receiving facility. EMS medical directors should be able to immediately respond to such incidents to make presumptive diagnoses and accurately direct patient care. When this is not possible, early identification of the index case facilitates early diagnosis and treatment.

The aim of this report is to point out the potential seriousness of the scombroid syndrome which, on the basis of our experience, can be characterized by extremely serious symptoms. We describe 12 cases of scombroid syndrome: two-thirds of the patients presented with rapid worsening of their clinical condition and hypotension severe enough to require use of plasma-expanders and hospitalization in an Internal Medicine Department. In the youngest patient, hypotension and symptoms were so marked that intravenous administration of epinephrine, and hospitalization in the Intensive Care Unit were required. Thus, in contrast to reports in the literature, the scombroid syndrome should be considered as a potentially serious ichthyotoxicosis. The pathogenetic role played by histamine, poorly absorbed by the intestine and rapidly metabolized by the liver, should be reevaluated. The potential onset of serious clinical symptoms warrants prolonged observation of the patient in an environment equipped to deal with the not infrequent emergencies that can arise, even in young and healthy subjects.

The consumption of seafood, which is contaminated by toxines of red tides, is a common cause of disease in tropic regions. The most important diseases, which are caused by red tides are Paralytic Shellfish Poisoning (PSP), Diarrhetic Shellfish Poisoning (DSP), Neurotoxic Shellfish Poisoning (NSP), Amnesic Shellfish Poisoning (ASP), Ciguatera Fish Poisoning (CFP).

In 1982, a new pathogen caused an outbreak of hemorrhagic colitis in this country. This new pathogen, Escherichia coli O157:H7, was not a known enteropathogen prior to this time. Since 1982, this organism has become the most commonly isolated pathogen from patients with bloody stools. Health officials estimate that E. coli O157:H7 causes 20,000 cases of hemorrhagic colitis annually in the U.S. Approximately 5% of all hemorrhagic colitis patients experience serious sequelae involving hemolytic anemia, thrombocytopenia, and kidney failure, and about 250 patients die each year with E. coli O157:H7 hemorrhagic colitis and sequelae. Even as many clinical laboratories become more efficient at detecting E. coli O157:H7 using simple media, other strains of enterohemorrhagic E. coli are appearing as causes of hemorrhagic colitis and hemolytic uremic syndrome. These non-O157:H7 are more difficult to detect and identify, and present a challenge to clinical microbiologists.

Food producers and consumers must continue to take precautions against foodborne diseases, and early diagnosis and appropriate treatment of these illnesses are essential. Food products and water can become contaminated with microorganisms and toxins that make people ill, and the very young, the elderly, and immunocompromised individuals are especially susceptible. Education of healthcare providers, food handlers, and the public is critical in reducing the incidence and spread of foodborne illness. Changes in eating habits and lifestyle and increased availability of both domestic and imported foods have made food hazards a more complex public health issue. Although most foodborne illnesses can be avoided by safe food handling procedures (see box on page 134), risk reduction is very important at every step from source to table. A concerted effort is needed to ensure continuing safety of the food supply in the United States while also assuring access to a wide variety of healthful foods. Time will tell whether consumers will accept irradiation of meats. If accepted, irradiation could rank in importance with pasteurization of milk and chlorination of water as a public health measure.

Food borne infections and intoxications, typically manifesting as gastroenteritis, are a common community acquired illness in Australia. For infants, immunocompromised people, pregnant women and the elderly, food borne illness can be fatal. Food borne illness can be difficult to distinguish from illness transmitted by other routes, but specific pathogens, clinical syndromes, and epidemiological clues suggest possible 'food poisoning'. Management is usually supportive, but investigations provide information of public health value. Persons with gastroenteritis should be given simple advice to reduce the risk of transmitting infection to others, and educated about how enteric infections may be spread from infected persons and animals, and from food.

Urgent critical condition during acute course of infectious diseases can be developed in early terms and suddenly with fast irreversible changes in vital organs and systems. In connection with generality of pathogenesis of many groups of infectious diseases the critical conditions characterized by stereotyped clinical syndromes. They include infective toxic shock, infective toxic encephalopathy and cerebral hypertension, acute dehydration, acute respiratory, cardiac, hepatic, adrenal and renal insufficiency. Urgent therapeutic measures can be standardized with reference to that or other syndromes of critical conditions. In their number--prescription of glucocorticosteroids, diuretics, neuroleptics, antipyretic preparations, solutions of various applicability. Application of antimicrobic preparations and specific antitoxic serums, antimalarial preparations requires care in connection with possible development of complications of toxic or allergic character.

History and Findings: A 49-year-old Turkish man, previously well, suddenly developed severe vertigo and a feeling of retrosternal compression. The symptoms had set in within one hour of eating Turkish wild honey. The patient was in a poor general state with a heart rate of 38/min after administration of atropine by the general practitioner who had been called. Arterial blood pressure was 90/45 mmHg., Investigation: All routine biochemical tests were normal. The electrocardiogram merely showed sinus bradycardia of 38 beats/ min., Treatment and Course: Under purely symptomatic treatment the heart rate and blood pressure returned to normal within 24 hours. The history of eating wild honey and typical symptoms indicated acetylandromedol poisoning., Conclusion: Turkish honey from the Black Sea coast occasionally contains concentrations of acetylandromedol (formerly called andromedotoxin) high enough to cause poisoning. The substance is obtained by bees from some species of Rhododendron which they then incorporate into their honey. Typical of the poisoning are gastrointestinal symptoms and marked, even life-threatening, bradycardia and arterial hypotension.

On April 29, 1996, three cases of tetrodotoxin poisoning occurred among chefs in California who shared contaminated fugu (puffer fish) brought from Japan by a co-worker as a prepackaged, ready-to-eat product. The quantity eaten by each person was minimal, ranging from approximately 1/4 to 1 1/2 oz. Onset of symptoms began approximately 3-20 minutes after ingestion, and all three persons were transported by ambulance to a local emergency department (ED). This report summarizes the investigation of these cases by the San Diego Department of Environmental Health (SDEH) and the Food and Drug Administration (FDA).

We report a foodborne outbreak causing a cholinergic syndrome in three members of a family. The clinical presentation was characterized by nausea, vomiting, abdominal pain, and weakness. Physical examination revealed evidence of peripheral motor weakness and decreased level of consciousness in all three patients. Bradycardia, hypotension, and seizures occurred in two patients. Although initial therapy included administration of antitoxin for possible botulism, subsequent investigation revealed evidence of accidental organophosphate (fensulfothion) poisoning. The ubiquitous use of organophosphates as agricultural and household insecticides has ensured their continuing importance as causes of foodborne poisoning in both developed and developing countries. Physicians must remain alert to the possibility of non-bacterial causes of foodborne outbreaks in order to initiate prompt and appropriate investigations and specific therapy.

Shock (hypovolemic and infectious-toxic) is a severe complication of acute intestinal infections. Of 35096 patients with acute intestinal infections (90.6% had food poisoning, 9.4% had salmonellosis), 24 (0.07%) patients developed hypovolemic, 26 (0.08%) infectious-toxic shock. Hypovolemic shock is based on decompensated dehydration, infectious-toxic one arises from generalized circulation disorders with severe affection of hemostasis. Hypovolemic shock was effectively managed with polyionic crystalloid solutions. In infectious-toxic shock hemodynamic and homeostatic defects should be corrected. In spite of intensive therapy, lethality in infectious-toxic shock in patients with acute intestinal infections reached 80.8%.

Some data on the specific features of the clinical course of acute enteric infections (AKI) and hypertensive disease (HD) are presented. The data indicate that the pathogenetic mechanisms of these diseases often act on the same points and in some cases in the same direction. 32,448 AEI patients were placed under observation, among them 29,398 patients with alimentary toxicoinfections and 3,050 patients with salmonellosis. Of these 1,483 patients had HD of stages II and III. In 266 patients of this group hypertensive crises of types I and II developed. In 128 AEI patients acute disturbances in cerebral blood circulation were observed. In 67.2% of cases these patients were found to have HD in their medical history. The treatment of patients with the combination of AEI and HD included rehydration with polyionic crystalloid solutions and the administration of hypotensive preparations.

Ciguatera fish poisoning is an important public health problem wherever humans consume tropical and subtropical fish. It accounts for over half of fish-related poisonings in the United States but is uncommonly diagnosed and underreported. Produced by dinoflagellates, ciguatoxin accumulates up the food chain in herbivorous and carnivorous fishes. Cnidaria jellyfish and related invertebrates) have not previously been associated with direct ciguatera intoxication in humans. We report the first case of ciguatera fish poisoning associated with cnidarian ingestion. A 12-year-old Tongan female presented to our Emergency Department with mid-abdominal pain, nausea, change in mental status, and new-onset movement disorder after ingestion of jellyfish imported from American Samoa. Clinical diagnosis was confirmed by strongly positive serum identification of ciguatoxin and related polyether toxins (including okadaic acid) with a rapid extraction method (REM) and highly reliable solid-phase immunobead assay (S-PIA) performed by the Food Toxicology Research Group, University of Arizona. Ciguatera pathophysiology, clinical presentation, differential diagnosis (including consideration of palytoxin poisoning), and treatment are briefly reviewed. We emphasize the growing incidence of ciguatera fish poisoning outside "high-risk" areas. In regions with immigrant populations, privately imported exotic fish may be toxin vectors. Marine species other than carnivorous fish are now suspect in human ciguatera intoxication. Reliable tests can aid in premarket fish testing, diagnosis, and follow-up of ciguatera fish poisoning. The global prevalence of marine toxins demands fishermen, consumers, and physicians maintain a high index of suspicion for ciguatera fish poisoning.

Ciguatera poisoning develops after ingestion of certain coral reef-associated fish. With travel to and from the tropics and importation of tropical food fish increasing, ciguatera has begun to appear in temperate countries with more frequency. The causative agents are certain varieties of the protozoan dinoflagellate Gambierdiscus toxicus, but bacteria associated with these protozoa may have a role in toxin elaboration. A specific "ciguatoxin" seems to cause the symptoms, but toxicosis may also be a result of a family of toxins. Toxicosis develops from 10 minutes to 30 hours after ingestion of poisoned fish, and the syndrome can include gastrointestinal and neurologic symptoms, as well as chills, sweating, pruritus, bradycardia, tachycardia, and long-lasting weakness and fatigue. More severe features are rare. In this review, the pathophysiologic features and symptoms of ciguatera are reviewed and compared with those of other seafood-related syndromes. Although no definitive therapy is known, the most promising treatment for ciguatera is intravenous administration of mannitol. Physicians should warn patients who are traveling to endemic areas about this toxicosis.

153 chronic alcoholics were given treatment against food poisoning. 55 of them developed withdrawal syndrome, 98 had alcoholic psychosis including 88 with delirium tremens. The acute intestinal infection in these alcoholics was managed with rehydration using polyionic crystalloid solutions under controlled diuresis. Previous relief of central excitation contributed much to a positive treatment outcome.

Ciguatera fish poisoning is the most common foodborne illness related to fin fish consumption and is endemic throughout the Caribbean and Indo-Pacific regions. The clinical picture is characterized by a variety of gastrointestinal, neurologic and, occasionally, cardiovascular symptoms. Patients with bradycardia and/or hypotension may require urgent care. Neurologic symptoms tend to be the most distinctive and enduring and include sensory changes such as generalized pruritus, circumoral numbness and reversal of hot and cold sensation. Intravenous mannitol has evolved as a unique remedy for patients with acute poisoning, but management of chronic symptoms continues to be problematic. Though difficult to implement, preventive strategies remain the best defense.

1. A ten-year (1980-1989) retrospective study of poisoning admissions due to food poisoning at six referral hospitals in urban Zimbabwe revealed 487 cases. This constituted 8.1% of all poisoning admission cases (6018). 2. The majority of patients were among the 2.1-5 (20%), 5.1-10 (16%) and 21-30 (15%) year age groups in that descending order. 3. The agents implicated in food poisoning were mushrooms (47%), food-borne and other food-related toxins (37%), Elephants Ear (10%), alcohol (7%) and cassava (1%). 4. The majority of poisoning cases were accidental, accounting for 99% of the total. 5. The treatment regimens mostly used included agents for correcting fluid and electrolyte imbalance (22.1%), antibiotics (16.7%) and supportive measures (15.5%). 6. Mortality was recorded at 2.5% and the main agents associated with fatality were food-related toxins (5 cases), mushrooms (4 cases) and alcohol (4 cases). 7. The prevention and treatment of poisoning caused by food poisoning is mandatory in the effort to reduce poisoning caused by these agents.

Each year from November to April, cases of fish poisoning are reported with variable incidences according to villages disseminated along malagasy coasts. Occasional mass poisonings are often mentioned but precise clinical signs are not described nor published. Several fishes are responsible for these poisonings but only four kinds are often mentioned: shark, tuna, sardine and mackerel. Among children, digestive, cutaneous and neurological signs predominate in a specially polymorphic ciguatoxin clinical schedule. The importance of cardio-vascular or respiratory diseases or high fever may compromise the life prognosis. In the main, the evolution is good after one week. In Toliara hospital, only symptomatic therapy is applied.

Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative diagnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.

A 1-year observational study of all standardized medical records of ciguatera fish poisoning notified cases was conducted in French Polynesia. The objective was to determine the factors that influence the clinical response to ciguatera fish poisoning. During the year 1991, there were 551 cases notified on standardized code sheets by physicians (notification rate 276 per 100,000). The mean age was 36.6 years (S.D. 15.6). The largest age group was that between 30 and 49 years old (notification rate 562 per 100,000). The gender ratio (M/F) was 1.6. Of the 551 cases, 257 (47%) presented with a history of a previous attack. A clinical score was calculated to assess the outcome for each case. The adjusted odds ratio (OR) for a severe disease (33% with a score greater than 5) was significantly increased when the fish ingested was carnivorous (OR = 1.62, P = 0.02) and when a history of a previous attack was reported (OR = 1.71, P = 0.006). The increased severity of multiple episodes and the increase of the notification rate with age suggest a possible accumulation of toxin in the human organism.

Seventy-two cases of Vibrio vulnificus infection from raw oysters were reported from 1981-1992; 36 (50%) patients died, making this infection the leading cause of reported deaths from foodborne illness in Florida. The bacterium naturally occurs in coastal waters and may contaminate legally harvested and properly handled shellfish. Infection, usually by ingestion of contaminated raw oysters, can cause severe illness especially in individuals with preexisting liver disease. They are at 80 times greater risk of illness and over 200 times greater risk of death. The case fatality rate (63%) among patients with liver diseases was over 2.5 times the rate (23%) among those without liver disease. Infections usually occurred during the warm weather months and presented as fulminant septicemia, often complicated by necrotizing cutaneous lesions. Early treatment with antibiotics, debridement and amputation when necessary may improve survival. Prevention relies upon educating patients regarding risk and thorough cooking of shellfish.

Ciguatera is a specific type of food poisoning associated with the ingestion of tropical fish, which, although normally safe for consumption, may at times contain high amounts of ciguatoxin, as well as other chemically related toxins. Widespread in tropical regions where coral reefs are present, ciguatera fish poisoning constitutes a major hindrance for local fishing industries, local economies and foreign trade. Because no symptomatic treatment has been totally satisfactory, folk remedies remain of great interest. In this paper, a list of plants used in treating ciguatera poisoning in the Western Pacific region is presented, with emphasis on species whose exact utilization (part of plant used, preparation, dosage) has been determined.

Ciguatera poisoning has long been recognized as a serious problem in the tropical and subtropical regions of the world. Due to international and interstate commerce and tourist travel the phenomenon is spreading to other parts of the globe. Various species of fish (surgeonfish, snapper, grouper, barracuda, jack, amberjack among others) have been implicated in this type of poisoning. These fish accumulate toxins in their flesh and viscera through the consumption of smaller fish that have been previously contaminated by feeding on toxic dinoflagellates. The most probable source of ciguatera is thought to be the benthic microorganism, Gambierdiscus toxicus, which produces both CTX and MTX, but other species of dinoflagellates such as Prorocentrum lima may also contribute with secondary toxins associated with the disease. Potentially ciguatoxic dinoflagellates have been isolated, cultured under laboratory conditions and dinoflagellate growth requirements as well as some factors affecting toxin production have been determined. Also, data from their ecological environment have been accumulated in an attempt to reveal a relationship with the epidemiology of ciguatera outbreaks. Several bioassays have been employed to determine the ciguatoxicity of fish. Cats have been used due to their sensitivity, but regurgitation has made dosage information difficult to obtain. Mongooses have also been used but they often carry parasitic and other type of diseases which complicate the bioassay. Mice have been used more commonly; they offer a more reliable model, can be easily housed, readily are dosed in several ways, and manifest diverse symptoms similar to human intoxications; but the amount of toxic extract needed, time consumed, complicated extraction techniques, and instrumentation involved limit the use of this assay commercially. Other bioassays have been explored including the brine shrimp, chicken, mosquito, crayfish nerve cord, guinea pig ileum, guinea pig atrium, and other histological preparations. All require elaborate time-consuming procedures, are not reproducible, lack specificity, and are semiquantitative at best. The techniques that appear to represent the major advance in identifying and detecting ciguatoxic fish are immunochemical methods: radioimmunoassay (RIA), competitive enzyme immunoassay (EIA), and enzyme-linked immunosorbent assay (ELISA). Of these, the enzyme immunoassay stick test is the simplest, fastest, most specific, more sensitive, and does not require complicated instrumentation.(ABSTRACT TRUNCATED AT 400 WORDS)

The efficacy of the solutions of oral rehydration salts (ORS) of the first and second generations was estimated in the treatment of patients with acute intestinal infections. 150 patients with food toxicoinfections were examined. Two groups of the patients received the solutions of ORS of the first generation (glucosalan and citroglucosalan) and one group were given the second generation ORS solution based on the rice and salt, manufactured by Galactina (Switzerland). The clinical cases were analyzed. Some biochemical parameters that characterize certain aspects of homeostasis and bioenergetics were explored. The authors emphasize a greater effectiveness of the second generation solutions of ORS producing not only detoxification and rehydration but also serving as a food.

This article highlights an outbreak of food poisoning, the result of ingestion of Ciguatoxin-infected fish in a community. The case presentations of the patients involved are used to illustrate the clinical aspects of Ciguatoxin poisoning. The public health aspects of this incident and their relevance to disease surveillance are then discussed. Information of significance to general medical practice in relation to this particular type of fish poisoning, the effect of which could prove fatal in some cases, is also discussed.