Foodborne infections remain a major public health problem. The Council for Agricultural Science and Technology estimated in its 1994 report, Foodborne Pathogens: Risks and Consequences, that as many as 9,000 deaths and 6.5 to 33 million illnesses in the United States each year were food-related. Hospitalization costs alone for these illnesses were estimated at over $3 billion a year. Costs for lost productivity for 7 specific pathogens estimated at $9 billion. In this chapter I briefly review the important food and water borne infections that cause gastrointestinal disease.
Doering reported in 2009: "The head of Kellogg Co, whose company lost nearly $70 million in products from a recent peanut recall, will tell lawmakers on Thursday the US food safety system must be overhauled with a focus on prevention… the country needs an authority within the Department of Health and Human Services devoted solely to food safety. Kellogg and hundreds of other companies have recalled 3,491 products from crackers to ice cream that contain peanuts after ingredients supplied by Peanut Corp of America were linked to a salmonella outbreak that began in September. Peanut Corp has since declared bankruptcy. The government says nearly 700 people have become ill after eating contaminated peanut products. President Obama has organized a panel to improve food safety laws. He blamed the recent outbreak partly on outdated food safety laws and underfunding and understaffing at FDA. In a 2009 review of the US experience, Maki asked: “Once again, we must ask ourselves how foodborne disease can develop in 76 million residents of one of the world's most technically advanced countries each year, causing 350,000 hospitalizations and 5000 deaths and adding $7 billion to our health care costs, despite intensive regulation of food production and distribution?”
The transportation of food in a global economy increased the spread of foodborne infections. The spread of avian flu viruses, for example was first blamed on wild birds, but tracking the spread with Google world mapping showed that the virus spread along transport routes, moving domestic foul for sale among countries. The idea of localized “endemic infections” is obsolete. Bacteria and other infectious organisms are pervasive in the environment. Salmonella enteritidis, for example, enters eggs directly from the hen. Bacteria inhabit the surfaces of fruits and vegetables in the field. Molds and their toxic byproducts can develop in grains during wet growing seasons and when damp conditions prevail during harvesting or storage. Seafood may become contaminated from agricultural runoff, by sewage, microorganisms and toxins present in marine environments. Many organisms are part of the normal flora of the gastrointestinal tract of food-producing animals. Milk, eggs, seafood, poultry, and meat from food-producing animals may become contaminated due to contaminated feed, misuse of veterinary drugs, or poor farming practices.
Common infectious pathogens
• Salmonella species
• Escherichia coli O157:H7 and other related strains
• Parasites Toxoplasma gondii and Cryptosporidium parvum;
• Norwalk virus.
The immediate consequences of these infections include acute illness with abdominal pain, diarrhea and vomiting. Salmonella, E. Coli and campylobacter actively infect after an incubation period of 1-3 days with acute diarrhea, abdominal pain, and fever as the chief symptoms. An infection may alter the immune reactivity of the GIT surface, leaving new food allergy in its wake. Many patients report an acute "food poisoning" episode at the onset of a long bout of digestive symptoms, often with delayed pattern food allergy downstream months later (fatigue, aching, headache, difficulty concentrating, memory loss.) Long-lasting conditions may follow foodborne infection - examples are reactive arthritis, sacroileitis, Guillain-Barré syndrome and hemolytic uremic syndrome (HUS or "Hamburger Disease") which can lead to kidney failure and death, particularly in young children.
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