Food poisoning by enterotoxin-forming bacteria A05.9

This is not an infection, but a food poisoning caused by bacterial enterotoxins. The enterotoxins are excreted by the pathogens as metabolites into the surrounding substrate. In Germany, food poisoning is most frequently caused by staphylococcal toxins (A to I), especially by enterotoxin B, which acts like a superantigen.

Staphylococcus aureus (40%), Clostridium perfringens (30%), less frequently Bacillus cereus (10%) which had multiplied excessively under suitable conditions in spoiled food (e.g. milk/egg products, meat, potato salad).

The S. aureus toxins are heat stable and are not destroyed by heating at^1000Cfor 30 minutes. Enterotoxin A causes vomiting in adults at doses as low as 1 µg, while enterotoxin B causes vomiting after 20 to 25 ng.

Food poisoning caused by enterotoxins is characterized by a short incubation period, usually only a few hours. The association with a previous food ingestion is almost always recognized by the patient and is an important differential diagnostic criterion.

Symptoms: Initially salivation, then nausea, retching, vomiting , and diarrhea. Vomiting and diarrhea may be explosive at the same time. In severe cases, exsiccosis, shock, the appearance of mucus and blood in stool and vomit, and hypokalemic muscle paralysis may occur. Body temperature is usually not elevated; in many cases, subnormal temperatures are measured. Restitution may occur within 24 hours or may take several days.

Frequent rapid increase in SGOT activity in blood serum; rapid onset of leukocytosis; at higher doses also leukopenia, later a clear shift to the left. Increase in blood glucose; decrease in serum protein and calcium and finally reduction in platelet count.

Clinic + medical history: Acute gastroenteritis in 2 or more people who have recently consumed the same food at the same time.

Infectious diarrhoea caused by salmonella, noroviruses

In combination of gastroenteritic symptoms with neurological symptoms (double vision, swallowing disorders), especially botulimic intoxication.

Mushroom poisoning

Symptomatic, possibly water and electrolyte replacement

Favourable; only short course of the disease of 1-2 days, only rarely there is an exitus, here mostly in newborns.

Food hygiene, especially in the warm season; eat food fresh.

Report by name in case of suspicion and illness.