Water And Foodborne Diseases

Front 1

Name some waterborne diseases

Back 1

Cholera

Giardiasis

Cryptosporidiosis

Legionellosis

Typhoid

Viruses

Amebiasis

Front 2

Name some Foodborne diseases

Back 2

S. aureus

Clostridium

Salmonella

E. Coli

Campylobacter

Listeriosis

Prions

Front 3

How many people in the US are sickened each year with foodborne illnesses?

Back 3

76 million people

Front 4

How many people are hospitalized because of foodborne illness?

Back 4

325,000

Front 5

How many people die because of foodborne illness?

Back 5

5,000

Front 6

What is the economic impact of foodborne illnesses?

Back 6

$14-152 billion

Front 7

Water is the most important ______ source of infectious disease

Back 7

potential

Front 8

Water quality ______ can cause massive spread of infectious disease

Back 8

Breakdwon

Front 9

What happens when there is water quality breakdown?

Back 9

Can be life-threatening, especially for the very young, elderly and immunocompromised

Front 10

______ are used to remove pollutants, in addition to physical and chemical purification procedures to water

Back 10

microorganisms

Front 11

Define Coliforms

Back 11

Indicators of fecal contamination of water

Front 12

Where do Coliforms live?

Back 12

In the intestinal tract of humans and other animals

Front 13

Describe Coliforms

Back 13

Rod-shaped Gram-negative non-spore forming bacteria which can ferment lactose with the production of acid and gas when incubated at 35-37C

Front 14

What are the typical genera of Coliforms

Back 14

Citrobacter, Enterobacter, Hafnia, Klebsiella, and Escherichia

Front 15

While not typically pathogenic themselves, the presence of ______ indicates fecal contamination of water and suggests water is unsafe for human consumption or use

Back 15

coliforms

Front 16

Effective water treatment practices were not developed until _____ century

Back 16

20th

Front 17

At first what did people do to purify water?

Back 17

Water was filtered to reduce turbidity

Front 18

In ____ coliform counting procedures were developed

Back 18

1905

Front 19

In _____ chlorine was introduced as a disinfectant

Back 19

1910

Front 20

What is the most significant procedure developed for preventing waterborne diseases?

Back 20

Chlorine

Front 21

What is the major sources of waterborne diseases?

Back 21

Improperly treated drinking water

Recreational water such as ponds, streams, lakes, pools, and fountains

Front 22

Microorganisms transmitted in water are _____ organisms that leave the body in the feces

Back 22

intestinal

Front 23

What is the source of the pathogens in waterborne diseases?

Back 23

May be animals (domestic or wild) or other humans

Front 24

In developing countries what diseases are important public health problems?

Back 24

cholera, typhoid fever, and amebiasis

Front 25

Define Cholera

Back 25

Severe diarrheal disease caused by Vibrio cholerae

Front 26

Describe vibrio cholerae

Back 26

Gram (-), comma shaped, flagellated

Front 27

Where is Cholera currently found?

Back 27

Largely in the developing world, although historically outbreaks were common in major cities such as London before water treatment and improvements in waste management

Front 28

What can cause Cholera?

Back 28

Aside from contaminated drinking water, consumption of raw shellfish from sewage-contaminated beds and raw vegetables washed in contaminated water can transmit V. cholerae and related species

Front 29

Since 1817 there have been ____ cholera pandemics

Back 29

7

Front 30

When was the 7th cholera pandemic?

Back 30

Began in 1961 and continues today

Front 31

What are the 2 strains of V. Cholera:

Back 31

Classic and El Tor

Front 32

What caused the first 6 cholera pandemics?

Back 32

Classic strain

Front 33

What caused the 7th cholera pandemic?

Back 33

The El tor strain

Front 34

How many cases of cholera have there been since 1961?

Back 34

5 million

Front 35

How many people have died of cholera since 1961?

Back 35

250,000

Front 36

How much bacteria is needed to cause a cholera infection?

Back 36

Ingestion of 10^8-10^9 bacteria

Front 37

Where do cholera bacteria colonize?

Back 37

Small intestine

Front 38

What does cholera bacteria release?

Back 38

enterotoxin, which causes severe diarrhea

Front 39

How much fluids can a patient lose if they have cholera?

Back 39

20L

Front 40

What is the mortality rate of untreated cholera?

Back 40

25-50%

Front 41

What has greatly improved cholera survival?

Back 41

Introduction of oral rehydration therapy

Front 42

What is Giardiasis caused by?

Back 42

Giardia species

Front 43

Giardiasis is ______ distributed protozoan parasite - ____ of all U.S. waterways

Back 43

Ubiquitously

97%

Front 44

Giardiasis is a major cause of ____ and ____ diarrheal disease

Back 44

endemic

epidemic

Front 45

Giardiasis is the most common protozoal disease in the United States. (T/F)

Back 45

True

Front 46

What is Giardiasis also known as?

Back 46

"Backpacker's disease"

"Beaver Fever"

Front 47

Who first observed Giardiasis?

Back 47

First observed by van Leeuwenhoek in 1681 using samples of his stool

Front 48

Giardia ____ (infectious stage) are resistant to chlorine and dehydration

Back 48

cysts

Front 49

The life cycle of Giardia lamblia (picture)

Back 49

Front 50

About half the people infected with Giardia are asymptomatic but may transmit infection (T/F)

Back 50

True

Front 51

When do Giardia symptoms usually begin?

Back 51

Begin within two weeks of infection

Front 52

What is the major symptom of Giardia?

Back 52

Diarrhea

Front 53

Describe the diarrhea symptom in Giardia

Back 53

Mild to severe

May last weeks to months

Exacerbation and remissions

Front 54

What are other symptoms (besides diarrhea) of Giardia?

Back 54

Steatorrhea (fatty diarrhea)

Abdominal cramps

Nutritional deficiencies due to malabsorption

Weight loss

Fatigue

In children, delayed growth and failure to thrive

Front 55

Municipal water should be properly ______ and _____

Back 55

treated

delivered

Front 56

How do you prevent Giardias when camping/backpacking

Back 56

ALL drinking water should be treated

Chemicals such as iodine or chlorine

Filtration using appropriate equipment

Boiling

Front 57

Travelers to developing countries should avoid tap water, ice, and raw food. (T/F)

Back 57

True

Front 58

How can you prevent Giardia?

Back 58

Avoid contact with feces and wash hands frequently

Front 59

What is Cryptosporidiosis caused by?

Back 59

Crytosporidium parvum

Front 60

Describe Cryptosporidium parvum

Back 60

a gastrointestinal protozoal parasite that causes watery diarrhea

Front 61

Cryptosporidiosis infection is usually self-limited but can be _____ in immunocompromised persons

Back 61

life-threatening

Front 62

Where can Cryptosporidiosis be found?

Back 62

In most bodies of water in the United States

Front 63

Cryptosporidiosis is a major global agent of disease (T/F)

Back 63

True

Front 64

Cryptosporidium is known to be among the most common ______ disease worldwide

Back 64

Intestinal

Front 65

How many crypto infections are there annually in the US?

Back 65

The CDC estimates that crypto causes 300,000 infections annually in the United States

Front 66

Why wasn't crypto recognized until recently?

Back 66

Symptoms are similar to other gastrointestinal pathogens

Most cases are self-limited and few are tested

Front 67

Crypto _____ cannot be killed by standard chlorination, and it is difficult to filter then out of water (Crypto ____ have been estimated to be present in >65% of surface water in the US)

Back 67

oocysts

oocysts

Front 68

What else can crypto infect besides humans?

Back 68

sheep, cattle, birds, rodents, and non-human primates

Front 69

Describe the Milwaukee outbreak

Back 69

In the Spring of 1993 pharmacies in Milwaukee, Wisconsin began to run out of anti-diarrheal medications

On April 5th the Milwaukee department of health reported that numerous cases of unknown gastrointestinal illness was causing widespread absences from work and school

On April 7th Cryptosporidium oocysts were detected in multiple patient stool samples

Mac Kenzie et al (NEJM 331:161-7) subsequently determined that one of the two water treatment plants serving the city and surrounding areas had allowed Cryptosporidium oocysts to enter the water supply and estimated that 403,000 persons (26% of the population) had been infected

Almost all infected people were able to clear their infections, but over 100 persons died from severe diarrhea; most of these deaths were in AIDS patients and the elderly

Front 70

The Cryptospordium life cycle (picture)

Back 70

Front 71

Describe the Crypto life cycle

Back 71

Following ingestion by the host, excystation occurs. The sporozoites are released and parasitize epithelial cells of the gastrointestinal tract, becoming trophozoites. In these cells, the parasites undergo asexual multiplication and then sexual multiplication (gametogony) producing microgamonts (male) and macrogamonts (female). Upon fertilization of the macrogamonts by the microgametes to produce a zygote, oocysts develop that sporulate in the infected host. Two different types of oocysts are produced, the thick-walled oocyst, which is commonly excreted from the host, and the thin-walled oocyst, which is primarily involved in autoinfection.

Front 72

What is Legionellosis (Legionnaires' Disease) caused by?

Back 72

Legionella pneumophila

Front 73

What is Legionellosis named for?

Back 73

the first recognized outbreak, which occurred during an American legion convention in 1976

Front 74

What happened during the first recognized outbreak of Legionellosis?

Back 74

More than 200 people infected, 29 died

Front 75

Describe Legionella pneumophila

Back 75

Gram (-) rod, complex nutritional requirements, such as requirement for high iron levels

Front 76

Legionella pneumophila is not related to any other organism associated with respiratory infections. (T/F)

Back 76

True

Front 77

Where can you find Legionella pneumophila in small numbers?

Back 77

Present in small numbers in lakes, streams, and soil

Front 78

Where can Legionella pneumophila in large numbers?

Back 78

In cooling towers and evaporative condensers of large air conditioning systems

How water tanks and spas, where they grow to high numbers in warm, stagnant water

Front 79

What is Legionella pneumophila resistant to?

Back 79

heating and chlorination

Front 80

How does Legionellosis infection occur?

Back 80

By inhaling airborne droplets

Front 81

How is Legionellosis an intracellular parasite?

Back 81

Invades and grows in alveolar macrophages and monocytes

Front 82

Legionellosis can be _____ or cause mild cough

Back 82

asymptomatic

Front 83

What happens if the elderly acquire Legionellosis?

Back 83

In the elderly, infections are more serious - intestinal disorders and pneumonia

Front 84

What is Typhoid fever caused by?

Back 84

Salmonella typhi

Front 85

______ are the only hosts of Typhoid fever

Back 85

Humans

Front 86

How does Typhoid fever infection occur?

Back 86

By ingestion of contaminated food or water

Contaminated with feces from asymptomatic carrier

Front 87

How is the infectious dose of Typhoid fever?

Back 87

1000-10,000 cells

Front 88

Where does the bacteria pass in Typhoid fever?

Back 88

Pass through intestinal wall and into the blood stream

Front 89

What is William Lincoln's connection to Typhoid fever?

Back 89

1850-1862 Third son of Abraham Lincoln, most likely died of typhoid fever contracted from contaminated water in the White House

Front 90

What happens to Typhoid bacteria in the blood?

Back 90

Are phagocytized, but not killed by macrophages

Front 91

Typhoid bacteria is carried where?

Back 91

To liver, spleen, bone marrow, and fall bladder

Front 92

What does Typhoid fever cause (symptoms)

Back 92

gradually increasing fever, headache, muscle pains, loss of appetite and "rose spot" rash

Front 93

What happens to Typhoid bacteria in gall bladder

Back 93

Bacteria in gall bladder are released back into the intestine - causing another round of gastroenteritis and bacteremia

Front 94

Describe "Typhoid Mary"

Back 94

Mary Mallon - first person in the US to be identified as an asymptomatic carrier of S. typhi

Caused many outbreaks of typhoid fever through her work as a cook

51 cases and 3 deaths were linked to her

She was involuntarily quarantined twice by public health authorities for a total of over 25 years

Front 95

Viruses can be transmitted by ____ and ____

Back 95

water

food

Front 96

Poliovirus has not be eliminated from the western hemisphere. (T/F)

Back 96

False. Now been eliminated from the western hemisphere

Front 97

Norovirus and ______ virus may also be spread in water contaminated with feces

Back 97

hepatitis A

Front 98

Water purification and _____ kill viruses

Back 98

chlorination

Front 99

Entamoeba hystolytica is transmitted by contaminated water. (T/F)

Back 99

True

Front 100

E. hystolytica is an Anaerobic amoeba - lack ______

Back 100

mitochondria

Front 101

E. Hystolytica cause many ______ infections

Back 101

asymptomatic

Front 102

What can E. Hystolytica lead to?

Back 102

amoebic dysentery

Front 103

What can E. Hystolytica invade?

Back 103

liver, lungs, and brain - can be fatal

Front 104

How many people develop amoebic dysentery worldwide each year?

Back 104

50 million people

Front 105

How many people die from amoebic dysentery?

Back 105

100,000 die from it

Front 106

In the US how many people get amoebic dysentery?

Back 106

In US several hundred cases per year, mostly in the Southwest near the Mexican border

Front 107

With Intestinal pathology was does severity depend on?

Back 107

the extent of damage to the colonic mucosa

Front 108

What are some symptoms in intestinal pathology?

Back 108

Chronic diarrhea (least sever)

Ulcerative colitis (more severe)

Amebic dysentery (most severe)

Front 109

Describe Ulcerative colitis

Back 109

abdominal pain and cramping

bloody stools

Front 110

Describe Amebic dysentery

Back 110

frequent watery stools containing blood and mucus

Severe abdominal pain

Dehydration

Front 111

What can perforation of the colon lead to?

Back 111

Peritonitis

Front 112

What does Extraintestinal pathology most frequently involve?

Back 112

The leader, leading to large abscesses

Front 113

What can large abscesses in the liver lead to?

Back 113

Leads to hepatic tissue destruction

May extend through the diaphragm, causing pulmonary symptoms

May erode through the abdominal wall

Front 114

What happens when E. histolytica spreads to the brain (via the blood)?

Back 114

Causes cerebral abscesses

Front 115

Cerebral abscesses due to E. histolytic is rare (About ____ of cases) but almost always _____

Back 115

0.1%

fatal

Front 116

describe the trophozoites form of E. histolytica

Back 116

Average 20 mm in diameter (range 12-60 mm)

Highly motile, uses pseudopodia

Has a prominent karyosome in the center of the nucleus

Feeds on host cells and bacteria

Anaerobic metabolism

Front 117

Describe the Cysts forms of E. histolytica

Back 117

10-15 mm in diameter

Contains 4 nuclei

Outer wall contains chitin

Can survive outside host for weeks to months

When ingested, produces 8 trophozoites

Front 118

What are the two categories of foodborne diseases?

Back 118

Food poisoning

Food infection

Front 119

Define Food Poisoning

Back 119

eating food containing preformed microbial toxins

Organism doesn't grow in the host

Organism does not need to be alive

Symptoms may begin within 30 min

Front 120

Define Food infection

Back 120

active infections resulting from eating pathogen-contaminated food

Front 121

Staphylococcus aureus is a common cause of _____/_____

Back 121

food poisoning

Front 122

Staphylococcus is a normal inhabitant of ____ and ______ tract

Back 122

skin

respiratory

Front 123

What does Staphylococcus aureus produce?

Back 123

Several heat stable toxins

Front 124

What does S. aureus cause?

Back 124

nausea, vomiting, diarrhea within 1-6 hours of ingestion

Front 125

What are foods commonly contaminated with S. Aureus?

Back 125

include custard and cream filled baked goods, poultry, meat, gravies, mayonnaise-based salads

Commonly kept in kitchens and outdoor parties at room temperature

Such conditions promote rapid growth in S. aureus and toxin production

Front 126

What happens when you heat S. Aureus contaminated foods?

Back 126

Toxin is heat stable - reheating foods may kill the bacteria but does not inactivate toxins

Front 127

What are the 2 members of the genus Clostridium that can cause food poisoning?

Back 127

Clostridium perfringens

Clostridium botulinum

Front 128

Both C. perfringens and C. botulinum are gram (_) spore formers

Back 128

+

Front 129

______ and ______ doesn't kill Clostridial spores

Back 129

canning

cooking

Front 130

When will Clostridial spores germinate?

Back 130

Under anaerobic conditions

Front 131

Where is Clostridium perfringens commonly found?

Back 131

in soil and intestinal tract of animals (Found in sewage)

Front 132

C. perfringens is the most common cause of food poisoning in the US (T/F)

Back 132

True

Front 133

How many cells is needed to cause a C. perfringens infection?

Back 133

10^8 cells

Front 134

In what foods can you find C. perfringens?

Back 134

found in cooked and uncooked meat, poultry, and fish

Front 135

What do C. perfringens enterotoxin alter?

Back 135

permeability of intestinal epithelium, leading to diarrhea and cramps

Front 136

How long does it take to develop symptoms after ingesting C. perfringens?

Back 136

Begins 7-15 hours after eating, resolves withing 24 hours

Front 137

Is C. perfringens infection fatal?

Back 137

Rarely

Front 138

What does C. botulinum cause?

Back 138

Often fatal food poisoning

Front 139

What is C. botulinum infection caused by?

Back 139

consumption of food containing the botulinum toxin

Front 140

What does C. botulinum normally inhabit?

Back 140

soil or water - spores may contaminate raw foods before harvest or slaughter

Front 141

If C. botulinum spores are not killed during canning what happens?

Back 141

They may grow in food and produce toxin

Front 142

What can introduce C. botulinum spores into can?

Back 142

Damage to packaging (e.g. dented cans) may introduce spores

Front 143

What does Botulinum toxin cause?

Back 143

flaccid paralysis

Front 144

How is Botulinum toxin destroyed?

Back 144

By high heat - heating to 80C for 10 min will inactivate toxin

Front 145

What do most cases of botulism occur from?

Back 145

eating home-canned foods that are not cooked after opening

Front 146

All forms of botulism are ____ in the US

Back 146

Rare

Front 147

About how many causes of botulism every ear?

Back 147

ABout 150 cases per year, of which 25% are fatal

Front 148

What is given to people with botulism to neutralize toxin?

Back 148

Antitoxin

Front 149

What is also necessary for botulism infection?

Back 149

Mechanical ventilations

Front 150

Describe infant botulism

Back 150

usually self-limiting and most infants recover with assisted ventilation

Front 151

Define Salmonellosis

Back 151

Food infection caused by species of Salmonella

Front 152

Salmonella are normal inhabitats of animal ______ tracts

Back 152

intestinal

Front 153

All Salmonella species are _____ to humans

Back 153

pathogenic

Front 154

Over _____ serotypes of known pathogenic Salmonella

Back 154

1400

Front 155

How many people get Salmonellosis each year?

Back 155

45,000 documented cases per year in US

Estimated 1.3 million cases per year in US

Front 156

What are the sources of infection for Salmonellosis?

Back 156

are the intestinal tracts of humans and animals

Front 157

_____ and ____ harbor Salmonella - eggs, meat, dairy products can be contaminated

Back 157

Chickens

Cattle

Front 158

What is Salmonellosis often traced to?

Back 158

Custards, cream cakes, meringues, pies, eggnog, meat pies, cured uncooked meats, poultry, milk and milk products

Front 159

How many Salmonella cells do you need to consume to get sick?

Back 159

10^5 to 10^8 organisms

Front 160

When do Salmonellosis symptoms typically begin?

Back 160

8-48 hours following ingestion and include headache, chills, vomiting, and diarrhea

Front 161

How long does Salmonellosis take to resolve?

Back 161

in 2-3 days, but can be fatal in the elderly and immunocompromised

Front 162

Salmonella is shed in _____ for several weeks

Back 162

feces

Front 163

Some people shed Salmonella for months or years - ________ carriers

Back 163

asymptomatic

Front 164

What happens if Salmonella enters the blood?

Back 164

Typhoid fever

Front 165

Describe Salmonella bioterrism in the US

Back 165

In 1984, Followers of Bhagwan Shree Rajneesh carried out a bioterrorism attack in Oregon by trying to incapacitate voters using Salmonella typhimurium. They got the pathogen from a biological supply company

Front 166

How many pathogenic strains of E. Coli ?

Back 166

200

Front 167

What can a pathogenic strain of E. Coli cause?

Back 167

Cause life threatening diarrheal disease and urinary tract infection

Front 168

How many groups are the pathogenic E. Coli strains divided into?

Back 168

several

Front 169

What does pathogenic E. coli groups depend on?

Back 169

Depending on toxin produced and disease they cause

Front 170

What does Enterohemorrhagi E. Coli (EHEC) cause?

Back 170

Hemorrhagic diarrhea and kidney failur

Front 171

How many infections does E. Coli O157: H7 cause in a year? Deaths?

Back 171

60,000 infections

50 deaths

Front 172

What is the treatment for pathogenic E. Coli?

Back 172

Treatment is supportive therapy and in severe cases antibiotic therapy

Front 173

How should you prevent E. Coli O157:H7?

Back 173

By cooking meat thoroughly

Front 174

What was approved specifically to prevent infection by E. Coli O157:H7?

Back 174

Irradiation of ground beef

Front 175

What is Pedestal formation associated with?

Back 175

Attaching and effacing (AE) lesions in epithelial cells

Front 176

What E. Coli strains form pedestals?

Back 176

EHEC (and EPEC)

Front 177

Why are some E. Coli strains pathogenic and not others?

Back 177

Pathogenicity islands - regions of the genome encoding virulence factors that are inherited by horizontal transfer

Front 178

Define Pathogenicity Islands

Back 178

Regions of the genome encoding virulence factors that are inherited by horizontal transfer

Front 179

Where can Pathogenicity island be found?

Back 179

Be part of the chromosome or plasmids

Front 180

A pathogenicity island is necessary for _____/_____

Back 180

eterocyte effacement

Front 181

What does enterocyte effacement carry?

Back 181

Carries the genes for pedestal formation

Front 182

What do the sequences of virulence genes often contain?

Back 182

Different amounts of guanine and cytosine (i.e., G + C) residues than are found in the rest of the genome

Front 183

What does PAI stand for?

Back 183

Pathogenicity Island

Front 184

Salmonella King Nut contamination

Back 184

2008-9

An investigation suggested King Nut brand creamy peanut butter as a likely source of Salmonella infections among many ill persons in Minnesota

Front 185

Salmonella Peanut Butter contamination

Back 185

2007

Salmonella from Peter Pan and Great Value Peanut Butter in 39 states since August of 2006

Front 186

E. Coli Taco Bell contamination

Back 186

2006

E. Coli O157: H7 from Taco Bell in New Jersey and Long Island. 39 people in central New Jersey and on Long Island were sickened

Front 187

E. Coli spinach contamination

Back 187

2006

North American E. Coli outbreak. E. Coli O157:H7 in bagged spinach packaged by Natural Selection Foods and most likely supplied by Earthbound Farm in San Juan Bautista

Front 188

Define prions

Back 188

Proteins that adopt altered structures and cause disruption of neural tissue

Front 189

Define Varian Creutzfeldt-Jakob Disease (vCJD)

Back 189

Slow acting degenerative neurological disease

Front 190

How is Variant Creutzfeldt-Jakob disease spread?

Back 190

Spread by eating meat from cattle infected with bovine spongiform encephalitis (BSE) - mad cow disease

Front 191

Prions are not destroyed by _____ - can affect related human protein configuration

Back 191

heat

Front 192

What did Stanley Pruisner get a Nobel Prize for?

Back 192

1997

For his discovery of prions

Front 193

What does prion stand for?

Back 193

Proteinaceous infections particle

Front 194

When can Prion disease occur?

Back 194

spontaneously, triggered by infection, or consequence of hereditary predisposition

Front 195

Previously prion-caused diseases thought to be due to "_____/_____"

Back 195

slow/viruses

Front 196

Define Kuru

Back 196

a neurodegenerative disorder that surfaced among the Fore of New Guinea

Front 197

Describe the Kuru epidemic

Back 197

Reaches it height in the 1960s. The vast majority of victims among the South Fore were women. In face, eight times more women than men contracted the disease

Front 198

What gets deposited into the brain during Kuru disease?

Back 198

Amyloid fibers get deposited in the brain (vCJB). May overload proteasome and cause cell death

Front 199

Describe Kuru as it progresses

Back 199

Neurons develop vacuoles. As the disease progresses, vacuolization becomes more pronouced and the cortical cells develop a spongy appearance, hence the term spongiform encephalopathy