18.Food poisoning

Botulism (Allantiasis)

• Food poisoning caused by botulin exotoxins (Neurotoxins A, B, C, D, E, F, G) produced by Clostridium botulinum.

• Characteristics: Gram-positive, spore-forming bacteria; grows in sausages, canned, and tinned food under unsterile conditions.

Pathophysiology

• Cl. botulinum proliferates in contaminated food and releases exotoxins in anaerobic environments.

• Toxins block the release of acetylcholine at synaptic vesicles, leading to flaccid muscular paralysis.

• Impacts the myoneural junctions, inhibiting nerve impulses.

Signs and Symptoms

• Fatal Dose: 0.005 mg

• Fatal Period: 24-48 hours, potentially extending to a week.

• Initial Symptoms: Dry mouth, difficulty swallowing, retching, vomiting, constipation.

• Nervous Symptoms: Drooping eyelids, dilated pupils, diplopia, impaired vision.

• Progressive Symptoms: Descending paralysis affecting muscles, including respiratory muscles, leading to respiratory failure.

• Other Symptoms: Aphonia, sense of suffocation, muscular weakness, weak pulse, cyanosis of the face, dysphagia, dysarthria

• Fluctuating body temperature (may rise to 103°F then fall before death).

• Consciousness: Maintained until death, which is preceded by delirium and coma.

Differential Diagnosis

• Myasthenia gravis, poliomyelitis, multiple sclerosis, Guillain-Barre syndrome, encephalitis, tetanus, CO poisoning, organophosphate poisoning, elapid snake bite.

Treatment

1. Artificial respiration.

2. Anti-toxin: 50,000 units of Trivalent Anti-botulinum toxin (against serotypes A, B, and E).

3. Symptomatic management: Correct electrolyte imbalances.

Postmortem Appearances

• Congestion of all internal organs, particularly the lungs (may appear edematous).

• Isolation of Cl. botulinum from stomach contents and feces.

Medicolegal Points

• Accidental poisoning is common; spores found in honey can cause infant botulism (floppy baby syndrome).

• Associated with Sudden Infant Death Syndrome (SIDS).

• Suspected use of botulin toxin for homicide by intelligence agencies.

Botulinum Toxin Type A (Botox)

• Uses:

  • Treats strabismus

  • Manages blepharospasm

  • Addresses risus sardonicus

  • Alleviates facial muscle pain disorders

  • Used for cervical dystonia

• Risks:

  • Wound botulism can occur due to contamination or intravenous drug use.

Poisonous Mushrooms

• Some mushrooms are edible, while others are toxic.

• Common Toxic Varieties:

  • Amanita phalloides (Death Cap)

  • Amanita muscaria (Fly Agaric)

Amanita Phalloides (Death Cap)

• Characteristics:

  • White in color, cup-shaped base

  • Often mistaken for edible mushrooms (like Agaricus)

  • Contains white gills

  • Unpleasant taste, offensive odor as it ages

  • Grows in wooded areas

Toxic Principles in Amanita Phalloides

1. Amotoxins

2. Phallotoxins

3. Phallolysin

4. Antamonide

Mechanism of Action

• Amotoxins:

  • Inhibit DNA-dependent RNA polymerase.

  • Cause deficient protein synthesis leading to cell necrosis.

• Phallotoxins:

  • Act on cell membranes and cellular metabolism.

  • Lead to liver and some renal cell necrosis.

Fatal Dosage and Symptoms

• Fatal Dose: 2 to 3 mushrooms

• Fatal Period: 6 to 24 hours

• Symptoms:

  • Abdominal pain, nausea, and vomiting

  • Burning throat pain and diarrhea

  • Possible sweating, cyanosis, circulatory collapse, death

  • Potential hepato-renal failure if the patient survives.

Treatment

1. Stomach wash

2. Glucose saline and electrolytes

3. Activated charcoal

4. Symptomatic management

5. Dialysis (in case of renal failure)

6. Antiphalloidin serum

7. Silibin (hepatoprotective from Silybum marianum)

Postmortem Appearances

• Inflammation of the GIT

• Fatty liver changes and cloudy swelling of kidneys

• Congestion in other internal organs, including the brain.

Amanita Muscaria (Fly Agaric)

• Characteristics:

  • Orange cap with white flecks, color may vary from yellow, orange, to red

  • White stem and gills

  • Known for attracting and killing flies.

• Toxic Principles

  1. Muscarin

  2. Muscimol

  3. Ibotenic Acid

• Actions

  • Muscarine: Stimulates post-ganglionic cholinergic fibers, mimicking parasympathetic stimulation.

    • Effects include liver necrosis and renal damage.

  • Muscimol & Ibotenic Acid: Stimulate the GABA neurotransmitter system, inhibiting neuronal activity in the brain; exhibit psychoactive and hallucinogenic properties.

• Fatal Dose: 2 to 3 mushrooms

• Fatal Period: 6 to 24 hours

Signs and Symptoms

• Symptoms typically appear 30 to 60 minutes post-ingestion:

  • Early signs: euphoria, hallucinations, muscle jerks, pupil dilation, and sweating.

  • Possible rise in body temperature.

  • Gastrointestinal symptoms: nausea, vomiting, diarrhea.

  • Severe outcomes: circulatory collapse, coma, convulsions, and potential death.

Treatment

1. Stomach wash

2. Activated charcoal

3. Glucose saline and electrolytes

4. Atropine

5. Symptomatic management

Postmortem Appearances

• Brain may appear congested and edematous.

• Congestion of internal organs.

• Liver exhibits fatty changes.

Food Poisoning from Other Microorganisms

1. Clostridium perfringens

2. Staphylococci

3. Streptococci

4. Shigella

5. Vibrio parahaemolyticus

Ptomaine Poisoning

• Definition: Produced by bacterial decomposition of proteins; not classified as bacterial poisons.

• Types of Ptomaines:

  • Cadaveric Alkaloids: Produced in dead tissues.

  • Leucoamines: Produced during metabolism in living tissues.

• Forms of Ptomaines:

  • Gaseous: Methylamine

  • Liquid: Ethylamine

  • Solid: Neurine, poisonous and causes symptoms akin to atropine and muscarine poisoning.

Argemone Mexicana

• Common Names: Mexican poppy, Prickly poppy.

• Grows widely in India, characterized by yellow flowers and spiny thistle-like leaves.

• Seeds: Dark brown, resemble mustard seeds.

• Oil is used for adulteration with edible oils

• Oil causes epidemic dropsy.

Toxic Principles in Argemone Oil

• Principal alkaloids:

  1. Sanguinarine

  2. Dihydrosanguinarine

  3. Berberine

  4. Protopine

Symptoms

• Initial symptoms:

  • Loss of appetite

  • Diarrhea

• Physical signs:

  • Edema in lower limbs

  • Enlarged and tender liver

  • Severe cases may present myocardial damage and cardiac dilatation

  • Tingling and hyperesthesia of skin

  • Tenderness in calf muscles

• Other symptoms:

  • Breathlessness

  • Dimness of vision

  • Glaucoma

  • Possible development of subcutaneous telangiectasias

• Possible cause of death:

  • Heart failure

Treatment for Initial Symptoms

1. Cease oil intake

2. Provide nutritious food

3. Implement supportive measures

Lathyrus sativa (Khesari Dal)

• Type: Pulse belonging to family Leguminosae

• Usage: Common dietary item in North India

• Disease caused by continuous use:

  • Lathyrism (characterized by spastic paraplegia)

• Toxic Principle:

  • B-(N) Oxalyl amino-L-alanine (BOAA)

  • Its neurotoxic effects lead to paralysis of gluteal and lower limb muscles

Symptoms of Lathyrism

• Start with agonizing calf muscle pain

• Spasmodic contractions in thigh

• Progression of symptoms:

  • Weakness in legs

  • Difficulty sitting/standing from squatting ("no stick stage")

  • Progression to needing one stick, then two sticks for walking

  • Eventually, inability to stand, leading to crawling

• Muscle pain without sensory loss

• Increased knee jerks, marked ankle clonus, positive Babinski's sign

• No loss of consciousness or bladder/rectal involvement

• Later stages may affect lumbar segments

• Risk of aortic aneurysm from toxin

Prevention and Treatment

• Preventative measure: Parboil the pulse

• Recommended dietary limit: Not more than 25% of total diet

Ergot Alkaloids

• Main types:

  1. Ergotamine

  2. Ergometrine

  3. Ergonovine

  4. Ergobasine

• Source: Dried sclerotium of fungus Claviceps purpurea

Chronic Poisoning Symptoms

• Results from long-term consumption of flour contaminated with ergot:

  • Tingling, numbness, and burning sensation in lower limbs

  • Intense heat feeling

  • Development of red patches and blisters

  • Possible delirium and convulsions

  • Known as St. Anthony's fire

Poisonous Fish and Marine Creatures

• Food Poisoning: Poisoning due to consumption of fish and marine creatures is known as Icthyosarcotoxicosis.

Puffer Fish

• General Information:

  • Puffer fish (fugu) is the second most poisonous vertebrate in the world.

  • They possess the ability to inflate their bodies as a defense mechanism, signaling that they are poisonous.

• Toxicity:

  • Contains Tetradotoxin (TTX), a neurotoxin that is 1200 times more toxic than cyanide.

  • TTX blocks sodium channels in excitable tissues, leading to severe health effects.

• Location of Toxin:

  • Present in the skin, ovaries, gonads, and liver of the fish.

• Consumption Risks:

  • Despite known toxicity, puffer fish are in high demand, requiring trained chefs to prepare them safely.

  • Approximately 100 cases of poisoning and 3 deaths occur per 1,00,000 puffer fish servings annually.

• Signs and Symptoms:

  • Immediate symptoms include tingling and numbness of lips and fingers, followed by muscular weakness, vomiting, and diarrhea.

  • Severe cases can lead to respiratory paralysis, convulsions, and coma, ultimately resulting in death.

• Treatment:

  1. Symptomatic management.

  2. Electrolytes and glucose saline.

  3. Mannitol to alleviate neurological symptoms.

Malabar Puffer Fish

• A rare variety found in India, known as Carinotetraodon travancoricus.

• Habitat: Found in the Pamba river in Kerala.

• Size: World's smallest puffer fish; maximum length is around one inch.

Ciguatera Poisoning

• Cause: Caused by Ciguatoxin (CTN) produced by certain algae (dinoflagellates and protozoa).

• Mechanism: Algae proliferate during 'red tide' and accumulate toxins which are then ingested by herbivorous fish.

• Bioaccumulation: Larger fish (e.g., sea bass, grouper, red snapper) accumulate these toxins by eating herbivorous fish.

• Resistance to Cooking: Ciguatoxin is not destroyed by heating or boiling.

• Timing: Symptoms may start 2-3 hours after ingestion of cooked fish.

• Common Symptoms:

  • Abdominal pain

  • Vomiting and diarrhea

  • Tingling and numbness of the tongue and lips

  • Myalgia (muscle pain), muscular weakness, and arthralgia (joint pain)

  • Sensation of hot substances feeling cold and cold substances feeling hot

  • Feeling that teeth are loose

  • Metallic taste in the mouth

  • Headache

  • Low blood pressure and heart rate

  • Possible death due to respiratory paralysis

• Treatment:

  • Symptomatic treatment

  • Mannitol may be given to reduce cerebral edema and neurological symptoms

Scombroid Poisoning

• Species Involved: Tuna, mahimahi, amberjack, bonito, etc.

• Process: Increased histidine concentration converts to histamine during preservation.

• Symptoms: Allergic reactions such as itching, urticaria, and breathlessness occurring 30-90 minutes after ingestion.

Shellfish Poisoning

• Affected Species: Clams, oysters, mussels, scallops (exoskeleton-bearing aquatic invertebrates).

• Toxin: Saxitoxin (STX), a potent neurotoxin, accumulates from feeding on marine algae.

• Onset: Symptoms start within 30 minutes post-ingestion.

• Effects: Poison acts on the peripheral and autonomic nervous system, blocking depolarization at the neuromuscular junction.

Venomous Fish

• Examples: Catfish, dragon fish, lion fish.

• Details:

  • Catfish (Heteropneustes) have spines with venom produced by glandular cells in the epidermal layer.

  • Some catfish can deliver electric shocks upon contact.

  • Dragon fish are found in deep sea and may possess photophores (light-producing organs).

Box Jellyfish

• One of the most venomous animals in the world.

• Box-shaped cap with four eyes on each side.

• Tentacles contain potent poison.

• Cardiotoxic

• Causes sudden cardiac arrest; over 100 fatalities annually from poisoning.

• Tentacles have biological booby traps known as cnidocysts.

• When tentacles wrap around a prey, venom is injected.

Dart Frogs

• Highly poisonous frogs found in subtropical and tropical regions (e.g., Bolivia, Brazil, Colombia, Venezuela).

• Small in size (1-2 inches) and brightly colored.

• Secrete poisonous alkaloids from skin glands.

• One drop of poison can kill a human within 3 minutes.