Diagnosis of food toxic infections

Diagnosis of food toxic infections is based on the clinical picture of the disease, the group nature of the disease, the connection with the use of a certain product in violation of the rules for its preparation, storage or sale.

The standard of examination of patients with suspected foodborne disease

Study	Changes in indicators
Hemogram	Moderate leukocytosis with a stab-shift left. With dehydration - an increase in hemoglobin and the number of red blood cells
Analysis of urine	Proteinuria
Hematocrit	Increase
Electrolyte blood composition	Hypokalemia and hyponatremia
Acid-base condition (with dehydration)	Metabolic acidosis, in severe cases - decompensated
Bacteriological examination of blood (with suspected sepsis), vomit, stool and gastric lavage	Isolation of culture of opportunistic pathogens. Studies are conducted in the first hours of the disease and before the start of treatment. The study of phage and antigenic uniformity of the culture of opportunistic flora obtained from patients and in the study of suspicious products. Identification of toxins in staphylococcosis and clostridiosis
Serologic examination in paired sera	RA and RPGA from the 7th-8th day of the disease. Diagnostic titer 1: 200 and above: the growth of antibody titer in the study in dynamics. Formulation of RA with an autostam-m of a microorganism isolated from a patient with PTI caused by a conditionally pathogenic flora

The decision on hospitalization of the patient is made on the basis of epidemiological and clinical data. In all cases, a bacteriological study should be conducted to exclude shigellosis, salmonella, iersiniosis, escherichiosis and other acute intestinal infections. An urgent need for bacteriological and serological studies arises when there is a suspicion of cholera, in case of group cases of the disease and the occurrence of nosocomial outbreaks.

To confirm the diagnosis of foodborne disease, it is necessary to isolate the same microorganism from the patient's feces and residues of a suspicious product. This takes into account the massiveness of growth, phage and antigenic uniformity, antibodies to the isolated strain of microorganisms found in convalescents. Diagnostic value is the setting of RA with an autostam in paired sera and a 4-fold increase in titer (with proteosis, cerosis, enterococcosis).

If suspected of staphylococcosis and clostridiosis, identification of toxins in vomit, feces and suspicious products is carried out. The enterotoxic properties of the isolated culture of staphylococcus are determined in animal experiments.

Bacteriological confirmation requires 2-3 days. Serological diagnosis of food poisoning is carried out in paired sera to determine the etiology of food toxic infection retrospectively (from 7-8 days). The general analysis of blood, urine, instrumental diagnostics (recto- and colonoscopy) is of little informative.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Indications for consultation of other specialists

Differential diagnosis of foodborne infections requires consultation:

• surgeon (acute inflammatory diseases of the abdominal cavity organs, mesenteric thrombosis);
• therapist (myocardial infarction, pneumonia);
• gynecologist (impaired tubal pregnancy);
• neurologist (acute violation of cerebral circulation);
• toxicologist (acute poisoning with chemicals);
• endocrinologist (diabetes mellitus, ketoacidosis);
• resuscitator (shock, acute renal failure).

Differential diagnosis of food poisoning

Differential diagnosis of food poisoning is carried out with acute diarrheal infections, poisoning with chemicals, poisons and fungi, acute diseases of the abdominal cavity, therapeutic diseases.

In the differential diagnosis of food poisoning with acute appendicitis, difficulties arise from the first hours of the disease, when the symptom of Kocher (pain in the epigastric region) is observed for 8-12 hours. Then the pain moves to the right iliac region; At the abnormal location of the appendage, the localization of pain may be indeterminate. Possible dyspeptic phenomena: vomiting, diarrhea of varying severity. With acute appendicitis, pain precedes an increase in body temperature, is of a permanent nature; patients note the increasing pain in coughing, walking, changing the position of the body. Diarrhea syndrome with acute appendicitis is less pronounced: feces are mushy, fecesome. With palpation of the abdomen, local tenderness is possible, corresponding to the location of the appendix. In the general analysis of the blood - neutrophilic leukocytosis. For acute appendicitis is characterized by a short period of "calm", after which in 2-3 days there is destruction of the appendage and develops peritonitis.

Mesenteral thrombosis is a complication of ischemic bowel disease. Its occurrence is preceded by ischemic colitis: colic pain in the abdomen, sometimes vomiting, alternation of constipation and diarrhea, flatulence. In thrombosis of large branches of the mesenteric arteries, gangrene of the intestine arises: fever, intoxication, intense pain, repeated vomiting, loose stools with an admixture of blood, bloating, weakening and disappearance of peristaltic sounds. Pain in the abdomen diffuse, permanent. On examination, symptoms of irritation of the peritoneum are detected; at a colonoscopy - erosive-ulcerative defects of a mucous membrane of wrong, sometimes annular form. The final diagnosis is established with selective angiography.

For strangulation obstruction is characterized by a triad of symptoms: cramping pain in the abdomen, vomiting and cessation of feces and gases. Diarrhea is absent. Typical bloating, increased peristaltic noise. Fever and intoxication occur later (with the development of gangrene of the gut and peritonitis).

Acute cholecystitis or cholecystopancreatitis begins with an attack of intense colicky pain, vomiting. Unlike food poisoning, pain is displaced in the right hypochondrium, radiating to the back. Diarrhea is usually absent. After the attack, chills, fever, darkening of the urine and fecal discoloration occur; ikterichnost sclera, jaundice; bloating. With palpation - soreness in the right hypochondrium, a positive symptom of Ortner and a frenicus-symptom. The patient complains of pain during breathing, soreness to the left of the navel (pancreatitis). In the study of blood - neutrophilic leukocytosis with a shift to the left, an increase in ESR; an increase in the activity of amylase and lipase.

Differential diagnosis of food poisoning with myocardial infarction in elderly patients with IHD is very difficult, as it is possible a complication of food poisoning with myocardial infarction. In case of food poisoning, the pain does not irradiate beyond the abdominal cavity, has a paroxysmal, colic character, while with myocardial infarction the pain is dull, pressing, constant, with characteristic irradiation. In case of food poisoning, the body temperature rises from the first day (in combination with other signs of intoxication syndrome) and in case of myocardial infarction - on the 2-3rd day of the disease. In people with a history of cardiovascular history with food poisoning in the acute period of the disease is possible the occurrence of ischemia, rhythm disturbances in the form of extrasystole, atrial fibrillation (polytopic extrasystole, paroxysmal tachycardia, shift of ST interval to ECG are not characteristic). In doubtful cases, the activity of cardiospecific enzymes is investigated, ECG is performed in dynamics, echocardiography. In case of shock in patients with foodborne toxicosis, dehydration is always found, therefore, signs of stagnation in the small circulation range (pulmonary edema) characteristic of cardiogenic shock are absent before the beginning of infusion therapy.

Hypercoagulation, hemodynamic disorders and microcirculatory disorders due to toxins damage to the vascular endothelium in food toxic infections contribute to the development of myocardial infarction in patients with chronic ischemic heart disease. Usually it occurs in the period of the abatement of food poisoning. This relapses pain in the epigastric region with characteristic irradiation, hemodynamic disorders (arterial hypotension, tachycardia, arrhythmia). In this situation, it is necessary to conduct the whole complex of studies for the diagnosis of myocardial infarction.

Atypical pneumonia, pneumonia in children of the first year of life, as well as in linden. Suffering from violations of the secretory function of the stomach and intestines, alcoholism, cirrhosis of the liver, may occur under the guise of food poisoning. The main symptom is a stooly stool; less often - vomiting, pain in the abdomen. Characterized by a sharp increase in body temperature, chills, cough, chest pain when breathing, shortness of breath. Cyanosis. X-ray examination (standing or sitting, as it is difficult to detect basal pneumonia in the lying position) helps confirm the diagnosis of pneumonia.

Hypertensive crisis is accompanied by repeated vomiting, fever, high arthritic pressure, headache, dizziness, pain in the heart. Diagnostic errors are usually associated with fixing the doctor's attention to the dominant symptom, which is vomiting.

Differential diagnosis of food poisoning should be conducted with alcoholic enteropathy; it is necessary to take into account the relationship of the disease with alcohol consumption, the presence of a period of abstinence from alcohol, the long duration of the disease, the ineffectiveness of rehydration therapy.

A similar clinical picture can be observed in people with drug dependence (with abstinence or drug overdose), but with anamnesis, a less pronounced diarrheal syndrome and a predominance of neuro-vegetative disorders over dyspepsia.

Foodborne diseases and uncompensated diabetes mellitus have a number of common signs (nausea, vomiting, diarrhea, chills, fever). As a rule, a similar situation is observed in young people with concealed type 1 diabetes mellitus. In both states there are disorders of water-electrolyte metabolism and acid-base state, hemodynamic disturbances in severe course. Due to the refusal to take hypoglycemic preparations and food, which is observed in foodborne toxic infections, the condition rapidly deteriorates and ketoacidosis develops in diabetic patients. Diarrhea syndrome in diabetics is less pronounced or absent. The decisive role is played by determining the level of glucose in the blood serum and acetone in the urine. Has a history of: complaints of the patient for dry mouth. A few weeks or months before the disease; weight loss, weakness. Skin itching, increased thirst and diuresis.

With idiopathic (acetonemic) ketosis the main symptom is a strong (10-20 times a day) vomiting. The disease is more likely to affect young women 16-24 years old, have suffered mental trauma, emotional overstrain. Characteristic odor of acetone from the mouth, acetonuria. Diarrhea is absent. The positive effect of intravenous administration of 5-10% glucose solution confirms the diagnosis of idiopathic (acetone) ketosis.

The main symptoms that make it possible to distinguish a disturbed tubal pregnancy from foodborne disease are pallor of the skin, cyanosis of the lips, cold sweat, dizziness, agitation, dilated pupils, tachycardia, hypotension, vomiting, diarrhea, acute pain in the lower abdomen with irradiation into the rectum, brownish discharge from the vagina, a symptom of Schetkin; in the anamnesis - the delay of menstruation. In the general analysis of blood - a decrease in the content of hemoglobin.

Unlike foodborne disease, with cholera, fever and abdominal pain are absent; diarrhea precedes vomiting; feces do not have a specific odor and quickly lose their fecal character.

In patients with acute shigellosis, the intoxication syndrome predominates, and dehydration is rarely observed. Typical cramping pain in the lower abdomen, "rectal spitting", tenesmus, spasm and soreness of the sigmoid colon. Characteristic is the rapid cessation of vomiting.

With salmonellosis, signs of intoxication and dehydration are more pronounced. The stool is liquid, plentiful, often greenish in color. The duration of fever and diarrhea syndrome is over 3 days.

Rotavirus gastroenteritis is characterized by an acute onset, epigastric pain, vomiting, diarrhea, loud rumbling in the abdomen, fever. Perhaps a combination with catarrhal syndrome.

Escherichiosis proceeds in various clinical variants and can resemble cholera, salmonellosis, shigellosis. The most severe course, often complicated by hemolytic-uremic syndrome, is characterized by enterohemorrhagic form caused by E. Coli 0-157.

The final diagnosis in the above cases is possible only after a bacteriological study.

When poisoning with chemical compounds (dichloroethane, organophosphorus compounds), liquid stools and vomiting also occur, but these symptoms are preceded by dizziness, headache, ataxia, psychomotor agitation. Clinical signs appear within a few minutes after taking a poison. Characterized by sweating, hypersalivation, bronchorrhea, bradypnoe, pathological types of breathing. Possible the development of coma. When poisoning with dichloroethane is likely the development of toxic hepatitis (up to acute liver dystrophy) and acute renal failure.

When poisoning with alcohol substitutes, methyl alcohol, poisonous fungi, the incubation period and prevalence of gastritic syndrome at the onset of the disease are more characteristic than for foodborne toxic infection. In all these cases, consultation with a toxicologist is necessary.

[13], [14], [15], [16], [17], [18], [19]