Sushi poisoning

Japanese traditional food has long been popular far beyond the borders of this country. Sushi and rolls are often present on our tables: they can be tasted in many restaurants, ordered with home delivery or prepared by yourself, which is not very difficult if you have the necessary ingredients. However, no less often there are complaints of sushi poisoning. Why does this happen, and what dangers await lovers of such food?

Epidemiology

The poisoning season opens mainly in the summertime. Thus, during the hot months, the number of sick people increases dramatically, and this can be easily explained. During the summer heat, pathogenic microorganisms multiply especially actively, as the temperature of +25 to +40 ° C - a favorable condition for the factor of their vital activity. In sushi bacteria develop, get into the gastrointestinal tract, defense mechanisms are activated: the body tries to get rid of "unwelcome guests" in all ways. Tests have shown that sushi stored at a temperature of 15 degrees Celsius for more than eight hours is at risk of becoming toxic. After 12 hours, the risk became even more obvious. [1]

Fish and sushi top the list of all foods that are dangerous during the summer heat. They are followed by meat, dairy products and eggs. It is this food, if stored incorrectly, spoils within a few hours. And if customers order sushi with delivery, the product's journey through the hot streets is significantly lengthened, which increases the risk of poisoning several times.

The most common causative agents of toxic infection after eating sushi are staphylococci, salmonella, and E. Coli. [2]

Causes of the sushi poisoning

Any dish containing raw or insufficiently heat-treated product can quickly spoil and cause the development of food poisoning. Poorly processed fish is a perfect environment for bacteria to grow and multiply, which becomes the main cause of intoxication. A person can eat sushi that has been stored improperly or for too long. The risk increases due to the fact that it is almost impossible to determine the spoilage of this product by its appearance.

The second cause of sushi poisoning may not be bacteria, but helminths - parasites contained in raw, undercooked, low-salted fish. The acute stage of such poisoning occurs in the form of acute allergosis: the patient has a fever, there is pain in the abdomen and liver area, there is a rash. Fish products that have been subjected to deep freezing are less dangerous in terms of helminthiasis.

According to sanitary recommendations, fish should be kept for a minimum of one week in freezers at -18 or -20°C to avoid parasitic pathologies.

To ensure that seafood does not lose its flavor and nutritional quality, but at the same time is not contaminated with pathogens (salmonella, E. Coli), it should be stored and handled only in accordance with sanitary hygiene standards. The most important points are: proper storage, defrosting and preparation of fish for sushi.

The third possible cause of toxic damage after eating sushi is the presence of heavy metal salts in the fish - for example, mercury. It is important to realize that the abuse of raw seafood can lead to chemical poisoning.

It should be noted that poisoning can be caused not only by sushi, but also by its sauces. For example, wasabi, a sauce based on the herbaceous plant Eutremes, which belongs to the genus Cabbage and is a distant relative of the well-known horseradish, is quite popular. Since real wasabi is an expensive product, it is often replaced by ordinary horseradish with the addition of all sorts of coloring, flavor enhancing and other substitute ingredients. Such substitution is not always good for health and can also lead to poisoning. [3]

Risk factors

The likelihood of sushi poisoning depends not only on the presence of pathogens or toxic substances in the product. Factors such as:

• The state of a person's immune defense;
• age;
• The total number of toxic substances or pathogens that have entered the body.

The most vulnerable category of people are the elderly, as their digestive and urinary systems are unable to respond adequately to the introduction of pathogens and toxins. Young children and pregnant women are also at high risk.

In children under 6-7 years of age, the immune system is still unstable, so it cannot adequately respond to any external stimuli. Reduced immune response is also present in patients suffering from chronic pathological processes, such as diabetes mellitus, chronic form of viral hepatitis, immunodeficiency states. A significant risk of poisoning is also present in weakened patients undergoing radiation therapy.

Pathogenesis

The most common sushi poisonings are due to the metabolic effects of certain pathogenic or opportunistic microorganisms. Pathogenic agents or their toxic secretions may enter sushi during preparation, processing, storage or delivery. So-called cross-contamination, or the transportation of bacteria from one food and surface to another, is considered the most common cause of subsequent poisoning.

The pathogens responsible for intoxication can generate food toxicosis in a variety of ways. First, some bacteria interact directly with the mucous membranes of the digestive organs and produce their own pathogenic effects. Second, many infectious agents may themselves produce protein exotoxins that are destroyed only by adequate heat treatment.

Fungi, including molds and yeasts, make up their own biological kingdom. Certain variations capable of producing toxins are considered very dangerous. Their ingestion with food can cause human death.

In addition to bacteria and fungi, there may be a virus present in seafood (raw fish, mussels, oysters) - particularly HAV (hepatitis A pathogen). Other likely viral pathogens include rotavirus and norovirus infection.

Symptoms of the sushi poisoning

If a person has sushi poisoning, the main signs of the disorder will be as follows:

• Acute onset of intoxication (½ to 2 hours after eating sushi);
• Nausea, increased salivation, general discomfort;
• recurrent vomiting (gastric contents come out, followed by bile secretion);
• diarrhea, repeated liquid stools (brown to light yellow and greenish), sometimes with mucus and bloody streaks;
• abdominal pain, spastic, spasmodic, attack-like, cutting, stabbing.

After an episode of vomiting and liquid defecation, the person notes a slight relief, which is again replaced by another attack. The urges can be debilitating, heavy. Often there is an increase in temperature, there is pain in the head. In persons prone to hypertension, there is an increase in blood pressure.

Even after the disappearance of the first acute signs of sushi poisoning for several days, the patient's condition remains uncomfortable: flatulence, general weakness, loss of appetite, sometimes - skin rashes.

In severe cases, there is dizziness, blurred consciousness, increasing signs of dehydration. This condition requires urgent medical intervention: self-treatment of sushi poisoning can only aggravate the situation.

The incubation period for sushi poisoning is relatively short, only a few hours (often 30-60 minutes). Despite the possible polyetiology of the disease, the basic symptomatology of intoxication and water-salt disorders is practically the same.

Poisoning most often begins with the appearance of nausea, recurrent vomiting, liquid enteritic defecation. Abdominal pain manifests itself in different ways: from mild aching to sharp attack-like pain. Temperature rise is often short-term (up to 24 hours), reaches 38-39°C. There are chills, general discomfort, headache.

During examination of the patient, pallor of the skin (less often acrocyanosis), cold hands and feet are noted. Palpatory pain in the epigastrium and perineal region, change in pulse rate, decreased blood pressure are noted. The severity of signs of dehydration and demineralization depend on the degree of fluid deficiency in the body.

Most often, sushi poisoning goes away within 1-3 days if the patient is adequately treated.

The course of the disease may have some peculiarities, depending on the causative agent of poisoning. For example, staphylococcal infection is characterized by rapid development of symptoms with predominant manifestations of gastritis:

• recurrent vomiting;
• sharp pain in the stomach area.

The nature of the feces may not change. Temperature values are normal or rise briefly. There is a decrease in blood pressure, acrocyanosis, convulsions.

If poisoning is caused by the presence of Clostridium perfringens in sushi, then to the above described clinical picture is added pronounced diarrhea with liquid frothy stools, rapid increase in dehydration, enlargement of the liver and spleen.

In poisoning caused by Escherichia coli, there is a relatively mild course with few signs of general toxic effects: diarrhea, abdominal pain.

In Protein poisoning, the basic symptomatology is usually epigastric pain and liquid stools without pathologic inclusions. A violent course with fever, recurrent vomiting, liquid stool is rare, but still possible. Sometimes prothean intoxication runs like an acute surgical disease (appendicitis, perforative inflammation, etc.). [4]

Stages

The clinical course of any poisoning is divided into two stages:

1. Toxicogenic stage, in which the poisoning agent reaches an amount in the body capable of producing specific toxic effects.
2. Somatogenic stage, which occurs in response to the negative effects of a toxic substance.

Separately, we can distinguish the stage of detoxification, in which the effect of the toxic substance is stopped or reduced, as it is eliminated from the body in one way or another. Detoxification, in turn, can be natural (toxic agents are eliminated with vomit, feces, urine), specific (associated with the introduction of antidote or antidote) and artificial (involving the administration of sorbent drugs and means that reduce toxicity).

Forms

• Clinical variations of sushi poisoning:
  • Gastric;
  • enteritic;
  • gastroenteritic;
  • gastroenterocolytic.
• Types according to severity of course:
  • Mild poisoning;
  • moderate;
  • severe.
• Types, depending on the etiologic factor:
  • Bacterial intestinal infection;
  • bacterial food poisoning;
  • poisoning by chemical constituents;
  • parasitic pathology.
• Variations, depending on complications:
  • uncomplicated sushi poisoning;
  • complicated sushi poisoning.

Complications and consequences

Failure to treat a patient with sushi poisoning can lead to severe and unfavorable consequences - particularly dehydration, signs of which include:

• thirst, dry mucous membranes;
• dizziness, headache;
• apathy, severe weakness;
• the appearance of dark circles under the eyes;
• dry skin;
• difficulty breathing.

Medium and severe dehydration is accompanied by an increase in the above symptoms, there are pathological signs of the nervous and urinary system (anuria). The risk of seizure syndrome, shock or collapse increases.

The most severe complications of sushi poisoning are considered to be:

• hypovolemic shock;
• acute heart failure;
• necrotizing enteritis;
• anaerobic sepsis.

Fortunately, the described adverse effects are very rarely recorded.

Diagnostics of the sushi poisoning

The most important role in the diagnosis of sushi poisoning is played by such clinical and epidemiologic indicators:

• acute onset of the disease, predominant symptoms of gastritis or gastroenteritis;
• group nature of the incidence, or a clear link between the occurrence of the problem and the consumption of a particular food product (sushi).

The main tests involve isolation of the pathogen from vomit, lavage water and feces. If the pathogen is isolated, its toxicogenic properties are studied. It should be noted that in most patients with poisoning, the degree of detection of the pathogen is small, and even the detection of the pathological agent does not always allow you to consider it the "culprit" of toxic infection. Its etiologic involvement can be proved only by serologic tests with autostrain or identification of pathogens found in the contaminated product.

Serologic tests directly in the diagnosis of sushi poisoning do not play an independent role. Only increases in the antibody titer to the autostrain of the detected microorganism can serve as evidence.

Instrumental diagnosis is prescribed not so much in terms of searching for the causes of pathology, but to clarify the possible complications of poisoning. For this purpose, the patient is recommended to conduct an ultrasound study of internal organs, electrocardiography, gastroduodenoscopy.

Differential diagnosis

In the course of preliminary diagnosis, it is necessary to differentiate sushi poisoning with pathologies that have a similar clinical picture, as well as between different food toxic infections.

	Incubation period	Dominant symptoms
Clostridium perfringens Streptococcus faecalis Bacillus cereus	Six to twelve hours	Abdominal pain, diarrhea, sometimes nausea with vomiting
Salmonella, Escherichia coli, Yersinia, Campylobacter, Vibrios	18 to 36 hours	Abdominal pain, diarrhea, vomiting, fever, headache
Intestinal viruses	24 to 72 hours	Diarrhea, fever, abdominal pain, vomiting, respiratory distress
Amoebae, Giardia (protozoa)	7 to 28 days	Abdominal pain, diarrhea, gauntness, headache.
Marinotoxins	Up to 1 hour	Respiratory, sensory and motor disorders
Botulinum toxin	12 to 36 hours	Dizziness, double vision, impaired swallowing, breathing problems, speech problems, dry mucous membranes, general weakness
Organic mercury	At least 72 hours	Weakness in limbs, paresthesias, muscle spasms, visual impairment
Scombrotoxin (histamine).	Up to 1 hour	Headache, dizziness, bad taste in mouth, skin redness, itching, rashes
Campylobacter, listeria	Unspecified	Fever, head and joint pain, enlargement of peripheral lymph nodes

It is important to timely distinguish sushi poisoning from myocardial infarction, from some surgical diseases of the abdomen (acute appendicitis, pancreatitis), as well as from mushroom poisoning, methyl alcohol.

Treatment of the sushi poisoning

If intoxication is suspected, it is important to be clear about what to do when poisoned with sushi (sushi) on your own, and when to seek medical attention.

At the onset of the first suspicious symptoms, you should:

• induce vomiting, wash the stomach by drinking 2-3 glasses of warm water or a weak solution of potassium permanganate;
• Gastric lavage should be repeated until clear water comes out during vomiting;
• drink a sorbent in the appropriate dosage (activated charcoal, Enterosgel, Smecta, Polysorb, etc.);
• rest as much as possible, lie down;
• refuse to eat (at least for the next 24 hours), drink more fluids (plain water, black or herbal tea).

If well-being after the above measures after sushi poisoning has not normalized, it is necessary to consult a doctor. The specialist will examine the patient, palpate the abdomen, measure the temperature, if necessary, refer for laboratory tests.

At signs of dehydration may prescribe the use of saline solutions (in particular, rehydron). It is necessary to observe strict restrictions in eating. During the first 24 hours it is desirable not to eat at all. Then the diet includes liquid rice soup or porridge, kissel, breadcrumbs. Under the ban fall fried, spicy, fatty, smoked, pickled dishes that can worsen the patient's well-being.

Broad-spectrum antibiotics are prescribed only when indicated:

• prolonged fever;
• incessant vomiting;
• incessant diarrhea;
• severe abdominal pain.

Patients with a severe course of sushi poisoning require inpatient treatment.

Comprehensive therapy may include the following medications:

• Enterosgel - take 1 tbsp. L three times a day with water.
• Sorbex - 2-6 capsules three times a day.
• White charcoal - 3-5 tablets up to 4 times a day.
• Activated charcoal - 6-8 tablets 4 times a day.
• Atoxil - 1 packet up to 3 times a day.

Duration of use of sorbents in sushi poisoning is 3-10 days. Longer administration may lead to the development of constipation.

With severe diarrhea, you can take Smecta: powder from one sachet is diluted in 100 ml of warm water, stir well, drink. Repeat three times a day.

After the cessation of vomiting to restore water-electrolyte balance should drink plenty of clean water (up to 2.5-3 liters). To replenish the deficit of sodium and potassium salts prescribe Regidron solution - 1 tbsp. Spoon every 10-15 minutes.

If the patient is concerned about severe abdominal pain, then you can take antispasmodics - for example, Drotaverine or Spazmalgon, and with pronounced flatulence Movespasm will help:

Drotaverine	Recommended 1-2 tablets per administration, up to three times a day. Treatment may be accompanied by slight dizziness, decrease in blood pressure, tachycardia.
Spasmalgon	Take no more than 1-2 tablets per day, for no more than 3 days. The drug should be washed down with plenty of liquid.
Movespasm	Take 1 tablet up to 4 times a day, for no more than 5 days. The drug is contraindicated in unstable state of cardiovascular system.

Antidiarrheal drugs Loperamide and Imodium should not be used, as stopping the excretion of toxic substances with feces may contribute to the deterioration of the patient's condition: it is important to allow the body to cleanse itself. [5]

When the patient's well-being after sushi poisoning normalizes, it is recommended to take a course of probiotics to restore the microflora and gastrointestinal function. The drugs of choice can be:

• Enterogermina - take 1 vial up to 3 times a day, at regular intervals (or 2-3 capsules per day).
• Linex - take 2 capsules three times a day, with a small amount of liquid.
• Probiz - take 1 capsule up to 2 times a day, with warm water. Duration of treatment - 1-1.5 months.

Prevention

To avoid sushi poisoning, you need to:

• store the food for preparation as well as the sushi itself in the refrigerator, consuming it as soon as possible;
• fully and properly process the ingredients of a dish;
• rinse all food ingredients well, especially those that will not be heat-treated;
• do not buy the ingredients in spontaneous markets, on beaches, in small stores with slow realization of goods;
• Wash hands thoroughly under running water - both before preparing and eating sushi;
• listen to the reaction of your senses: if the aroma or taste of sushi seems strange to you, it is better not to eat it.

Particular care should be taken in the summertime.

Forecast

The prognosis for sushi poisoning depends on many factors:

• the general health of the patient;
• species affiliation of the causative agent of the toxic infection;
• the age of the person.

Special attention should be paid to patients who are at risk due to weak immunity. These are young children, elderly people, pregnant women, people with chronic pathologies that undermine the reactivity of immune defense.

Severe cases of intoxication may be accompanied by rapid deterioration of the patient's condition, general increasing dehydration of the body due to frequent urges to vomit and defecation, which may further lead to the development of septic complications.

Sushi poisoning is mostly successfully treated at home. However, if taking appropriate measures does not lead to an improvement in the patient's well-being, it is necessary, without wasting time, to seek qualified medical help. People who are in risk groups should contact their doctor as soon as the first suspicious symptoms are detected.