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Foodborne Illnesses Listed by Category Below

 

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  Summary
Background
Clinical Features (symptoms)
Diagnosis and Control
Route of transmission
Foods to avoid
Risk Groups
Treatment & Prevention
  
     
  Summary:  
  Helicobacter pylori (H.pylori) is the scientific name for a type of bacteria which resides in the protective mucous lining of the stomach where it causes gastritis, an inflammation of the stomach lining.  
 
 
  Background:  
  Approximately 25 million people in the US are infected with H.pylori; a number roughly equivalent to 10% of the population. This number is higher in less developed nations where sanitation issues exist. H.pylori is the leading cause of ulcers and accounts for some 80-90% of all cases in the United States. Other reported causes of cases include individuals with acid hypersecretory disease (ie- Zollinger Ellison Syndrome) and there has been an association with the use of non-steroidal anti-inflammatory (NSAIDS) drugs like aspirin. In 1982 when helicobacter was discovered, ulcers were believed to be caused by factors such as stress and spicy or acidic foods. H.pylori burrows its way into the mucous lining of the stomach where it resides protected for an indefinite period of time. Logically, many people were treated with medications, such as H2 blockers and drugs blocking acid secretion and while temporary releif was often attained, such remedies failed to provide an effective long term cure. After a bacterial source of the ulcers was identified the majority of ulcers were found to be quite treatable with antibiotics various antibiotic cocktails.  
 
 
  Clinical features (Symptoms)  
 

The vast majority of infected people never develop any symptoms at all. It is the active cases which receive the most attention and call for action. In those people persistent gastritis in children and adults can occur . Ulcers of the duodenum (upper part of the intestine) and gastic mucosa (lining of the stomach) often occur. Some of these symptoms of ulcers include:

  • most commonly gnawing or burning pain occurs when the stomach is empty or between meals
  • less commonly nausea, vomiting and loss of appetite
  • bleeding can sometimes occur (hematemesis, hematochezia, or melena if bleeding is severe enough
  
 
 
  Diagnosis and control  
 

Several tests exist for the detection of H.pylori.    They are listed as follows:

  • Serological tests- examination of the blood to detect antibodies to H.pylori.  The presence of antibodies typically indicates past infection.   These test are between 80 and 90% accurate.
  • Breath Test- the patient is given a radioactive urea drink (labeled with13C or 14C).  As the bacteria metabolize the urea, it is formed into carbon dioxide which is mildly radioactive and can be detected as the perosn exhales.
  • Endoscopy and biopsy-  During endoscopy stomach and duodenum samples are collected and tested for (1) their ability to metabolize and enzyme called urease, (2) identification of the bacteria through classical histology; an approach which uses chemicals to selective stain bacteria, and (3) by culturing the bacteria in the lab.
  
 
 
  Routes of transmission?  
  Little is known about how people come to be infected.   The most plausible explantion involves transmission by a fecal-oral route in which bacteria are passed from person to person through improper handwashing and inadequate personal hygiene.   Contaminated drinking water may be a source of infection, particularly in poorer nations which may lack suitable resources to sterilize their drinking water.  
 
 
  Foods to avoid  
   
 
 
  Risk groups  
  Not known, however, most infections seem to occur sometime during childhood.  
 
 
  Treatment and prevention  
 

Treatment today consists of a 1 or 2 weeks of one or more antibiotics.   Eradication rates range from 70% to 90% depending upon the regimen used.   In those cases where treatment has failed, antibiotic resistence and patient non-compliance are the two major causes.

FDA Approved Treatment Options .

Omeprazole 40mg QD + clarithromycin 500mg TID for 2 weeks, then omeprazole 20mg QD x 2 weeks

or

Ranitidinebismuth citrate (RBC) 400mg BID + clarithromycin 500mg TID for 2 weeks then RBC 400mg BID for 2 weeks

or

Bismuth subsalicylate (Pepto Bismol) 525 mg QID + metronidizole 250mg QID + tetracycline 500mg QID* for 2 weeks + H2 receptor antagonist therapy as directed for 4 weeks

or

Lansoprazole 30mg BID + amoxicillin 1 g BID + clarithromycin 500mg BID for 14 days

or

Lansoprazole 30mg TID + amoxicillin 1 g TID for 14 days**

*amoxicillin is not FDA approved for this purpose, it is often substituted for tetracycline in individuals for whom tetracylcine is not recommended.

Disclaimer: these like any prescription drugs require the approval of a licensed physician and it is unlawful to take these drugs without their consent!

**This therapy has restricted labeling.   It is only recommended for individuals with allergies or intolerance for clarithroycin or for infections resistant to toclarithromycin. 

For more information on travel related foodborne-illness please visit the Centers for Disease Control and Prevention.   In case of accidental exposure, immune globulin may be administered.

 
 
 
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