Leading clinical syndromes
The disease is characterized by an acute onset and rapid development of symptoms. As a rule, the total duration of clinical manifestations in an uncomplicated course is about 48 hours.
The clinical picture is based on the gastroenteritic variant of the course of bacterial poisoning. Patients complain of persistent nausea, repeated vomiting, spastic pain in the epigastric region, and frequent loose stools.
Against the background of fluid loss with vomit and stool, dehydration syndrome rapidly develops. In most cases, it is moderately expressed: general weakness, dizziness are noted, and an objective examination reveals dryness of the skin and mucous membranes. In parallel, intoxication syndrome develops — it is also moderate in nature, while body temperature most often remains within subfebrile values.
Pathogenesis and potential complications
The development of clinical manifestations is due to the direct interaction of opportunistic bacteria with the epithelial cells of the gastrointestinal tract. A key role in the formation of pathology is played by the toxigenic properties of the pathogen. It is the action of specific bacterial toxins that leads to the development of the leading gastroenteritic (or, in rarer cases, gastroenterocolitic) syndrome, as well as general intoxication.
In severe cases, massive toxin exposure and critical electrolyte and fluid loss can provoke life-threatening conditions. The main complications requiring emergency resuscitation measures are hypovolemic shock (due to critical dehydration) and toxic-infectious shock (TIS).
Role of epidemiological history
Targeted collection of epidemiological history is critically important for making a preliminary diagnosis. The leading diagnostic criterion is the identification of a group character of morbidity.
Outbreaks most often occur among contacts or acquaintances who jointly visited the same catering establishment (e.g., a sushi bar) and consumed similar dishes. The disease affects a group of people almost simultaneously, although sporadic (single) cases are also possible.
In addition to the shared meal factor, the epidemiology of foodborne toxic infections takes into account:
- Main sources of infection (including humans).
- Seasonality of pathogen spread.
- Routes and factors of transmission of infection.
- Mechanisms of infection, as well as general population susceptibility and immune response features.
Laboratory and differential diagnosis
A presumptive clinical diagnosis requires confirmation by a set of laboratory tests. Clinical and epidemiological data are of primary importance, but tests are necessary for differentiation and assessing the patient's severity.
Differential diagnosis is mandatory with other acute intestinal infections (AII) occurring with gastroenteritis syndrome and moderate intoxication. First of all, it is necessary to exclude:
- Escherichiosis;
- Viral gastroenteritis.
To exclude the role of other pathogenic bacteria and viruses, bacteriological and immunological (serological) studies are used, including the use of autologous strains of the pathogen.
To clarify the severity of the course and assess the severity of metabolic disorders, the following are prescribed:
- Determination of plasma acid-base balance (ABB).
- Blood electrolyte profile study.
- Hematocrit level determination.
- Creatinine level assessment.
- Standard complete blood count (CBC) and urinalysis (UA).
Prehospital stage and management tactics
Prehospital management tactics are based on assessing the severity of the patient's condition and formulating a preliminary diagnosis. Based on clinical and epidemiological indications, the physician determines the feasibility of referring the patient to a specialized infectious disease hospital department.
Therapeutic measures must be started immediately:
- The basis of prehospital care is the immediate initiation of rehydration therapy.
- In parallel with the initiation of fluid replacement, an ambulance team should be called.
- Adequate rehydration must not be interrupted: it continues during the patient's transportation to the hospital in an ambulance vehicle.
Briefly: answers to topical questions
What objective clinical signs are characteristic of dehydration syndrome in foodborne toxic infections?
Objective clinical signs of dehydration syndrome in foodborne toxic infections include changes in the skin, mucous membranes, and hemodynamic parameters.
The main manifestations include:
- dryness of the skin and mucous membranes;
- decrease in skin fold turgor;
- presence and severity of cyanosis;
- changes in hemodynamic parameters;
- with more pronounced dehydration — decreased skin elasticity, moderate dry mouth, soft eyeballs, oliguria, decreased blood pressure against the background of tachycardia.
By what criteria is the severity of the course of foodborne toxic infection determined?
The severity of the course of foodborne toxic infection is determined by the severity of dehydration and clinical-laboratory criteria of exicosis.
Assessment of the severity of dehydration includes three blocks:
- Body weight deficit: up to 5% — mild degree, 6–9% — moderate degree, 10% and more — severe degree.
- Local tissue signs: state of skin turgor and elasticity, moisture of mucous membranes, state of the eyeballs.
- Systemic disorders: CNS state, hemodynamics, diuresis, acid-base balance.
Class and exam questions
Which diseases should be included in the differential diagnosis of food poisoning?
First of all, differential diagnosis is carried out with escherichiosis, viral gastroenteritis, and other acute intestinal infections proceeding with gastroenteritis and moderate intoxication.
Which complications pose the greatest threat to the patient's life?
The most dangerous conditions in a severe course are hypovolemic shock resulting from fluid loss, and toxic-infectious shock (TIS).
Which laboratory parameters need to be checked to assess metabolic disorders?
To assess the severity of the condition, a hematocrit test, plasma acid-base balance (ABB), blood electrolytes are prescribed, and the creatinine level is checked along with general blood and urine tests.
What is the first step in pre-hospital management?
The primary measure is the immediate initiation of rehydration therapy. It must be continued uninterrupted, including during the transportation of the patient to the hospital by an ambulance team.
What else to study on this topic
- Etiological structure and significance of opportunistic flora in the development of poisonings
- Main properties and pathogenicity factors of intestinal infection pathogens
- Mechanisms of development of hypovolemic and toxic-infectious shock
- Clinical classification of bacterial food poisoning and severity criteria
- Features of bacteriological diagnosis using autologous pathogen strains
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