【正文】 ytic shellfish poisoning ? 毒蕈中毒 Noxious mushroom poisoning 2/3/2022 Food poisioning 95 Puffer fish poisoning 河豚魚中毒 The puffer fish lives in shallow coastal waters, coral reefs and tidal lagoons in the western and central Pacific Ocean. The puffer fish has rounded fins and eyes that protude from its head. The puffer fish gets its food by using its pufferlike beak like teeth. The pufferfish protects itself by puffing itself up by taking gulps of water or air to fill its stomach. This makes the spine on its body which normally lies flat against its skin puff up. 2/3/2022 Food poisioning 96 Toxin: tetrodotoxin ? 性質：無色針狀結晶，微溶于水，性質穩(wěn)定，為毒性極強的非蛋白類毒素，100℃ 7小時或 200℃ 以上 10分鐘才可破壞。 ? 毒性大?。郝殉病⒏闻K最毒 ? 腎、血液次之 ? 魚體以皮膚最毒，肌肉次之 ? 毒性與季節(jié)有關，春季最毒 2/3/2022 Food poisioning 99 Poisoning Mechanism ? 口腔與胃腸道粘膜吸收 ? 作用于神經(jīng)系統(tǒng) ? 阻斷神經(jīng)肌肉間的傳導 ? 使神經(jīng)末梢和中樞神經(jīng)麻痹。g/kg) because stomach acid destroys the toxin. ? TTX is a slightly water soluble and heat stable, but it is sensitive to strong acids and alkalis. The toxin can enter the body by ingestion, injection, inhalation and through abraded skin. 2/3/2022 Food poisioning 98 毒素分布及毒性大小 ： ? 卵巢、肝、脾、腎等臟器及皮膚、血液、眼球等部位。 芽孢可耐濕熱 100℃ 5h或干熱 180℃ 5~min或高壓蒸汽 121℃ 30min， 對營養(yǎng)條件要求不高 ， 自然界分存廣泛 ， 在土壤中半永久性生長 。這與酒店內部管理不善，操作者衛(wèi)生知識缺乏有直接關系；而所有的環(huán)境條件又正好適宜于副溶血性弧菌的生長繁殖，最終導致了這次中毒的發(fā)生。s membrane is another way of killing cells. Bacteria use hemolysin to put holes in our membranes. 2/3/2022 Food poisioning 52 Epidemiological Characteristic ? 1. Distribution： a worldwide distribution in estuarine and coastal environments ? 近海海灣，近海淡水，富含有機物（中國、日本多見） ? 2. Season： warmer months （ 7~9月） ? Incidences correlate with water temperature. It attaches to plankton, which is eaten by the fish, later eaten by people. ? 3. Susceptibility: ? 4. Poisoning food： marine product including many species of fish, shellfish, and crustaceans（ crabs, shrimp, and lobsters ） . （ 檢出率與季節(jié)有關） ? 墨魚： 93%，蟹： %， ? 帶魚： %，大黃魚： % 2/3/2022 Food poisioning 53 V. parahaemolyticus has been implicated in numerous outbreaks of seafoodborne gastroenteritis in the United States. Crab, oyster, shrimp, and lobster were implicated in 14 outbreaks, which may have resulted from the consumption of raw or insufficiently heated seafood or properly cooked seafood contaminated after cooking. 2/3/2022 Food poisioning 54 Mechanism發(fā)病機理 ? 感染型中毒：活菌侵襲腸粘膜 腸道 ? 毒素型中毒：耐熱性溶血毒素 中毒癥狀 混合型 2/3/2022 Food poisioning 55 Clinical Manifestation – 1. 潛伏期短 ? Usually these symptoms occur within 24 hours of ingestion. Illness is usually selflimited and lasts 3 days. Severe disease is rare and occurs more monly in persons with weakened immune systems. – 2. 腹痛（ 陣發(fā)性 ）、腹瀉、嘔吐 ? Intense abdominal pain, vomiting, and diarrhea. In most cases, the stool was watery, but there were some cases of bloody stool. ? Coldness of extremities, increased pulse, and constriction of blood vessels were also reported. ? Less monly, this anism can cause an infection in the skin when an open wound is exposed to warm seawater. – 3. 預后 2/3/2022 Food poisioning 56 Background ? 1998年 8月 1日，我市某酒店職工加餐， 8∶00 左右從某熟食店購得 17只 鹽水鴨 ，其中 3只由冷盤間廚師領去制作冷盤供應顧客；其余 14只存放于廚房生配案板上作職工加餐用。 2/3/2022 Food poisioning 23 ? 近幾年以散發(fā)為主未報告的因食用豬肝所致獸藥鹽酸克倫特羅（瘦肉精）食物中毒累計已有 10起以上；此類因在畜禽養(yǎng)殖過程中濫用各種獸藥和飼料添加劑，造成畜禽產(chǎn)品中殘留高濃度的獸藥導致人的急性中毒是近年來化學性食物中毒的新特點。美國密歇根州 14人 死亡，在另外 22個州也有 97人因此患病， 6名婦女流產(chǎn)。 2/3/2022 Food poisioning 4 2/3/2022 Food poisioning 5 Contents ? 源于傳統(tǒng)的食物中毒 ， ? 經(jīng)食物而感染的腸道傳染病 、 ? 食源性寄生蟲病 ， ? 由食物中有毒 、 有害污染物所引起的中毒性疾??； ? 慢性退行性疾病 (心腦血管疾病 、 腫瘤 、 糖尿病等 )， ? 食源性變態(tài)反應性疾病 ， ? 食物中某些污染物所致的慢性中毒性疾病等 2/3/2022 Food poisioning 6 Food Safety 食品安全 ?水 ?食品合格率 ?面粉，大米 ?蔬菜、水果 ?雞，豬肉 ?酸奶 我國每年食物中毒人數(shù)： 20~40萬 Data From USA/CDC 2/3/2022 Food poisioning 7 acidophilus milk酸奶 ?北京抽查酸奶合格率為 % – 1. 產(chǎn)品微生物超標 – 2. 防腐劑超標 – 3. 亞硝酸鹽、硝酸鹽超標 – 4. 亂用商標，誤導消費者 – 5. 蛋白質、脂肪含量參差不齊 2/3/2022 Food poisioning 8 國內外食品安全事件 1. 1987年 12月至 1988年２月上海 甲型肝炎 暴發(fā)性流行事件 30萬市民染上肝炎 2. 1996年 6月 27日至 7月 21日，云南曲靖地區(qū)會澤縣發(fā)生食用散裝 白酒甲醇 嚴重超標的特大食物中毒事件 ,192人中毒， 35人死亡， 6人致殘。 12. 2022年 1月，浙江省杭州市 60多人到醫(yī)院就診，癥狀為心慌、 心跳加快、手顫、頭暈、頭痛等，原因是食用了含有 “ 瘦肉 精 ” (即鹽酸克倫特羅 )的豬肉。 Food poisoning tends to occur at piics, school cafeterias, and large social functions. These are situations where food may be left unrefrigerated too long or food preparation techniques are not clean. Food poisoning often occurs from undercooked meats or dairy products (like mayonnaise mixed in cole slaw or potato salad) that have sat out too long. 2/3/2022 Food poisioning 26 食物中毒漏報問題 ? 據(jù) WHO有關專家估計，發(fā)展中國家報告的食物中毒僅占實際發(fā)生的食物中毒的 5%或更低。采集 1日午餐職工用餐所使用的刀板刮取物，幫廚所用抹布及 2例病人大便，均檢出 副溶血性弧菌 ；采集冷盤間冰箱剩余鹽水鴨，未檢出副溶血性弧菌。 2/3/2022 Food poisioning 60 ? 2. 加強對酒店管理人員及廚師的衛(wèi)生知識培訓，提高他們的衛(wèi)生意識，特別要強化廚師生熟分開的意識，對直接入口熟鹵菜的加工制作真正做到 “ 五專 ” 。 potent and rapid acting, lethal marine neurotoxin The molecule consist of a positively charged Guanidinium group (resonance stabilized cation, which consists of three Nitrogen atoms, is outlined in blue) and a Pyrimidine ring (shown in red) with additional fused ring systems (five additional ring systems, certainly help stabilize the TTXsodium channel binding plex at the aqueous interface). 2/3/2022 Food poisioning 97 河豚魚毒素毒力 毒性為氰化鉀的 1000倍 ? The LD50 for rats is 8 181。 ? 感覺神經(jīng) 運動神經(jīng)麻痹 ? 外周血管擴張，使血壓急劇下降， ? 呼吸中樞和血管運動中樞麻痹而致死。g/kg). Ingested TTX requires much higher doses (30 181。g/ 耐熱： 100℃ 下可耐受 30min， 破壞食物中的腸毒素 100 ℃ , 2小時 . 抗酶解：人體蛋白酶