Epidemiology and clinical features of Bacillus cereus food poisoning

* Bacillus cereus food poisoning was reported as early as 1906 (Lubenau). However, it was not until 1950 that the cause was identified, and many countries, especially J. Europe and Eastern Europe, reported similar poisoning. In the case of bacterial food poisoning in Hungary from 1960 to 1968, Bacillus cereus was the common pathogen of the third zui. The food poisoning caused by the bacteria was 84% ​​of the reported food poisoning, and the number of poisoned persons accounted for the total number of poisoning cases. 14.8%. Since 1971, the UK has reported excessive food poisoning of the bacteria. In 1973, the Nanjing Municipal Health and Epidemic Prevention Station first reported the food poisoning of vomiting Bacillus cereus in a nursery school in Nanjing due to eating rice. In addition to Tibet, all provinces and municipalities have reported food poisoning.

Bacillus cereus food poisoning involves a variety of foods: including dairy foods (ice cream, milk), meat (burned meat, roast chicken, fish, meatloaf), rice starch products, dessert, cooking, soup, Vegetables and foods such as bean sprouts, fruits, salads, and pickles. The food poisoning of Bacillus cereus in China is mostly related to rice or starch products. According to the survey, the prevalence of food is up to 70%. In addition to the above reasons, the high rate of infection is related to the failure to strictly abide by the health system and operating procedures in food processing, transportation, marketing and sales. The main source of pollution of the bacteria is dust, soil, and can also be transmitted by flies, insects, unclean utensils and containers.

Most foods that cause food poisoning by this bacterium do not have spoilage. Sensory inspection: In addition to the rice sometimes a little bun, the taste is not good, most foods have normal sensory traits. The onset has obvious seasonality: it is more prone to occur in the hot season from June to October. Usually, due to improper food preservation, it takes too long to be placed in the environment above 20~C. The bacteria multiply and produce toxins, which are not fully heated before eating, causing poisoning. A large number of Bacillus cereus is not easily isolated in the feces of poisoned patients.

The food poisoning caused by the bacteria is caused by eating a large number of live bacteria and its enterotoxin. The toxin is classified into heat-resistant enterotoxin and heat-labile enterotoxin, which cause the following two types of symptoms, respectively.

1. Vomiting gastroenteritis is mainly caused by nausea and vomiting. Most of them are caused by rice and oil fried rice. It is characterized by a short incubation period of only 0.5 to 5 hours; 100% vomiting, as many as 2 to 10 times; patients have abdominal paralysis, 33% less diarrhea; stomach upset, dizziness, fever, limb weakness, Conjunctival congestion and so on. A large number of such bacteria can be detected in the poisoned rice, which is a low molecular enterotoxin with a relative molecular mass of <5000. It is quite stable and is not sensitive to pH, trypsin or pepsin. It can withstand 126~C90min. Generally not destroyed by boiling or autoclaving. The fungus of Zui is suitable for 30~C, and the rice culture of 24h can produce toxin. Vomiting toxins can be vomiting in the stomach of monkeys or kittens.

2. Diarrhea-type gastroenteritis is mainly caused by abdominal pain and diarrhea. The incubation period is longer, usually 8 to 16 hours, mainly caused by diarrhea toxins. Its toxin-producing strains can produce toxins in various foods (including rice), and some scholars believe that toxins can also be produced after bacteria enter the intestines. This type of characteristic is a sudden onset, and it is fierce. About 96% of cases were diarrhea, and the number of diarrhea was high; 75% of abdominal cramps, vomiting was rare (about 23%), and occasionally had a fever. The toxin increases the adenylyl cyclase in the intestinal epithelial cells, resulting in an increase in the concentration of cyclic adenosine monophosphate in the intestinal epithelial cells, causing fluid retention in the intestinal lumen, leading to diarrhea, and the toxin also has a vomiting effect.

3. Toxin types and their properties There are many kinds of toxic products of Bacillus cereus, such as enterotoxin, hemolytic toxin, lecithinase A, proteolytic enzyme and DNA extracellular enzyme, among which the first three are studied more. Only enterotoxin is described.

The enterotoxin uses the cyclic adenosine monophosphate activity test to classify Bacillus cereus enterotoxin into the following four types.

(1) Vomiting toxin (heat-resistant enterotoxin) The toxin is extremely antigenic. Meling et al. (1978) once fed four monkeys within 8 months, and the monkey did not produce significant resistance.

(2) Diarrhea toxin (laboratory enterotoxin) Almost all of the toxins can be produced by Bacillus cereus, but the amount of toxin produced is different. The relative molecular mass is 55,000 to 60,000. 45~C30min can inactivate it. Sensitive to proteases and trypsin. Feeding monkeys with this toxin can cause diarrhea. The mice were injected intravenously with the toxin, which usually died rapidly within 2 minutes.

(3) Purulolytic toxin (pyogenictoxin) was isolated from a baby brain abscess and may be a purulent factor. Injecting rabbit intestinal fistula can destroy the structure of the villus and cause intestinal effusion. Rabbits or mice can be killed.

(4) The fluid volume factor only causes intestinal effusion. Feeding monkeys does not produce symptoms of diarrhea or vomiting.

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