Food Borne Diseases Associated

with Foods of Animal Origin

Assoc. Prof. Dr. Saleha Abdul Aziz
Faculty of Veterinary Medicine
Universiti Putra Malaysia
Veterinary Inspection Course, IPV, 18 September 2000.

Introduction

Food borne diseases are a major burden on the

public, causing considerable illness and
sometimes death, loss of productivity and
adding to the cost of health care.

Reports of the incidence of food borne diseases

show that meat, milk and their products are
important vehicles of the causative agents.

Such foods are not only contaminated with

pathogenic microorganisms but may contained
toxins, harmful chemicals or veterinary drug
residues.

Definition of a food borne disease

- an acute attack or disturbance of the
gastrointestinal tract with stomach pain or
cramp, diarrhoea, with or without nausea,
vomiting and fever; it has a sudden onset (in
few minutes) or it can occur in less than two
hours or more than 48 hours after the
ingestion of the contaminated foods.

Classification of food borne diseases

A. Food borne infections
- are caused by the entrance of the pathogenic
microorganisms into the body and the reaction of the
body tissues to their invasiveness or to the toxins they
produced in the body.

B. Food borne intoxications (Food poisoning)

- are caused by ingesting (i) toxicants naturally found in
certain plants and animals, (ii) toxins produced by
microorganisms while they multiply in foods or (iii)
chemical / poisonous substances which are intentionally
added or unintentionally present in foods during
production or processing

Pathogenic microorganisms in foods of animal

origin include:
- bacteria
- viruses
- parasites

Modes of transmission to man are by:

- eating raw or undercooked meat
- eating foods cross-contaminated with raw meat
- handling or in direct contact with the animals or
their products
- accidental exposure to the organisms

The contamination of the carcasses / meats may

come from:

the animals - the presence of microorganisms in

and on infected and carrier food animals may
caused the contamination during processing
operations skinning/ dehiding/ pelting,
scalding, defeathering/ dehairing, eviscerating

the workers - improper handling, clothings

the environment premises, equipments, pests,

water

Food borne Bacterial Diseases

Bacteria associated with foods of animal origin

include:
- Salmonella sp.
Salmonella enteritidis, S. typhimurium DT104
- Campylobacter jejuni, C. coli
- E. coli
E. coli O157: H7
- Clostridium perfringens
- Enterococci / Faecal streptococci
Vancomycin resistant enterococci (VRE)
- Listeria monocytogenes
- Yersinia enterocolitica
Food borne infections

Salmonella sp.

about 2000 serotypes

S. pullorum [pullorum disease] and

S.gallinarum [fowl typhoid]; S. choleraesuis;
S.dublin; S. abortus equi; - animal host
specific

S. typhi, S. paratyphi - man host specific

other serotypes S.enteritidis, S.typhimurium,

others [paratyphoid infection / salmonellosis] animals and man

Mokhtar et al, 1996

1991-1995 = 8084 Salmonella
isolates - 17.2% S. enteritidis
- 6.0% S. typhimurium
- 5.1% S. weltevreden

40.5% from food animals 26.8% in

chickens, 5.4% in cattle, 2.8% in
ducks, 2.0% in pigs
46.7% from livestock products
11.3% from chicken mea, 30.4%
from beef & buffalo meat, 2.6% from pork

Rusul et al, 1993

33 chicken portions 39.0% positive
S. blockley 33.3% , S. enteritidis 26.7%
S. chincol

13.3% , S. kentucky

Raw satay
S. blockley 25.9%
S. muenchen 14.8%
S. chincol
11.1%
S. enteritidis 11.1%
S. agona
7.4%

6.7%

Cooked satay
S. blockley
S. muenchen
S. agona
S. enteritidis
S. chincol

28.6%
21.4%
21.4%
7.1%
7.1%

Rohani et al (1994)
In 1960s 1980s, S. typhi was commonly isolated in
man; since 1989 1992, S. weltevreden was always the
leading serotype, not less than 28%
Since 1993, more than 30% of salmonellosis cases in
man in Malaysia were due to S.enteritidis and majority
were phage type 4 (PT4).
Joseph et al (1978, 1986, 1988), Mokhtar et al (1996)
Since 1960s - 1980s, S. pullorum was the common
serotype isolated from poultry and S. sofia from beef ;
between 1981 - 1985
During these periods, S. typhimurium 1.0%
S. enteritidis
0.5%
Since 1991, S. enteritidis is most frequently isolated

Salmonella typhimurium DT104

- commonly isolated from cattle; also found in

pigs, sheep and poultry
- resistant to
chloramphenicol, ampicillin, streptomycin,
tetracycline, sulphonamides; some appeared
to be resistant to trimethoprim and quinolones
- causes more severe disease than other
salmonellae, with more hospitilizations and
deaths

Salmonella in Eggs

Reports on the occurrence of egg-associated

salmonellosis and the isolation of Salmonella
enteritidis (SE), in particular SE PT4, in eggs
SE can invade the ovary their presence in the
contents of the egg or on the egg shell during or
shortly after laying
Layer flocks in Malaysia and Singapore, were found
infected with SE (Jamal Hassan et al, 1998; Iyu et al, 1999)
Eating raw or undercooked shell eggs
salmonellosis in man
USDA requires that eggs be stored, transported
and sold at refrigeration temperature of 7.2oC

Salmonellosis in man

One of the most frequently reported food -borne

infection in man; poultry, meat and their products,
raw egg dishes are common vehicles.

Infants, aged persons, immunocompromised and

malnourished persons are highly susceptible.

Major syndromes are enterocolitis / gastroenteritis,

enteric fever (eg. typhoid fever), bacteraemia,
focal infections of various organs that may follow
bacteraemia
Food borne infections

symptoms of enterocolitis: abdominal pain,

watery diarrhoea, fever and chills; nausea,
vomiting and headache sometimes occur
duration of diarrhoea is usually 3-5 days, but may
persist for 2 weeks;

- half of those infected may shed the organisms for

2-4 weeks, usually terminating within 2-3 months;
shedding longer than 6 months is rare except in
cases of typhoid fever.
- sequelae to infections include reactive arthritis,
Reiters syndrome.

Campylobacter sp.
5 species in animals of importance to man
Campylobacter jejuni, C. coli, C. lari, C.
upsaliensis, C. fetus
They live as commensals in the intestines
of animals, including poultry and birds
Chickens are said to be the most significant
reservoirs for C. jejuni, with isolation rates
of up to 100%.
The occurrence of campylobacters on
chicken carcasses was shown to range
from 14 to 88%

1. Saleha and Latif (1997)

646 chickens (508 broilers, 138 ayam kampung) 482
(74.6%) were positive
C. jejuni (71%) and C.coli (29%)
2. Joherman and Saleha (1997)
3 poultry processing plants Campylobacter isolations
ranged from 32.1% to 49.5%
C. jejuni (82.5%), C.coli (15.1%), C. lari (2.4%)

3. Nazarina et al (1998)
90 chicken carcasses from various retail outlets 78
(86.6%) were contaminated with Campylobacter; more
than 50% were C. jejuni

Campylobacteriosis in man
The most frequent food borne disease in many
countries
In US, estimates place the number of illnesses
caused by Campylobacter at 1-4 million annually,
with 200-730 deaths per year
The highest incidence is among infants (relate to
time of weaning) and adults 20 30 years of age
(starting to be on their own and prepare foods)

Malaysia and Singapore reported low incidence,

about 3% - but the true incidence may be 5 -10
times higher (Puthucheary et al, 1994)
Food borne infections

Several studies and reports identified poultry meat

as the risk factor handling raw chicken, eating
raw or undercooked chicken, cross-contamination
from raw poultry to salads and prepared foods;
raw milk is also a source of infection.

The main symptom is diarrhoea, lasting about 2

5 days, with fever, abdominal pain and malaise.
Some cases may be severe enough to mimic
appendicitis
Less frequently, Campylobacter infections may
produce bacteraemia and septic arthritis
Guillain-Barre syndrome (GBS) and Reiters
syndrome are serious sequelae

Reiters arthritis
- a subtype of reactive arthritis with a triad of
symptoms - arthritis, urethritis, conjuctivitis; it is
sterile arthritis
- triggered by either enteric or urethral infections
- occurs 7- 30 days after infection and can last for 4- 5
months or become chronic
- besides Campylobacter and Salmonella, other
organisms that may trigger are Shigella and Yersinia.

Guillain Barre syndrome

- acute neuromuscular paralysis
- one case for every 1000 cases of campylobacteriosis;
- 40% of patients with GBS had recent evidence of
Campylobacter infection (1- 3 weeks after infection)

Escherichia coli (E. coli)

They are commonly found in the intestinal tract of
man and animals, as well as in the environments
soil, vegetation, surface water.
Many types and strains few of which are
pathogenic (enterovirulent E. coli, EEC)
The different pathogenic strains may cause illness
by different infective and toxin - producing
mechanisms:
ETEC (travellers diarrhoea), EPEC (watery /
bloody diarrhoea), EIEC (mild form of dysentery),
EHEC, EaggEC.

EHEC - Enterohaemorrhagic E. coli

- also known as verotoxin E. coli (VTEC)
- produces verotoxin, VT
Serotype O157 : H7 is the predominant cause of
infection in man; other serotypes have also been
implicated
Cattle appear to be the main source of infection
most cases associated with undercooked
minced beef, beef burgers, raw milk; other foods
have also been implicated vegetables, apple
juice, water
Son et al (1998): 9 of 25 (36%) beef samples from
retail stores were positive for E. coli O157:H7 and
they produced Shiga toxin

E. coli O157:H7 infection in man

The clinical symptoms range from mild diarrhoea
to severe bloody diarrhoea (haemorrhagic colitis)
- severe cramping and diarrhoea, initially watery
but becomes grossly bloody; occasionally
vomiting occurs;
- is usually self-limited and lasts for an average of
8 days.
In some cases, children develop haemorrhagic
uraemic syndrome (HUS) and renal failure, which
can be fatal

Food borne infections

Listeria sp.
2 pathogenic species for man
Listeria monocytogenes, L. ivanovii
The organisms are widespread in nature water,
soil, vegetation, silage, seafoods, animals which
include poultry
Listeriae are relatively hardy organisms and
capable of growth at refrigeration temperature
A variety of nonpathogenic Listeria sp. has been
found on meat and meat products use as
indicators for the presence of L. monocytogenes

Ghulam et al (1991)
16 poultry samples 6 (37.5%) positive
9 beef samples
9 (40.9%)

Arumugaswamy et al (1994)
32 chicken parts 19 (60%) positive
12 beef
6 (50%)
16 fresh prawns
7 (44%)

[ 22 leafy vegetables
5 (22%) positive
Satay 23 uncooked
11 (48%)
39 ready-to-eat 11 (26%)]

Listeriosis in man

Most outbreaks of listeriosis were due to

L.monocytogenes and the foods implicated
were milk and dairy products, coleslaw, raw
vegetables; undercooked chicken and
uncooked frankfurters have also been shown
as the source of outbreaks.

Listeriosis is a serious infection and primarily

affects the elderly, immunocompromised
persons, newborns and pregnant women; it
can cause meningitis and septicaemia.
Mortality rate can be as high as 30%.
Food borne infections

A person with listeriosis usually has fever, muscle

aches and sometimes gastroenteritis with
diarrhoea ; the infection can spread to the
nervous system and cause symptoms such as
headache, stiff neck, confusion, loss of balance
and convulsion to occur.

Infected pregnant women may experience only a

mild, flu-like illness; however, it can lead to
abortion, premature delivery, infection of the
newborns or even stillbirth.

Vancomycin-resistant Enterococci (VRE)

The common species are Enterococcus faecalis,
E. faecium
They are normal flora of the GIT of nearly all
warm-blooded animals, including man

The organisms have the ability to cause a wide

range of infections, primarily serious infections in
heath-care setting patients, such as hospital
patients
Enterococci are found to be resistant to many
antibiotics; and in several cases, vancomycin is
the only treatment drug that remains effective

VRE was first isolated in France in 1986;

since then they rapidly became a frequent
cause of hospital-acquired infections
In 1993, VRE were recovered outside the
heath- care settings: man in the community
and animals chickens, turkeys, pigs

VRE were isolated from livestock faeces as

well as raw meat

Son et al (1999): VRE were isolated from

13.3% of beef and 10% of chicken meat; all
isolates were E. faecium.

Enterococcal Infection in Man

Enterococci are one of the important causes of
hospital / nosocomial infections
They account for 16% of the urinary tract
infections and 8% of bacteraemias; the mortality
associated with enterococcal bacteraemia ranged
from 42 68%
They can cause endocarditis, meningitis,
neonatal sepsis and respiratory infections, but
less commonly
VRE are a problem as they are resistant to
multiple antibiotics; as such treatment options for
VRE infections are very limited

Food borne infections

Clostridium perfringens

The organisms are widely distributed in the environment

and frequently occurs in the intestines of man and animals
Meats and meat products (roast beef, ham) have been
implicated in outbreaks
The organisms are ingested in large numbers and produce
toxin in the gastrointestinal tract during sporulation
The infection is characterized by intense abdominal
cramps and diarrhoea; the illness is usually over within 24
hours but in some may persist for 1-2 weeks; can be fatal.
C. perfringens type C strains cause a more serious but
rare illness - necrotic enteritis or pig-bel - deaths are
caused by necrosis of the intestines and
Food borne infections

Yersinia enterocolitica

Many species of animals, such and birds are

symptomless faecal carriers
- pigs are important reservoir of infection for man
The organisms are found in soil, water; capable of growth
at refrigeration temperature
Strains of the organisms can be found in meats (pork,
beef, lamb), oysters, fish and raw milk.
The infection, yersiniosis - is frequently characterized by
gasroenteritis with diarrhoea and/or vomiting; fever and
abdominal pain are the hallmark symptoms.
The infection mimic appendicitis and mesenteric
lymhadenitis
Serious sequela include Reiters arthritis
Food borne infections

The following bacteria cause food borne

intoxications in man:
- Staphylococcus aureus
- Clostridium botulinum
- Aeromonas hydrophila
- Bacillus cereus
- Vibrio parahaemolyticus

Staphylococcus aureus
The organisms are commonly present on the skin
(in the pores, hair follicles) and on mucous
membranes of nose and throat of man and
animals; they are also found in the intestines of
about 30% of populations
Foods associated with outbreaks include baked
ham, meat pies, poultry, raw milk, dairy products
The organisms can be destroyed by heating but
not the toxin present in the food
The onset is rapid (2-4 hours); symptoms include
severe vomiting, abdominal pain and diarrhoea;
recovery is rapid, usually within 24 hours

Food borne intoxications

Aeromonas hydrophila

A potential food borne pathogen usually associated

with water environments and has been frequently found
in fish, frog, shellfish
The organisms are capable of growth at low temperature
Water, milk and seafoods are considered to be main
sources for man
Several reports showed that the organisms were
recovered from livestock faeces and were found in
chicken meat , beef, pork, lamb
Studies in broiler processing operation found a high
percentage of carcasses with A. hydrophila; the
organisms were present in large numbers particularly at
post-evisceration and in iced final products
Food borne intoxications

Clostridium botulinum
C. botulinum spores are in the environment soil, sediments
Botulism is due to consumption of processed
foods (smoked, pickled, canned - sausages,
ham, cured meats) in which the organisms
have been growing and producing neurotoxin
Symptoms include vomiting, blurred or double
vision, ocular paresis, pharyngeal paralysis; in
fatal cases, there is coma and asphyxia

Food borne intoxications

Food borne Viral Infections

Viral hazards in foods of animal origin include:

- hepatitis A viruses
- rotavirus / gastroenteritis viruses
- small round structured viruses (SRSVs)
Norwalk viruses

All food borne viruses originate from human

intestine and are shed exclusively in faeces

The contamination of foods occurs :

- due to contact with sewage or polluted water, eg.
shellfish grown in shallow coastal or estuarine
waters, commonly near sewage outlets
- by infected food handlers during final preparation
and serving, without any further heat treatment -the person failed to wash his/her hands properly
after defaecation
- by using contaminated water or ice in food
preparation

Food borne viruses are hardy

- may survive for prolonged periods in foods or the
food handling environment
- highly resistant to chilling, freezing, preservatives
and ionising radiation
- are resistant to acidic conditions (pH 3)
However, they are rapidly destroyed by heating
temperatures above 85oC for at least 2 minutes

Symptoms of hepatitis A infection include loss of

appetite, malaise, fever and vomiting, followed by
jaundice; illness usually lasts a few weeks to
several months

* New Variant Creutzfeldt-Jakob Disease (nv-CJD)

- it has been suggested that the new variant form of CJD or
nv-CJD may be linked to exposure to bovine spongiform
encephalopathy (BSE) or mad cow disease
- 24 human cases in Great Britain (GB) and France
- the difference with classical CJD: patients are younger
(about 28 vs above 63 years) and course of disease is
longer (average 13 months as compared to 6 months)
- the agent is said to be a prion which is composed
exclusively of the host-coded protein
- reports on the use of feed for cattle which contains
unidentified transmissible spongiform encephalopathies
(TSE) contaminated meat and bone meal from either
scrapie-infected sheep or cattle
- cases in cattle in other countries appear to be a result of
importation of live cattle or contaminated feed from Gb

Food borne Parasitic Infections

Parasitic hazards associated with meat:

a.
Meat borne parasites:
- are those parasites that are present in
tissues of food animals and they persist in such
tissues in a form that is infectious to
man, such
as larvae in cysts in meat.
Such parasites include:
- Taenia saginata (beef tapeworm) /
Taenia saginata (pork tapeworm) [taeniasis]
- Toxoplasma gondii [toxoplasmosis]
- Trichinella spiralis [trichinosis / trichinellosis]
- Gnathostoma spinigerum [gnathostomiasis]
- Sarcocystis sp. [sarcocystosis]

b.

Foods contaminated with eggs or oocysts

of the parasites
- those parasites found in the environment
(soil, water) which originate from animals and
man; they are in an infective form such as
embryonated eggs or sporulared oocysts which
contaminate foods.
Such parasites include:
- eggs of Taenia solium [cysticercosis]
- oocysts of Toxoplasma gondii [toxoplasmosis]
- eggs of Toxocara canis, T. cati
[toxocariasis / visceral larva migrans]
- oocysts of Cryptosporidium parvum
[cryptosporidiosis]

Toxoplasmosis

It has a worldwide distribution; infection in man and animals

is widespread
Cats and other felines are definitive hosts, shedding
oocysts in faeces; pigs, sheep, cattle, goats rats, dogs,
rabbits are intermediate hosts
In Malaysia, prevalent in man and animal populations;
prevalent rate highest in Malays followed by Chinese,
Indians and Orang Asli. Ocular toxoplasmosis is quite
common
Afifi et al (1989) found the presence of Toxoplasma cysts in
beef, goats meat, pork and poultry meat in Malaysia
Dorny et al (1993) reported seroprevalence rate of 35.3% in
goats
Man can get infected by eating undercooked meat, foods
contaminated with sporulated oocysts and drinking
unpasteurized milk

Sarcocystosis

In Malaysia, Sarcocystis cysts have been reported in a

wide range of domestic and wild animals - include rats,
buffalo, cattle, goat, sheep, slow loris, long-tailed macaque
Seroprevalence rate of 19.7%
Two forms of human sarcocystosis - muscular form has
been reported; caused by consuming food/drink
contaminated with sporocysts shed in faeces of domestic
or wild animal definitive hosts (cats, dogs, phython)
- intestinal form, exact
prevalence unknown; caused by eating undercooked meat
infected with sarcocysts of S. hominis (beef), S. suihominis
(pork)

Gnathostomiasis

The life cycle of this nematode involves mammals,eg. dogs,

cats (adults in the stomach) - ova in faeces - 1st and 2nd
stage larvae in water cyclops - 3rd stage larvae in muscles
of freshwater fish, frogs, snakes; domestic poultry may also
be a source of human infection
The infection has been reported in Malaysia
Gnathostomiasis is characterized by migratory skin
swellings, feverish at times, subcutaneous larva migrans or
abscesses, which are usually peripheral
Some interesting cases - an immature gnathostome was removed
by a young adult male from his own finger; two worms were removed
from the tip of the right middle finger of an adult male at a ten-year
interval; a gnathostome larva was surgically removed from the pulp of
the right middle finger of a female adult; an immature gnathostome was
removed from the base of the right middle finger of an adult female.

Cryptosporidiasis

The protozoa, Cryptosporidium parvum, are fpund in many

animal species causing scours in young animals, older
animals may be carriers
The organisms complete their life cycle in one host ; the
oocysts are excreted in the faeces and are highly infective
The oocysts are resistant to chlorine; they are inactivated
by heat, freezing and drying
Man can acquire infection from contaminated water,
animals, person-to-person contact and contaminated raw
foods meat, milk, fruits and vegetables
The symptoms in man include abdominal pain, profuse
diarrhoea, anorexia, weight loss; infection is usually selflimiting and resolves within a few weeks

Chemical Residues and Additives

Chemical residues and additives

The presence of residues and additives can pose

health hazards, in particular :
- the presence of residues in foods - antibiotics,
insecticides / pesticides, fungicides - exceeds the
MRLs
- the presence of residues of prohibited drugs in
foods
- the use of the additives is not permitted in
foods or if permitted, it exceeds the MRL

Antibiotic Residues in Foods of Animal Origin

The residues can enter the human diet:

- directly as compounds of edible animal tissues
and products, or
- indirectly from the environment.

The possible clinical implications of consuming

residues of antibiotics are:
- toxicity
- allergy
- treatment failure / limited treatment option in
infections caused by antibiotic-resistant pathogens

The concern is over the spread of these antibiotic resistant

bacteria from one host to another - man to man, animal to
animal, animal to man - with the resistance genes from food
borne pathogens infecting man may get transfer into other
more virulent human pathogens (such as, Staphylococcus
aureus, Streptococcus pneumoniae, Streptococcus
pyogenes, Salmonella typhi and Mycobacterium
tuberculosis)

Transmission of resistant bacteria from animals to man are

mainly :
- by handling or in contact with contaminated animals
- upon consumption of the contaminated animal products.

In Malaysia, Food Regulations 1985 (Act 281) has set

under:
14th

Schedule (Regulation 38)

- maximum residue limits (MRLs) / tolerance levels in
mg / kg (ppm) for metal contaminants in specified foods
15th

A Schedule (Regulation 39)

- the MRLs g / kg (ppb) for 75 veterinary drugs,
mainly for antibiotics (Table 1)
- prohibit the presence of beta-agonists, nitrofurans
and chloramphenicol in foods (Table 2)
16th

Schedule
- the MRLs mg / kg (ppm) for pesticides residues

Physical Hazards in Foods

Apart from biological and chemical contaminants,

meat may also become contaminated with grits,
small stones, pieces of metals, glass chips, hairs,
rust flakes, grease, others
This was usually found in to occur with processed
meat, but may be found in fresh meat.

Sometimes meat may contain meat from other

species (unless the labels specifically state so)
this is adulteration; often occurred with processed
or minced / ground meat

Conclusion
Safe Feed - Healthy Animals - Safe Food - Healthy Man
Food borne diseases are largely preventable measures are needed to prevent, reduce or remove
contamination all the way from the farm to the table
- GAHP, Biosecurity measures, Prudent use of
antibiotics
The reduction of the pathogens in animals in turn
reduce the contamination of carcasses
- GPP; HACCP
Careful review of the food production process can
identify the principal hazards (biological, chemical,
physical), and the critical control points where
contamination can be prevented, reduced or removed

Safe Feed - Healthy Animals - Safe Food - Healthy Man

Even in sanitary plants, these pathogens are
present scalding, defeathering/dehairing, dehiding,
evisceration are major points of contamination
concerted efforts are required to minimise
contamination
For some foods, definitive microbe-killing step
must be included in the process, such as adequate
heat treatment
- Training of food producers, processors, handlers

Education of consumers
Proper preparation, cooking and serving

 in the end, it is up to consumers to

demand safe food; up to industries to
produce them; up to researchers to
develop better ways of doing so; and up to
government to see that it happens, to
make sure it works and to identify
problems still in need of solutions.

Thank you