Ptomaine Poisoning

Ptomaine poisoning is more commonly known as food poisoning. A recent scientific review by the Food Standards Agency (FSA) estimates that around 2.4 million cases of foodborne illness occur every year in the UK; this is up from the 2009 estimate of approximately one million. More than 20,000 patients are hospitalised in the UK each year because of food poisoning.

Researchers have estimated there are 180 deaths per year in the United Kingdom caused by foodborne diseases from 11 pathogens. Foodborne norovirus is projected to cause 56 deaths per year, salmonella 33 deaths, Listeria monocytogenes 26, Clostridium perfringens 25, and campylobacter 21. Most fatalities occur in those aged 75 years and older.

Campylobacter, Clostridium perfringens, Listeria monocytogenes, salmonella and norovirus are responsible for 98% of the 180 deaths, but it is not possible to rank the five pathogens. Foodborne deaths from the remaining pathogens shigella, cryptosporidium, giardia, adenovirus, astrovirus and rotavirus are rare.

The FSA study reveals that:

• An estimated 380,000 cases of norovirus linked to food occur in the UK per year.
• A breakdown of the roles of the main transmission pathways in food suggest eating out accounts for an estimated 37% of all foodborne norovirus cases, takeaways at 26%, open-headed lettuce on retail sale at 30%, raspberries on retail sale at 4%, and oysters on retail sale at 3%.

Statutory notifications to Public Health England of cases of ptomaine or food poisoning in the weeks between August 15^th and September 12^th 2021 totalled 328.

What is ptomaine poisoning?

The term Ptomaine Poisoning is food poisoning caused by any of various amines formed by putrefactive bacteria. The word ptomaine comes from the Greek ptōma meaning fall, fallen body, corpse. Ptomaine poisoning nowadays is much more commonly known by the generic term of food poisoning.

There are four main sources of ptomaine or food poisoning:

• Bacteria – By far the most common source.
• Viruses – These do not actually grow on food but may be carried in food.
• Chemicals and Metals – Food poisoning caused by chemicals is rare and is most likely to be caused through carelessness, for example allowing cleaning chemicals to contaminate food.
• Poisonous Plants – Food poisoning caused by eating or handling poisonous plants, for example deadly nightshade or some fungi; however, this cause of illness is rare.

There are several main bacteria indicated in ptomaine poisoning, when the term is used interchangeably with food poisoning.

These include:

• Campylobacter – Sources include meat and poultry. Contamination occurs during processing if animal faeces contact meat surfaces. Other sources include unpasteurised milk and contaminated water.
• Clostridium botulinum – Sources include home-canned foods with low acidity, improperly canned commercial foods, smoked or salted fish, potatoes baked in aluminium foil, and other foods kept at warm temperatures for too long.
• Escherichia coli (E. coli) – Sources include beef contaminated with faeces during slaughter. Spread mainly by undercooked ground beef, but other sources include unpasteurised milk and apple cider, alfalfa sprouts, and contaminated water.
• Listeria – Can be spread through contaminated soil and water, deli type cooked meats, unpasteurised milk and cheeses, and unwashed raw produce.
• Norovirus – Spread from person to person, through contaminated food or water.
• Salmonella – Can be spread by knives, cutting surfaces or an infected food handler. Other sources include raw or contaminated meat, poultry, milk, or egg yolks. Salmonella survives inadequate cooking.

What causes ptomaine poisoning?

Ptomaine or food poisoning is most usually caused by eating food that is contaminated by bacteria. Contamination of food can happen at any point of production: growing, harvesting, processing, storing, shipping or preparing. Cross-contamination, that is the transfer of harmful organisms from one surface to another, is also often a cause.

Cross-contamination is where harmful bacteria are spread between food, surfaces and equipment. This is especially troublesome for raw, ready-to-eat foods, such as salads or other produce; because these foods are not cooked, harmful organisms are not destroyed before eating and can cause food poisoning.

Other foods that are most likely to cause ptomaine or food poisoning include:

• Poultry – Research from the UK, US and Ireland found that 41–84% of raw chicken sold in supermarkets was contaminated with campylobacter bacteria and 4–5% was contaminated with salmonella. The rates of campylobacter contamination were slightly lower in raw turkey meat, ranging from 14–56%, while the contamination rate for raw duck meat was 36%.
• Fish and shellfish are a common source of food poisoning. Fish that has not been stored at the correct temperature has a high risk of being contaminated with histamine, a toxin produced by bacteria in fish. Shellfish such as clams, mussels, oysters and scallops also carry a risk of food poisoning. Algae that are consumed by shellfish produce many toxins, and these can build up in the flesh of shellfish, posing danger to humans when they consume the shellfish.
• Rice is one of the oldest cereal grains and a staple food for more than half the world’s population. However, it is a high-risk food when it comes to food poisoning. Uncooked rice can be contaminated with spores of Bacillus cereus, a bacterium that produces toxins that cause food poisoning. If cooked rice is left standing at room temperature, these spores grow into bacteria that thrive and multiply in the warm, moist environment. The longer rice is left standing at room temperature, the more likely it will be unsafe to eat.
• Deli meats including ham, bacon, salami and hot dogs can be a source of food poisoning. They can become contaminated with harmful bacteria including listeria and Staphylococcus aureus at several stages during processing and manufacturing.
• Unpasteurised dairy products are at least 150 times more likely to cause food poisoning and 13 times more likely to result in hospitalisation than pasteurised dairy products. Food manufacturers pasteurise dairy products including milk and cheese to make them safe to consume. Pasteurisation kills harmful bacteria and parasites such as brucella, campylobacter, cryptosporidium, E. coli, listeria and salmonella.
• Eggs can also be a source of food poisoning when they are consumed raw or undercooked. This is because eggs can carry salmonella bacteria, which can contaminate both the eggshell and the inside of the egg.
• Fruit products including berries, melons and pre-prepared fruit salads have been linked to food poisoning outbreaks. Fruits grown on the ground such as cantaloupe melon, watermelon and honeydew melon have a high risk of causing food poisoning due to listeria bacteria, which can grow on the rind and spread to the flesh.
• Raw bean sprouts of any kind, including alfalfa, sunflower, mung bean and clover sprouts, are considered to have a high risk of causing food poisoning. This is mainly due to the presence of bacteria including salmonella, E. coli and listeria; their growing conditions are ideal for the rapid growth of bacteria.

Ptomaine or food poisoning can happen if food is:

• Not washed or cleaned properly.
• Not cooked or reheated thoroughly.
• Not stored correctly, for example it has not been frozen or chilled.
• Left out for too long.
• Handled by someone who is ill or who has not washed their hands.
• Eaten after its ‘use-by’ date.

Signs and symptoms of ptomaine poisoning and how long ptomaine poisoning lasts for

Ptomaine or food poisoning symptoms vary with the source of contamination.

Most types of food poisoning cause one or more of the following signs and symptoms:

• Nausea.
• Vomiting.
• Watery or bloody diarrhoea.
• Abdominal pain and cramps.
• Headache.
• A high temperature or fever.
• A lack of energy and weakness.
• Loss of appetite.
• Aching muscles.
• Chills.

Symptoms can start at any point between a few hours and a few weeks later, although usually the symptoms start within 1 to 2 days after eating contaminated food. If you suspect you are suffering from food poisoning, it is important to realise that the last meal you ate may not be the cause of your symptoms.

Symptoms will usually last for more than 12 hours, but in most cases, these symptoms will pass in a few days and you will make a full recovery.

Whether you become ill after eating contaminated food depends on the organism, the amount of exposure, your age and your health. Most often, food poisoning is mild and resolves without treatment. But some people may need to go to the hospital if the symptoms are severe or they are in a high-risk group.

High-risk groups include:

• Older adults. As you get older, your immune system may not respond as quickly and as effectively to infectious organisms as when you were younger.
• Pregnant women. During pregnancy, changes in metabolism and circulation may increase the risk of food poisoning. Your reaction may be more severe during pregnancy. Rarely, your baby may get sick, too.
• Infants and young children. Their immune systems haven’t fully developed.
• People with chronic disease. Having a chronic condition such as diabetes, liver disease or AIDS or if you are receiving chemotherapy or radiation therapy for cancer, reduces your immune response.

You should see a doctor or seek medical attention if you experience any of the following signs or symptoms:

• Frequent episodes of vomiting and inability to keep liquids down.
• Bloody vomit or stools.
• Diarrhoea for more than three days.
• Extreme pain or severe abdominal cramping.
• An oral temperature higher than 38ºC (100.4ºF).
• Neurological symptoms such as blurry vision, muscle weakness and tingling in the arms.
• Signs or symptoms of dehydration, excessive thirst, dry mouth, little or no urination, severe weakness, dizziness, or light-headedness.

The elderly and pregnant women are at increased risk of serious dehydration and complications from ptomaine or food poisoning.

The features of dehydration include:

• Mild dehydration — Lassitude, anorexia, nausea, light-headedness, postural hypotension.
• Moderate dehydration — Apathy or tiredness, dizziness, nausea, headache, muscle cramps, oliguria (low urine output), reduced skin elasticity, dry tongue or sunken eyes.
• Severe dehydration — Profound apathy, weakness, confusion leading to coma, shock recognised by tachycardia, oliguria, low blood pressure.

Treatment for ptomaine poisoning

Ptomaine or food poisoning can usually be treated at home, and most cases will resolve within three to five days. The diarrhoea, vomiting and upset stomach is how your body tries to get rid of the toxins that have poisoned you. Your treatment partly depends on what gave you food poisoning and how sick you are.

Diarrhoea and vomiting can really throw off your body’s balance of fluids and electrolytes. Electrolytes are minerals, such as sodium and potassium, that help with everything from keeping your heartbeat normal to controlling how much water is in your body.

It is crucial to remain properly hydrated when you have suffered ptomaine or food poisoning, although you will need to drink plenty of fluids, start with ice cubes or small sips of water to avoid upsetting your stomach further. Once it starts to settle, you can then try sports drinks which are high in electrolytes that can be helpful to replace lost minerals.

Fruit juice and coconut water can restore carbohydrates and help with fatigue. Avoid caffeine, which may irritate your digestive tract. Decaffeinated teas with soothing herbs like chamomile, peppermint and dandelion may calm an upset stomach. You might also try oral rehydration solutions if you have severe dehydration symptoms or diarrhoea.

It is advisable to gradually hold off on solid foods until vomiting and diarrhoea have stopped; ease back to your regular diet by eating simple to digest foods that are bland and low in fat.

Such as:

• Crackers.
• Bananas.
• Rice.
• Oatmeal.
• Boiled chicken.
• Chicken broth.
• Boiled potatoes.
• Boiled vegetables.
• Toast.
• Ginger ale.
• Diluted fruit juices.
• Sports drinks.

Best to avoid harder-to-digest foods such as:

• Dairy products, especially milk and cheeses.
• Fatty foods.
• Highly seasoned foods.
• Food with high sugar content.
• Spicy foods.
• Fried foods.
• Caffeine such as fizzy drinks, energy drinks, coffee.
• Alcohol.

Also avoid over the counter medications that help to control diarrhoea and suppress nausea, as the body uses vomiting and diarrhoea to rid the system of the toxin. Also, using these medications could mask the severity of the illness and could delay you seeking medical treatment.

Anyone experiencing the symptoms of ptomaine or food poisoning for more than 72 hours in healthy adults, over 48 hours in the elderly or frail, or more than 24 hours in patients with diabetes due to increased risk of a poor outcome, should seek medical treatment.

If you need to seek medical treatment for ptomaine or food poisoning, depending on your symptoms and health history, your doctor may conduct diagnostic tests, such as a blood test, stool culture or examination for parasites, to identify the cause and confirm the diagnosis.

For a stool test, your doctor will send a sample of your stool to a lab, where a technician will try to identify the infectious organism. If an organism is found, your doctor likely will notify your local health department to determine if the food poisoning is linked to an outbreak.

In severe cases of ptomaine or food poisoning, you may require hydration with intravenous (IV) fluids in hospital. In the very worst cases of ptomaine or food poisoning, a longer hospitalisation may be required while you recover.

For all cases of ptomaine or food poisoning it is really important to get plenty of rest; sleep is a great healer.

Ptomaine or food poisoning is a notifiable disease. If a case of food poisoning has been formally confirmed by a doctor or hospital, by analysis of a stool sample these details are passed to Environmental Health. If you think that a particular food has caused your illness then you can contact your local Environmental Health department yourself; this is particularly important if you yourself work with food.

If you work with food or ‘vulnerable groups’, for example young children, the elderly or anyone with reduced immunity such as in a hospital or nursing or care home, you must tell your employer. You should not return to work until 48 hours after your symptoms have stopped.

If you do suffer from ptomaine or food poisoning type symptoms, particularly diarrhoea and vomiting, you must observe strict personal hygiene to prevent the spread to others and also prevent re-infection.

You should:

• Wash your hands regularly with soap and hot water, particularly after using the toilet. Young children must be supervised in this and a separate hand towel should be used by the infected person.
• Wipe the toilet seat, flush, door handle and taps regularly with a disinfectant.
• Avoid preparing food for others whilst you have symptoms.
• Tell your employer if you work with food or other high-risk occupations as detailed above and stay off work for until 48 hours after your symptoms have gone.

In conclusion

As with most things, prevention is often better than the cure, so how can you prevent ptomaine or food poisoning?

There are four main things to remember for good food hygiene:

• Cleanliness.
• Cooking.
• Chilling.
• Cross-contamination.

Cleanliness – You can prevent the spread of harmful bacteria by observing good personal hygiene and keeping work surfaces, utensils etc. clean. And remember, don’t handle food when you are ill with stomach problems, such as diarrhoea or vomiting, and don’t touch food if you have sores or cuts, unless they are covered with a waterproof dressing.
Cooking – Proper cooking kills ptomaine or food poisoning bacteria, so it is important to cook food thoroughly, especially meat. When reheating food make sure it is piping hot all the way through and don’t reheat it more than once.
Chilling – It is very important to keep certain foods at the right temperature to prevent bacteria growing or toxins forming. Always look at the label on the packaging. If it says that the food needs to be refrigerated, make sure you keep it in the fridge and check that your fridge is cold enough, about 5˚C, by having a thermometer in it. If food that needs to be chilled is left standing at room temperature, food poising bacteria can grow and multiply to dangerous levels. Cooked leftovers should be cooled quickly and then put in the fridge. Putting food in shallow containers and dividing it into smaller amounts will speed up the cooling process.
Cross-contamination – This is the transfer of bacteria from a source, often raw foods to other foods. The bacteria can be transferred directly when one food touches or drips onto another, or indirectly, for example from hands, equipment, work surfaces or knives and other utensils. Cross-contamination is one of the major causes of food poisoning.

To prevent cross-contamination:

• Always wash your hands thoroughly after touching raw food and then wash your sink taps.
• Keep raw and ready-to-eat food separate.
• Store raw meat in sealable containers at the bottom of the fridge, so it can’t drip onto other foods.
• Use different chopping boards or work surfaces for raw food and ready-to-eat food.
• Clean knives and other utensils thoroughly after use with raw food.