Botulism (Clostridium botulinum)



Botulism (Clostridium botulinum)

Canada's food supply is one of the safest in the world. But sometimes the foods we eat may carry bacteria that can make us sick, like Clostridium botulinum, which causes botulism.

What is botulism?

The bacterial spores that cause botulism - Clostridium botulinum - are widespread in nature, commonly found in soil and dust. These bacterial spores rarely cause problems because they cannot grow if they are exposed to oxygen. Since the spores do not grow, they cannot produce the toxins that cause illness.

Botulism is a rare but serious paralytic illness caused by a nerve poison that is produced by the bacterium Clostridium botulinum (C. botulinum). Foodborne botulism is caused by eating foods that contain the botulism toxin. Infant botulism occurs when infants eat the spores of the bacteria, which then grow in their intestines and release toxin. You can also get botulism from an infected wound. All forms of botulism can cause paralysis and be fatal.

How do people get sick?

Botulism is rare in Canada. While C. botulinum bacteria can be found in soil and dust, they cannot grow in air, so they only tend to cause problems when certain foods are stored or prepared improperly.

The most common way of getting botulism is by eating or drinking contaminated foods and beverages, like:

• improperly prepared low-acid, home-canned foods (like asparagus, beets, green beans, mushrooms, peppers)

• improperly smoked fish

• improperly prepared raw marine mammal meat (like whale, walrus, seal)

• non-refrigerated storage of low-acid fruit juices (like carrot juice)

• baked potatoes stored in aluminium foil

C. botulinum bacteria are heat-resistant and can survive high temperatures. The bacteria can grow in a moist, oxygen-free environment, so home canning or bottling provides the perfect conditions for the bacteria to multiply and produce the toxin, unless the food is properly canned or heat processed.

Honey (which naturally contains C. botulinum) has been linked to infant botulism. While the bacteria can't grow or produce toxins in honey, they can grow and produce toxins in a baby's intestine.

What are the symptoms and treatment?

Anyone can get foodborne botulism. Most people with botulism develop the following symptoms 12 to 36 hours after eating or drinking food containing the toxin produced by C. botulinum bacteria:

Botulism (Clostridium botulinum) - Continued

• nausea

• vomiting

• diarrhea (early)

• constipation (late)

• fatigue

• weakness and dizziness

• blurred or double vision

• dry mouth

• difficulty speaking and swallowing

• descending paralysis of the arms, legs, trunk and breathing muscles (starts in the arms and moves down)

With infant botulism, symptoms include constipation, weakness, a weak cry, a poor sucking reflex, irritability, lack of facial expression, and loss of head control. In some cases, the child may have trouble breathing because of paralysis of the diaphragm.

Most people recover if diagnosed and treated quickly. Treatment includes early doses of antitoxin and intensive respiratory care. Recovery can take several weeks to months. In some cases, it can take years and the person may never fully recover.

Severe botulism can require intensive medical and nursing care. It can also lead to paralysis and respiratory failure, which can require a person to be on a ventilator (breathing machine) to breathe. If not diagnosed and treated, botulism can lead to death from respiratory failure within three to ten days.

How do I avoid getting sick?

Foods contaminated with C. botulinum toxin might look, smell and taste normal. Unlike other bacteria, C. botulinum are not necessarily destroyed by cooking, so preventing the toxin from forming is key.

These tips will help protect you and your family from getting botulism:

• When canning or bottling low-acid foods at home, use up-to-date recipes and equipment, and follow all instructions carefully. See Home canning and Canning seafood for more safe canning tips.

• Keep all work surfaces, food, utensils, equipment, and hands clean during all stages of the canning process.

• Date and label all preserves and canned goods.

• Don't give honey (even pasteurized honey) to children under one year old. Healthy children over one year of age can safely eat honey because they have a very low risk of developing infant botulism.

• Never eat food from cans that are dented, bulging, or leaking.

• Don't use aluminium foil to wrap potatoes or other vegetables for baking, unless the vegetables will be cooked and eaten right away. If you want to store them after they've been cooked, unwrap and refrigerate them right away.

• Keep all low-acid juices (like carrot juice) and other products labelled "keep refrigerated" in the fridge.

• Be careful with home-prepared foods stored in oil (like garlic, Vegetables, herbs and spices). If these products are prepared using fresh ingredients, they must be kept refrigerated and be used within ten days.

Clostridium perfringens - bacteria

Symptoms

Symptoms may include:

• abdominal bloating and increased gas

• fatigue

• loss of appetite and weight loss

• muscle ache

• nausea

• profuse, watery diarrhea

• severe abdominal pain and stomach cramps

Start of symptoms / how long they last

Symptoms of C. perfringens may occur within 6 to 24 hours after eating contaminated food. The usual onset time is 10 to12 hours.

Most symptoms subside within 24 hours. However, some can last for up to two weeks.

Potential health impacts

C. perfringens are a spore-forming bacteria. They are found in soil, dust, sewage, and human and animal intestines.  If consumed, these spores produce toxins (poison) in the intestinal tract, which can make you sick.

Food commonly associated

A wide variety of food can become contaminated with C. perfringens. Typically this bacterium will grow in foods that are high in starch or high in protein, such as cooked beans, meat products, thick soups, and gravy. Leftovers that aren't cooled and reheated properly may contain a lot of the bacteria.

The toxins are most commonly associated with foodborne illness, which can happen where food is

• made in large amounts, then allowed to cook slowly for several hours before consumption, and is

• allowed to cool slowly or is improperly refrigerated

This pattern is common in cafeterias, hospitals, nursing homes and prisons.

How to protect yourself

• Refrigerate all leftovers promptly in uncovered, shallow containers so they cool quickly.

• Very hot items can first be cooled at room temperature. Refrigerate once steaming stops.

• Leave the lid off or wrap loosely until the food is cooled to refrigeration temperature.

• Avoid overstocking the refrigerator to allow cool air to circulate freely.

Ordinary cooking will not kill C. perfringens spores because some strains can survive at the boiling point (100° C or 212° F) for up to an hour.

Salmonella and Salmonellosis

While the food we eat in Canada is generally very safe, sometimes it may carry bacteria that can make us sick, like Salmonella.

What is Salmonella?

Salmonella bacteria are found naturally in the intestines of animals, reptiles and birds. The bacteria are usually transmitted to people when they eat foods contaminated with animal feces (stool). Contaminated foods often come from animal sources, like poultry, beef, milk or eggs. But all foods, including fruits and vegetables, can become contaminated. It is important to remember that foods that are contaminated with bacteria can have a completely normal appearance. This is why it is important to always use safe food handling techniques.

People who eat food contaminated by Salmonella can become ill with salmonellosis. The disease is more common in summer than in winter. Like other foodborne illnesses, the symptoms of salmonellosis can feel like stomach flu, but they can also develop into serious illness with long-lasting effects.

How do people get sick? Did you know?

Intestinal illness can be caused by viruses, bacteria or parasites, and usually involves vomiting and diarrhea. People often call it the flu, though it is in no way related to the influenza virus, which causes respiratory illness.

Both animals and people can be carriers of Salmonella. They can then spread the bacteria to foods, surfaces, other animals or people. Food can become contaminated with Salmonella during butchering, when food is handled by a person infected with Salmonella, or from cross-contamination when raw foods or pets are handled improperly.

The most common way of getting salmonellosis is by eating contaminated foods that have not been cooked properly. Common sources of Salmonella include:

• raw and undercooked meat (especially poultry)

• raw or undercooked eggs

o homemade salad dressings, hollandaise sauce, mayonnaise, ice cream, cookie dough, tiramisu and frostings

• raw fruits and vegetables (especially sprouts and cantaloupes) and their juices

• unpasteurized dairy products, like raw milk and raw milk cheeses, cream-filled deserts and toppings

• pet treats

• fish and shrimp

You can also be exposed to Salmonella by:

• not washing fresh fruits and vegetables before eating them

• not thoroughly cleaning work surfaces used to prepare raw meat and other foods

• not washing your hands with soap after handling raw meat or using the bathroom

• not washing your hands with soap after handling pets, especially those with diarrhea or exotic pets like snakes, turtles and reptiles

Salmonella – Continued

What are the symptoms and treatment?

People infected with Salmonella can experience a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others feel as though they have a bad case of the flu. Still others become seriously ill and must be hospitalized.

Most people with salmonellosis develop the following symptoms 6 to 72 hours after being infected:

• fever

• chills

• diarrhea

• abdominal cramps

• headache (with sudden onset)

• nausea

• vomiting (sometimes)

The illness usually lasts four to seven days and most people recover without treatment. As with any disease causing diarrhea or vomiting, people infected should drink plenty of liquids to replace lost body fluids and prevent dehydration. In severe cases, patients may need to be given fluids intravenously. Although anyone can get salmonellosis infection, pregnant women, people with weakened immune systems, young children and the elderly are most at risk for developing serious complications.

In a small number of cases, Salmonella may spread from the intestines to the blood stream and other body sites, causing severe illness and, in vulnerable people, death. In cases of severe illness, patients may be treated with antibiotics. However, some Salmonella bacteria have become resistant to many commonly used antibiotics.

A small number of infected people go on to develop chronic pains in their joints, irritation of the eyes and painful urination, a condition called Reiter's Syndrome. It can last for months or years, sometimes leading to chronic arthritis, which is difficult to treat.

Because many different illnesses cause the same symptoms as salmonellosis, the only way to diagnose it is through laboratory tests on the stools of infected people. Once Salmonella bacteria have been identified, further testing can determine the type of Salmonella and the appropriate antibiotics to use in treatment.

How do I avoid getting sick?

Food safety tip

When cooking a chicken or turkey, it is safest to cook the stuffing in a separate dish, to prevent cross-contamination and undercooking. For more on cooking poultry safely, see Poultry Safety.

Foods contaminated with Salmonella look, smell and taste normal. The good news is, Salmonella and many other harmful bacteria can be killed by cooking food properly.

Salmonella – Continued – Page 3

These tips will help protect you and your family from Salmonella:

• Cook food to a safe internal temperature using a digital thermometer.

• Poultry and meat, including hamburgers, should be well cooked, not pink in the middle. If you are served undercooked food in a restaurant, send it back.

• Do not eat raw or undercooked eggs. Raw eggs may be found in homemade foods like hollandaise sauce, Caesar and other salad dressings, tiramisu, ice cream, mayonnaise, cookie dough and frostings.

• Only buy clean and uncracked eggs. Store eggs in their original carton (so you can check the "best before" date) and place them in the coldest section of the fridge, not the door.

• Eat and drink only pasteurized juice, cider, milk and milk products. Mother's milk is the safest food for infants. Breastfeeding prevents salmonellosis and many other health problems.

• When buying and storing groceries, keep meats separate from fruits, vegetables, cooked foods and ready-to-eat foods. If you use reusable grocery bags and bins, make sure to clean them often with hot, soapy water.

• Wash your hands before handling any food. Be sure to wash your hands, cutting boards, counters, knives and other utensils after preparing raw foods.

• Wash raw fruits and vegetables thoroughly with clean, safe running water before you prepare and eat them. Use a brush to scrub produce with firm or rough surfaces, like oranges, cantaloupes, potatoes and carrots.

• Never place cooked food on the unwashed plate that held raw meat, poultry or fish. Wash thermometers in between testing.

• Wash your hands after contact with animal feces (for example, after changing kitty litter or scooping up after your dog).

• Since reptiles can have Salmonella, always wash your hands after handling them. Reptiles, including turtles, are not good pets for children and should not be in the same house as an infant.

• Keep pets away from food storage and preparation areas. Wash your hands well with soap and water after handling pet treats, pet food and pet toys, or after playing with or cleaning up after your pet.

• If you have been diagnosed with salmonellosis or any other gastrointestinal illness, do not prepare food or pour water for other people.

• If you are diagnosed with salmonellosis, be sure that you or your doctor tells the local Public Health Department. If many cases happen at the same time, it may mean that a restaurant or a particular food item has a problem that needs to be corrected.

Listeria and Listeriosis

The food we eat in Canada is very safe, but sometimes it can carry bacteria, like Listeria monocytogenes (commonly called Listeria), that can make us sick.

What is Listeria?

Listeria is bacteria found in food, soil, plants, sewage and other places in nature. Animals and humans can carry Listeria in their intestines without knowing it.

Eating food with Listeria on it can cause a serious disease called listeriosis. While it is rare in Canada, it is very dangerous to pregnant women, older adults and people with weakened immune systems. In serious cases, listeriosis can lead to miscarriage, brain infection, blood poisoning and even death.

How do people get sick?

People can get listeriosis by eating meat, fish, dairy products, plants or vegetables contaminated with Listeria. Listeria can get on your food from the soil, water, manure-based fertilizers, and even farm animals that look healthy. You can also transfer Listeria from one food to another by not handling it properly.

What are the symptoms and treatment?

The mild form of listeriosis usually begins about one day after eating heavily contaminated food. For the more serious form of the disease, the incubation period is generally much longer: on average about 21 days, but can be up to 70 days after exposure.

Many people are exposed to Listeria, but only a few will actually develop listeriosis. Symptoms of "food poisoning" may start suddenly, and include:

• vomiting

• nausea

• cramps

• diarrhea

• severe headache

• constipation

• persistent fever

Listeriosis can be treated with antibiotics, but early diagnosis is key, especially for people at high risk (e.g., pregnant women, older adults and people with weakened immune systems). At the moment, there is no vaccine to prevent listeriosis.

How do I avoid getting sick?

Foods that are contaminated with Listeria look, smell and taste normal. Unlike most bacteria, Listeria can survive and sometimes grow on foods being stored in the refrigerator. The good news is Listeria can be killed by cooking food properly.

These steps will help you reduce your risk of getting listeriosis and other foodborne illnesses:

1. Check your fridge temperature. Check the temperature in your refrigerator using a thermometer to make sure it is at 4ºC (40ºF) or below. As the storage temperature increases, so does the growth of Listeria in foods. The higher the number of bacteria in foods, the greater the risk of getting sick.

Listeria or Listeriosis - Continued

2. Clean your fridge often. Wash and disinfect your refrigerator regularly. The more often it is cleaned, the less chance that Listeria will be transferred from contaminated food and surfaces to non-contaminated foods.

3. Use leftovers safely. Keep leftovers for a maximum of four days, preferably only 2-3 days, and reheat them to an internal temperature of 74ºC (165ºF) before eating them.

4. Pay attention to "Best before" dates. "Best before" dates do not guarantee product safety, but they indicate how long the unopened products will retain their freshness and high quality. Once a package is opened, the "best before" date no longer applies. In general, after opening, refrigerated ready-to-eat (RTE) foods should not be stored in the refrigerator for longer than 4 days, and preferably only 2-3 days.

5. Serve and store food quickly. Serve food right away, and refrigerate or freeze perishable food, prepared food and leftovers within two hours. Avoid letting foods sit at temperatures between 4ºC (40ºF) and 60ºC (140ºF).

6. Cook thoroughly. Cook food completely, using a clean thermometer to measure the temperature. See Health Canada's safe internal cooking temperature chart to learn the proper way of taking measurements and to ensure that the food has been cooked to a safe internal temperature.

7. Follow package directions. Read and follow all package labels and instructions about food preparation and storage.

8. Separate meat from produce. Keep raw meats, poultry and seafood separate from produce and RTE foods in your shopping cart and fridge. Use a separate cutting boards for raw meats, poultry and seafood and one for washed fruits/vegetables and RTE foods.

9. Wash your hands. Wash your hands with soap and water for at least 20 seconds before, during and after handling food, using the bathroom, changing diapers or handling pets.

10. Wash produce. Wash fruits and vegetables well before you eat them.

11. Defrost safely. Never defrost food at room temperature. Defrost in the refrigerator, in the microwave, or in cold water (replaced every 30 minutes).

12. Clean before re-using. To avoid cross-contamination, clean all knives, cutting boards, thermometers and utensils that touched raw food before using them again. Change dishcloths daily, and avoid using sponges since they are hard to keep clean.

13. Sanitize. After handling foods in the kitchen, especially raw foods like meat and fish, thoroughly clean and sanitize all surfaces used for preparing food. Use a kitchen sanitizer (following the directions on the container) or a bleach solution (5 ml household bleach to 750 ml of water), and rinse with water.

On top of these tips, high-risk people should avoid eating the following foods:

• hot dogs, unless reheated until steaming hot

• deli meats, unless dried and salted or heated until steaming hot

• raw or unpasteurized dairy products, including soft and semi-soft cheese, such as Brie, Camembert and blue-veined cheese.

• pâté and meat spreads, unless frozen, canned or shelf-stable

• refrigerated smoked seafood and fish. Frozen smoked seafood and fish are of lower risk, with fully cooked, canned or shelf-stable being the safest alternatives.

• raw or undercooked meat, poultry and fish

Escherichia coli – E. coli

Our food supply in Canada is generally very safe, but sometimes the food we eat may carry bacteria that can make us sick, like Escherichia coli O157:H7, which is commonly called E. coli.

What is E. coli?

Escherichia coli (E. coli) are bacteria that live naturally in the intestines of cattle, poultry and other animals. Most E. coli are harmless to humans, but some varieties carry genes that allow them to cause disease.

The bacteria can be transferred to the outer surface of meat during butchering. Processing can then spread the bacteria throughout the meat. Raw fruits and vegetables can also become contaminated with E.coli while in the field, through improperly composted manure, contaminated water, wildlife and contaminated harvesters.

If you eat undercooked ground beef or other foods contaminated with E. coli, you can become ill. While most people experience a few days of upset stomach and then recover fully, E. coli infections can sometimes be life threatening.

How do people get sick? Did you know?

Intestinal illness can be caused by viruses, bacteria or parasites, and usually involves vomiting and diarrhea. People often call it the flu, though it is in no way related to the influenza virus, which causes respiratory illness.

Both animals and people can be carriers of E. coli without showing signs of illness. They can then spread the bacteria to foods, surfaces or other people. Food can become contaminated with E. coli during butchering, when food is handled by a person infected with E. coli, or from cross-contamination when raw foods are handled improperly.

Two of the most common ways to come into contact with E. coli are by improperly handling raw ground meat and by eating ground meat that is undercooked.

You can be exposed to this type of E.coli by eating or drinking:

• raw and undercooked meat, especially ground beef

• contaminated raw fruits and vegetables, including sprouts

• untreated water

• unpasteurized (raw) milk and (raw) milk products, including raw milk cheese

• unpasteurized apple juice/cider

Finally, you can be infected with E. coli through contact with the feces (stool) of infected people or with cattle or other farm animals (including at petting zoos and fairs).

Fast fact

You cannot tell the difference between contaminated and non-contaminated food by the way it looks, smells, or tastes. Safe food handling and cooking practices are key to preventing foodborne illness.

What are the symptoms and treatment?

People infected with E. coli can have a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others feel as though they have a bad case of upset stomach. Still others become seriously ill and must be hospitalized.

The following symptoms can appear within one to ten days after contact with the bacteria:

• severe stomach cramps

• watery or bloody diarrhea

• vomiting

• nausea

• headache

• little or no fever

Most symptoms clear up within five to ten days. But some people who are infected with E. coli develop life-threatening symptoms, including kidney failure, seizures and stroke. While most will recover completely, others may suffer permanent health effects, like kidney damage, and some may die.

Although anyone can get an E. coli infection, pregnant women, people with compromised immune systems, young children and older adults are most at risk for developing serious complications.

There is no real treatment for E. coli infections, other than monitoring the illness, providing comfort, and preventing dehydration through proper hydration and nutrition. People who develop complications may need further treatment, like dialysis for kidney failure. You should contact your health care provider if symptoms persist.

How do I avoid getting sick?

Because ground beef can turn brown before disease-causing bacteria are killed, use a digital food thermometer to make sure you cook hamburger to an internal temperature of at least 71°C (160°F).

Foods contaminated with E. coli look, smell and taste normal. The good news is, E. coli and many other harmful bacteria can be killed by cooking food properly.

These tips will help protect you and your family from E. coli:

• Cook food to a safe internal temperature using a digital thermometer.

• Do not eat hamburger patties that are pink in the middle. If served an undercooked hamburger, send it back for further cooking. Ask for a new bun and a clean plate, too.

• Avoid spreading harmful bacteria. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they have come in contact with raw meat. Never place cooked hamburgers on the unwashed plate that held raw patties. Wash thermometers in between testing patties.

• Eat and drink only pasteurized juice, cider, milk and milk products.

• Drink water from a safe (treated or boiled) supply.

• Wash your hands thoroughly before preparing or eating food.

• Wash raw fruits and vegetables thoroughly with clean, safe running water before you prepare and eat them. Use a brush to scrub produce with firm or rough surfaces, like oranges, cantaloupes, potatoes and carrots.

• Wash your hands after contact with animals (at home, farms, petting zoos and fairs).

• Keep pets away from food storage and preparation areas.

• If you think you are infected with E. coli bacteria or any other gastrointestinal illness, do not prepare food for other people.

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