THE OFFICIAL PATIENT’S SOURCEBOOK
on
OODBORNE LLNESS J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Foodborne Illness: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83385-0 1. Foodborne Illness-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of foodborne illness.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to foodborne illness. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to foodborne illness, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
·
The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis A
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
·
The Official Patient's Sourcebook on Hirschsprung
·
The Official Patient's Sourcebook on Indigestion
·
The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
·
The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Lactose Intolerance
·
The Official Patient's Sourcebook on Ménétrier
·
The Official Patient's Sourcebook on Pancreatitis
·
The Official Patient's Sourcebook on Peptic Ulcer
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The Official Patient's Sourcebook on Porphyria
·
The Official Patient's Sourcebook on Primary Biliary Cirrhosis
·
The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
·
The Official Patient's Sourcebook on Proctitis
·
The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
·
The Official Patient's Sourcebook on Wilson's Disease
·
The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 9
PART I: THE ESSENTIALS ............................................... 11 CHAPTER 1. THE ESSENTIALS ON FOODBORNE ILLNESS: GUIDELINES ............................................................................................................. 13
Overview............................................................................................................. 13 What Is Foodborne Illness? ................................................................................ 15 Causes ................................................................................................................. 15 Symptoms ........................................................................................................... 16 Risk Factors ........................................................................................................ 16 Complications ..................................................................................................... 16 Diagnosis ............................................................................................................ 17 Treatment............................................................................................................ 17 Prevention........................................................................................................... 18 Food Irradiation .................................................................................................. 19 Links to Other Disorders .................................................................................... 19 Common Sources of Foodborne Illness ............................................................... 20 Points to Remember............................................................................................ 21 For More Information......................................................................................... 21 More Guideline Sources ..................................................................................... 23 Vocabulary Builder............................................................................................. 25
CHAPTER 2. SEEKING GUIDANCE ....................................................... 29
Overview............................................................................................................. 29 Associations and Foodborne Illness.................................................................... 29 Finding Doctors.................................................................................................. 31 Selecting Your Doctor ........................................................................................ 33 Working with Your Doctor ................................................................................ 33 Broader Health-Related Resources ..................................................................... 35
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 37 CHAPTER 3. STUDIES ON FOODBORNE ILLNESS .................................. 39
Overview............................................................................................................. 39 Federally-Funded Research on Foodborne Illness .............................................. 39 E-Journals: PubMed Central .............................................................................. 43 The National Library of Medicine: PubMed ...................................................... 43 Vocabulary Builder............................................................................................. 44
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Contents
CHAPTER 4. BOOKS ON FOODBORNE ILLNESS .................................... 47
Overview............................................................................................................. 47 Book Summaries: Online Booksellers ................................................................. 47 The National Library of Medicine Book Index ................................................... 47 Chapters on Foodborne Illness............................................................................ 50 General Home References ................................................................................... 51 Vocabulary Builder............................................................................................. 52
CHAPTER 5. MULTIMEDIA ON FOODBORNE ILLNESS ......................... 53
Overview............................................................................................................. 53 Bibliography: Multimedia on Foodborne Illness ................................................ 53 Vocabulary Builder............................................................................................. 55
CHAPTER 6. PHYSICIAN GUIDELINES AND DATABASES ..................... 57
Overview............................................................................................................. 57 NIH Guidelines................................................................................................... 57 NIH Databases.................................................................................................... 58 Other Commercial Databases ............................................................................. 62 Specialized References......................................................................................... 62
PART III. APPENDICES .................................................... 65 APPENDIX A. RESEARCHING YOUR MEDICATIONS............................ 67
Overview............................................................................................................. 67 Your Medications: The Basics ............................................................................ 68 Learning More about Your Medications ............................................................ 69 Commercial Databases........................................................................................ 71 Contraindications and Interactions (Hidden Dangers) ..................................... 72 A Final Warning ................................................................................................ 73 General References.............................................................................................. 74 Vocabulary Builder............................................................................................. 74
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ..................... 75
Overview............................................................................................................. 75 What Is CAM? ................................................................................................... 75 What Are the Domains of Alternative Medicine?.............................................. 76 Can Alternatives Affect My Treatment? ........................................................... 79 Finding CAM References on Foodborne Illness ................................................. 80 Additional Web Resources.................................................................................. 87 General References.............................................................................................. 88 Vocabulary Builder............................................................................................. 88
APPENDIX C. FINDING MEDICAL LIBRARIES ...................................... 91
Overview............................................................................................................. 91 Preparation ......................................................................................................... 91 Finding a Local Medical Library ........................................................................ 92 Medical Libraries Open to the Public................................................................. 92
Contents
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APPENDIX D. NIH CONSENSUS STATEMENT ON TRAVELERS’ DIARRHEA ........................................................................................... 99
Overview............................................................................................................. 99 What Is Travelers’ Diarrhea? ........................................................................... 100 Epidemiology of Travelers’ Diarrhea................................................................ 101 What Causes Travelers’ Diarrhea?................................................................... 102 Effective Prevention Measures ......................................................................... 105 Effective Treatment Measures .......................................................................... 106 Directions of Future Research .......................................................................... 109 Summary and Conclusions............................................................................... 111 Vocabulary Builder........................................................................................... 111
ONLINE GLOSSARIES.................................................... 117 Online Dictionary Directories.......................................................................... 119
FOODBORNE ILLNESS GLOSSARY........................... 121 General Dictionaries and Glossaries ................................................................ 133
INDEX................................................................................... 136
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Foodborne Illness
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Foodborne Illness has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to foodborne illness, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on foodborne illness. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on foodborne illness should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching foodborne illness (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to foodborne illness. It also gives you sources of information that can help you find a doctor in your local area specializing in treating foodborne illness. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with foodborne illness. Part II moves on to advanced research dedicated to foodborne illness. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on foodborne illness. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with foodborne illness or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with foodborne illness. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with foodborne illness.
Scope While this sourcebook covers foodborne illness, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that foodborne illness is often considered a synonym or a condition closely related to the following: ·
Acute Bacterial Nephritis
·
Acute Bacterial Tracheitis
4
Foodborne Illness
·
Acute Bladder Infection
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Acute Gastroenteritis
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Acute Urinary Tract Infection (uti)
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Afferent Loop Syndrome
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Allergic Bowel Disease
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Allergy to Food
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Bacterial Arthritis
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Bacterial Endocarditis
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Bacterial Keratitis
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Bacterial Labyrinthitis
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Bacterial Liver Abscess
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Bacterial Meningitis
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Bacterial Meningococcal Meningitis
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Bacterial Pneumonia
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Bacterial Tracheitis
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Bacterial Tracheobronchitis
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Bacterial Vaginitis
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Bacterial Vaginosis
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Chronic Bacterial Prostatitis
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Classic Pneumococcal Pneumonia
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Corynebacterium Vaginitis
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Dietary Protein Sensitivity Syndrome
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Endocarditis, Bacterial
·
Flesh-eating Bacteria
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Food Hypersensitivity
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Food Poisoning
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Gardnerella Vaginalis
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Gardnerella Vaginosis
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Gastroenteritis - Bacterial
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Gastrojejunal Loop Obstruction
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Haemophilus Vaginalis
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Lobar Pneumonia
Introduction
·
Membranous Tracheitis
·
Mycobacteria Other Than Tuberculosis
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Mytilotoxism
·
Nonspecific Bacterial Epididymitis
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Nonspecific Vaginitis
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Nontuberculous Atypical Mycobacterial Disease
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Overgrown Intestinal Bacteria
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Paralytic Shellfish Poisoning
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Post Gastrectomy Syndrome
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Primary Peritonitis
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Pseudomembranous Croup
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Purulent Arthritis
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Purulent Pericarditis
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Pyarthrosis
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Pyogenic Arthritis
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Pyogenic Meningitis
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Septic Arthritis
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Stagnant Loop
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Subcutaneous Infection - Bacterial
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Suppurative Arthritis
·
Uncomplicated Urinary Tract Infection
5
In addition to synonyms and related conditions, physicians may refer to foodborne illness using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for foodborne illness:4 ·
003.0 salmonella gastroenteritis
·
004.0 shigella dysenteriae
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
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Foodborne Illness
·
004.9 shigellosis, unspecified
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005.0 staphylococcal food poisoning
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005.1 botulism
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005.2 food poisoning due to clostridium perfringens [c. welchii]
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005.3 food poisoning due to other clostridia
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005.4 food poisoning due to vibrio parahaemolyticus
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005.8 other bacterial food poisoning
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005.81 food poisoning due to vibrio vulnificus
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005.89 other bacterial food poisoning
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005.9 food poisoning, unspecified
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008.0 escherichia coli intestinal infection
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031.9 unspecified diseases due to mycobacteria
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320 bacterial meningitis
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422.92 myocarditis, bacterial
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428.0 pneumonia, klebsiella
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464.1 acute tracheitis
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464.2 acute laryngotracheitis
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477.1 due to food
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481 pneumococcal pneumonia
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481 pneumonia, pneumococcal
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482 other bacterial pneumonia
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482.0 pneumonia due to klebsiella pneumoniae
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482.1 pneumonia due to pseudomonas
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482.1 pneumonia, pseudomonas
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482.2 pneumonia due to hemophilus influenzae [h. influenzae]
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482.2 pneumonia, haemophilus influenzae
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482.3 pneumonia due to streptococcus
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482.30 streptococcus, unspecified
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482.31 group a
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482.32 group b
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482.39 other streptococcus
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482.4 pneumonia due to staphylococcus
Introduction
7
·
482.4 pneumonia, staphylococcal
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482.40 pneumonia due to staphylococcus, unspecified
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482.41 pneumonia due to staphylococcus aureus
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482.49 other staphylococcus pneumonia
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482.8 pneumonia due to other specified bacteria
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482.81 anaerobes
·
482.82 escherichia coli [e. coli]
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482.83 other gram-negative bacteria
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482.84 legionnaires' disease
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482.89 other specified bacteria
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482.9 bacterial pneumonia unspecified
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482.9 pneumonia, bacterial
·
486.0 pneumonia, acute
·
507.0 due to inhalation of food or vomitus
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507.0 pneumonia, aspiration
·
511.1 with effusion, with mention of a bacterial cause other than tuberculosis
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558.2 toxic gastroenteritis and colitis
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558.9 unspecific noninfectious gastroenteritis and colitis
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567.2 peritonitis
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616.10 vaginitis and vulvovaginitis, unspecified
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616.10 vulvovaginitis
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692.5 contact dermatitis and other eczema due to food in contact with the skin
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692.5 due to food in contact with skin
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693.1 dermatitis due to food taken internally
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693.1 due to food
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711 pyogenic arthritis, site un-specified
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711.00 pyogenic arthritis, site unspecified
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711.4 arthropathy associated with other bacterial diseases
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933.1 larynx
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960.6 antimycobacterial antibiotics
·
978 poisoning by bacterial vaccines
8
Foodborne Illness
·
978.0 bcg
·
978.1 typhoid and paratyphoid
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978.2 cholera
·
978.3 plague
·
978.4 tetanus
·
978.5 diphtheria
·
978.6 pertussis vaccine, including combinations with a pertussis component
·
978.8 other and unspecified bacterial vaccines
·
978.9 mixed bacterial vaccines, except combinations with a pertussis component
·
979.7 mixed viral-rickettsial and bacterial vaccines, except combinations with a pertussis component
·
988 toxic effect of noxious substances eaten as food
·
988.0 fish and shellfish
·
988.0 toxic effect of fish and shellfish eaten as food
·
988.1 mushrooms
·
988.1 toxic effect of mushrooms eaten as food
·
988.2 berries and other plants
·
988.8 other specified noxious substances eaten as food
·
988.9 unspecified noxious substance eaten as food
·
989.7 aflatoxin and other mycotoxin [food contaminants]
·
994.2 effects of hunger
·
995.6 anaphylactic shock due to adverse food reaction
·
995.60 anaphylactic shock or reaction due to food
·
995.60 anaphylaxis due to food
·
995.60 due to unspecified food
·
995.61 due to peanuts
·
995.62 due to crustaceans
·
995.63 due to fruits and vegetables
·
995.64 due to tree nuts and seeds
·
995.65 due to fish
·
995.66 due to food additives
Introduction
·
995.67 due to milk products
·
995.68 due to eggs
·
995.69 due to other specified food
·
995.7 other adverse food reactions, not elsewhere classified
9
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to foodborne illness. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with foodborne illness will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with foodborne illness is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of foodborne illness, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a
10 Foodborne Illness
chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
11
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on foodborne illness. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of foodborne illness to you or even given you a pamphlet or brochure describing foodborne illness. Now you are searching for more indepth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines 13
CHAPTER 1. THE ESSENTIALS ON FOODBORNE ILLNESS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on foodborne illness. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on foodborne illness can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on foodborne illness. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
14 Foodborne Illness
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with foodborne illness and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 15
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on foodborne illness.
What Is Foodborne Illness?7 Foodborne illness results from eating food contaminated with bacteria (or their toxins) or other pathogens such as parasites or viruses. The illnesses range from upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration. Although most foodborne infections are undiagnosed and unreported, the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from pathogens in food. Of these, up to 5,000 die.
Causes Harmful bacteria are the most common causes of foodborne illness. Some bacteria may be present on foods when you purchase them. Raw foods are not sterile. Raw meat and poultry may become contaminated during slaughter. Seafood may become contaminated during harvest or through processing. One in 20,000 eggs may be contaminated with Salmonella inside the eggshell. Produce such as lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7. Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of contamination are varied; however, these items are grown in the soil and therefore may become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in the restaurant or in the person’s kitchen. When food is cooked and left out for more than 2 hours at room temperature, bacteria can multiply quickly. Most bacteria grow undetected because they do not produce an “off” odor or change the color or texture of the food. Freezing food slows or stops bacteria’s growth but does not destroy the bacteria. The microbes can become reactivated when the food is thawed. Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/bacteria/bacteria.htm. 7
16 Foodborne Illness
Refrigeration may slow the growth of some bacteria, but thorough cooking is needed to destroy the bacteria.
Symptoms In most cases of foodborne illness, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include ·
Abdominal cramps
·
Nausea
·
Vomiting
·
Diarrhea
·
Fever
·
Dehydration
Risk Factors Some people are at greater risk for bacterial infections because of their age or immune status. Young children, pregnant women and their fetuses, the elderly, and people with lowered immunity are at greatest risk.
Complications Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious illness than vomiting or diarrhea. They can cause spontaneous abortion or death. In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7, and can lead to kidney failure and death. HUS is a rare disorder that affects primarily young children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. The child may become infected after consuming a contaminated food, such as meat (especially undercooked ground beef), unpasteurized apple cider or apple juice, or raw sprouts.
Guidelines 17
The most common symptoms of infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 2 to 6 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Symptoms of HUS include fever, lethargy, irritability, and pallor. In about half the cases, the disease progresses until the kidneys are unable to remove waste products from the blood and excrete them into the urine (acute renal failure). A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely. You need to see a doctor right away if you have any of the following symptoms, with or without gastrointestinal symptoms: ·
Signs of shock, such as weak or rapid pulse; shallow breathing; cold, clammy, pale skin; shaking or chills; or chest pain.
·
Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urine output, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing.
·
Confusion or difficulty reasoning.
Diagnosis Your doctor may be able to diagnose foodborne illness from a list of what you’ve recently eaten and results from the proper laboratory tests. Diagnostic tests for foodborne illness should include examination of the feces. A sample of the suspected food, if available, can also be tested for bacteria and their toxins as well as for viruses and parasites.
Treatment Most cases of foodborne illness are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. In cases with gastrointestinal or neurologic symptoms, people should seek medical attention. In the most severe situations, such as HUS, the patient may need hospitalization in order to receive supportive nutritional and medical therapy. Maintaining adequate fluid and electrolyte balance and controlling
18 Foodborne Illness
blood pressure are important. Doctors will try to minimize the impact of reduced kidney function. Early dialysis is crucial until the kidneys can function normally again, and blood transfusions may be needed.
Prevention Most cases of foodborne illness can be prevented through proper cooking or processing of food, which kills bacteria. In addition, because bacteria multiply rapidly between 40°F and 140°F, food must be kept out of this “danger zone.” To prevent harmful bacteria from growing in food, always: ·
Refrigerate foods promptly. If you let prepared food stand at room temperature for more than 2 hours, it may not be safe to eat. Set your refrigerator at 40°F or lower and your freezer at 0°F.
·
Cook food to the appropriate temperature (145°F for roasts, steaks, and chops of beef, veal, and lamb; 160°F for pork, ground veal, and ground beef; 165°F for ground poultry; and 180°F for whole poultry). Use a thermometer to be sure! Foods are properly cooked only when they are heated long enough and at a high enough temperature to kill the harmful bacteria that cause illness.
·
Prevent cross-contamination. Bacteria can spread from one food product to another throughout the kitchen and can get onto cutting boards, knives, sponges, and countertops. So keep raw meat, poultry, seafood, and their juices away from other foods that are ready to eat.
·
Handle food properly. Always wash your hands before touching food and after using the bathroom, changing diapers, or handling pets, as well as after handling raw meat, poultry, fish, shellfish, or eggs. Clean surfaces well before preparing food on them.
·
Keep cold food cold and hot food hot.
·
Maintain hot cooked food at 140°F or higher.
·
Reheat cooked food to at least 165°F.
·
Refrigerate or freeze perishables, prepared food, and leftovers within 2 hours.
·
Never defrost food on the kitchen counter. Use the refrigerator, cold running water, or the microwave oven.
·
Never let food marinate at room temperature; refrigerate it.
Guidelines 19
·
Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.
·
Remove the stuffing immediately from poultry and other meats and refrigerate it in a separate container.
·
Do not pack the refrigerator. Cool air must circulate to keep food safe.
Food Irradiation Food irradiation is the treatment of food with high energy such as gamma rays, electron beams, or x rays as a means of cold pasteurization, which destroys living bacteria, to control foodborne disease. The United States relies exclusively on the use of gamma rays, which are similar to ultraviolet light and microwaves and pass through the food leaving no residue or “radioactivity.” Food irradiation is currently approved for wheat, potatoes, spices, seasonings, pork, poultry, red meats, whole fresh fruits, and dry or dehydrated products. Although irradiation destroys many bacteria, it does not sterilize food. Even if you’re using food that has been irradiated by the manufacturer, you must continue to take precautions against foodborne illness, through proper refrigeration and handling, to safeguard against any surviving organisms.
Links to Other Disorders Scientists suspect that foodborne pathogens are linked to chronic disorders and can even cause permanent tissue or organ destruction. Research suggests that when some people are infected by foodborne pathogens, the activation of their immune system can trigger an inappropriate autoimmune response, which means the immune system attacks the body’s own cells. In some people, an autoimmune response leads to a chronic health condition. Chronic disorders that may be triggered by foodborne pathogens are: ·
Arthritis
·
Inflammatory bowel disease
·
Kidney failure
·
Guillain-Barré syndrome
·
Autoimmune disorders
20 Foodborne Illness
Further research is needed to explain the link.
Common Sources of Foodborne Illness Source of illness: Raw and undercooked meat and poultry. Symptoms: Abdominal pain, diarrhea, nausea, and vomiting. Bacteria: Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, Salmonella. Source of illness: Raw (unpasteurized) milk and dairy products, such as soft cheeses. Symptoms: Nausea and vomiting, fever, abdominal cramps, and diarrhea. Bacteria: L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, C. jejuni. Source of illness: Raw or undercooked eggs. Raw eggs may not be recognized in some foods such as homemade hollandaise sauce, caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings. Symptoms: Nausea and vomiting, fever, abdominal cramps, and diarrhea. Bacteria: Salmonella enteriditis. Source of illness: Raw or undercooked shellfish. Symptoms: Chills, fever, and collapse. Bacteria: Vibrio vulnificus, Vibrio parahaemolyticus. Source of illness: Improperly canned goods, and smoked or salted fish. Symptoms: Double vision, inability to swallow, difficulty speaking, and inability to breathe. (Seek medical help right away!) Bacteria: C. botulinum. Source of illness: Fresh or minimally processed produce. Symptoms: Diarrhea, nausea, and vomiting. Bacteria: E. coli O157:H7, L. monocytogenes, Salmonella, Shigella, Yersinia enterocolitica, viruses, and parasites.
Guidelines 21
Points to Remember ·
Foodborne illness results from eating food that is contaminated with bacteria, viruses, or parasites.
·
People at greater risk for foodborne illness include young children, pregnant women and their fetuses, the elderly, and people with lowered immunity.
·
Symptoms usually resemble intestinal flu. See a doctor immediately if you have more serious problems, or if you do not seem to be improving as you’d expect.
·
Treatment may range from replacement of lost fluids and electrolytes for mild cases of foodborne illness, to hospitalization for severe conditions such as hemolytic uremic syndrome.
You can prevent foodborne illness by taking the following precautions: ·
Wash your hands with hot, soapy water before preparing food and after using the bathroom or changing diapers.
·
Separate raw meat, poultry, or seafood from other foods to keep these foods and their juices away from ready-to-eat foods.
·
Cook foods properly and at a high enough temperature to kill harmful bacteria.
·
Refrigerate foods within 2 hours or less after cooking because cold temperatures will help keep harmful bacteria from growing and multiplying.
·
Clean surfaces well before using them to prepare foods.
For More Information U.S. Department of Agriculture 14th & Independence Avenue, SW. Washington, DC 20250 Meat and Poultry Hotline: 1-800-535-4555 www.usda.gov U.S. Department of Health and Human Services 200 Independence Avenue, SW. Washington, DC 20201
22 Foodborne Illness
www.os.dhhs.gov U.S. Environmental Protection Agency (EPA) 401 M Street, SW. Washington, DC 20460-0003 Phone: (202) 260-2090 www.epa.gov U.S. Food and Drug Administration FDA (HFE-88) 5600 Fishers Lane Rockville, MD 20857 Phone: 1-888-INFO-FDA www.fda.gov Center for Food Safety & Applied Nutrition Food and Drug Administration 200 C Street, SW. Washington, DC 20204 Food Information Line: 1-800-SAFEFOOD vm.cfsan.fda.gov/list.html Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 Phone: (404) 639-3534 or 1-800-311-3435 www.cdc.gov Gateway to Government Food Safety Information www.FoodSafety.gov Partnership for Food Safety Education www.fightbac.org American Dietetic Association 216 West Jackson Boulevard Chicago, IL 60606-6995 Consumer Nutrition Hotline: 1-800-366-1655 www.eatright.org
Guidelines 23
More Guideline Sources The guideline above on foodborne illness is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to foodborne illness. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with foodborne illness. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:
24 Foodborne Illness
·
Consumer Advice: Meat and Poultry Summary: Ground meat and ground poultry are more perishable than most foods. Improper handling and preparation can lead to bacterial food poisoning. Source: Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=204 The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to foodborne illness. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
Guidelines 25
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Chronic: Persisting over a long period of time. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH]
26 Foodborne Illness
Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Intestinal: Pertaining to the intestine. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all
Guidelines 27
over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pathogen: Any disease-producing microorganism. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
28 Foodborne Illness
Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
Seeking Guidance 29
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with foodborne illness. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with foodborne illness. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Foodborne Illness As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
30 Foodborne Illness
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about foodborne illness. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “foodborne illness” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “foodborne illness”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making
Seeking Guidance 31
these selections and typing in “foodborne illness” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with foodborne illness. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “foodborne illness” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with foodborne illness must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
32 Foodborne Illness
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
Seeking Guidance 33
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about foodborne illness?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for foodborne illness?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
34 Foodborne Illness
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 35
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
37
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on foodborne illness. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on foodborne illness. In Part II, as in Part I, our objective is not to interpret the latest advances on foodborne illness or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with foodborne illness is suggested.
Studies 39
CHAPTER 3. STUDIES ON FOODBORNE ILLNESS Overview Every year, academic studies are published on foodborne illness or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on foodborne illness. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on foodborne illness and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
Federally-Funded Research on Foodborne Illness The U.S. Government supports a variety of research studies relating to foodborne illness and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.15 CRISP Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control 15
40 Foodborne Illness
(Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to foodborne illness and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore foodborne illness and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for foodborne illness: ·
Project Title: S. typhimurium Genes Required for Colonization of Cattle Principal Investigator & Institution: Andrews-Polymenis, Helene L; Texas A&M University Health Science Ctr, College Station, TX 77843 Timing: Fiscal Year 2002 Summary: S. typhimurium is the most common cause of foodborne illness with lethal outcome in the US. The ability of S. typhimurium to consistently contaminate our food supply, creates an urgent need for better understanding of the molecular mechanisms that allow this pathogen to persist successfully in food producing animals. Epidemiological surveillance strongly suggests that pigeon adapted S. typhimurium variants (phage types DT2 and DT99) that cause fatal pigeon paratyphoid do not persist in cattle. The objective of this proposal is to identify the genes responsible for the epidemiologic success of S. typhimurium.in cattle through genomic comparison and characterize their function using the calf model of enterocolitis. The first specific aim of this proposal is to evaluate the virulence and persistence of S. typhimurium pigeon adapted variants in calves. The calf ligated ileal loop model will be used to evaluate the ability of pigeon variants to cause fluid accumulation, inflammation and tissue damage in the calf small intestine, and persistence in calves will be studied using oral models of infection. The second specific aim of this proposal is to identify genes present in S. typhimurium strain LT2 but absent from pigeon isolates. To identify LT2 specific genes unique to cattle isolates we will establish a epidemiological correlation within a large number of S.typhimurium
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
Studies 41
isolates by southern blotting. The final specific aim of this proposal is to test unique regions of DNA isolated from S. typhimurium cattle variants for the ability to alter host specificity of pigeon adapted S. typhimurium isolates. Dr. Andrews-Polymenis completed her Ph.D. in the laboratory of Dr. Ralph Isberg, identifying novel factors necessary for intracellular growth of Legionella pneumophila. She completed her D.V.M. cum laude at Texas A&M University College of Veterinary Medicine in May 2001. Having a strong interest in bacterial pathogenesis and in veterinary medicine, Dr. Andrews-Polymenis' career goal is to become an independent investigator at the interface between these two areas. The research collaboration between Dr. Baumler in the Texas A&M Health Science Center and Dr. Adams in the College of Veterinary Medicine provides a unique opportunity to achieve this career goal. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Foodborne Norwalk-Like Viruses: are They Infectious? Principal Investigator & Institution: Atmar, Robert L.; Baylor College of Medicine 1 Baylor Plaza Houston, TX 77030 Timing: Fiscal Year 2001 Summary: This application is submitted in response to RFA announcement DK-00-005, "Foodborne Illnesses, Gastrointestinal and Renal Complications." A new program for developing a strategy for determining the infectivity of Norwalk virus and other Norwalk-like viruses is proposed. Norwalk-like viruses are the single, most important cause of foodborne illness, but to date no system for determining the infectivity of these viruses exists. Two approaches will be pursued using the Norwalk virus strain to determine the infectivity of these viruses: (1) development of an in vitro method for virus cultivation in cell culture and (2) development of a biosensoring method to permit the rapid detection of potentially infectious Norwalk-like viruses. Several features make Norwalk virus, the prototype strain of NLVs, an attractive candidate to use in the development of in vitro measures of Norwalk-like virus infectivity: (i) virus stock for which infectivity in humans has been determined will be available; (ii) sensitive methods for detecting complete or partial Norwalk virus replication have been developed, including RT-PCR assay, immunofluorescence assays, and in situ-RTPCR assays; (iii) fresh stool samples containing Norwalk virus (from human experimental infection studies) are expected to be available during the grant period; (iv) and hyperimmune animal and acute and convalescent human sera are available for use in neutralization assays. The assays developed initially using Norwalk virus will then be generalized to other Norwalk-like viruses. The results obtained from our studies will generate new knowledge about the replication of Norwalk-
42 Foodborne Illness
like viruses and develop systems for assessing determining correlates of immunity from infection and measuring virus viability after exposure to different environmental conditions. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Phage-Encoded Functions in Enterohemorrhagic E.Coli Principal Investigator & Institution: Christie, Gail E.; Virginia Commonwealth University, 901 W Franklin St Richmond, VA 23284 Timing: Fiscal Year 2001 Summary: The long-term goal of this research is to understand the role of temperate phages in, and the contribution of phage-encoded gene products to, the virulence of enterohemorrhagic Escherichia coli (EHEC). EHEC are emerging foodborne pathogens that have caused large-scale outbreaks of gastrointestinal illness in developed countries during the past two decades. Intestinal infection can lead to diarrhea, hemorrhagic colitis or more severe systemic complications, such as hemolytic uremic syndrome. The production of Shiga toxins by EHEC strains plays an important role in the development of serious complications following EHEC infection. Two immunologically distinct Shiga toxins, designated Stx1 and Stx2, have been identified among clinical E. coli isolates of many serotypes. Genes for both Shiga toxin types in E. coli have been shown to be encoded on lysogenic lambdoid bacteriophages. These Shiga toxinencoding phages have played an important role in transmitting the stx genes during the evolution of Stx-producing enteric pathogens, and continue to be involved in ongoing dissemination of Shiga toxin genes to new hosts. In addition, recent studies have shown that the toxin genes appear to be integrated into the lytic circuitry of these phages in such a way that prophage induction leads to increased toxin gene expression and concomitant release of toxin by host cell lysis. One aim of the experiments outlined in this application is to define more clearly the roles of phage-encoded functions in toxin gene expression and toxin release. A second aim of the application is to investigate other phage-encoded genes that are postulated to play roles in lysogenic conversion. The products of these genes may affect processes, such as colonization or immune evasion, that could contribute to the virulence of lysogenic bacteria. Using the Stx2-encoding phage 933W, which has been sequenced in its entirety, directed mutations in individual genes will be constructed. The effects of these mutations on Shiga toxin production or other interactions with host cells will be assessed in vitro, and effects on virulence using a mouse model system will be determined. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
Studies 43
E-Journals: PubMed Central16 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).17 Access to this growing archive of e-journals is free and unrestricted.18 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “foodborne illness” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for foodborne illness in the PubMed Central database: ·
A prospective study of rural drinking water quality and acute gastrointestinal illness by Barbara Strauss, Will King, Arthur Ley, and John R. Hoey; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=57004
·
Characterization of a Toxin A-Negative, Toxin B-Positive Strain of Clostridium difficile Responsible for a Nosocomial Outbreak of Clostridium difficile-Associated Diarrhea by Michelle J. Alfa, Amin Kabani, David Lyerly, Scott Moncrief, Laurie M. Neville, Ali Al-Barrak, Godfrey K. H. Harding, Brenda Dyck, Karen Olekson, and John M. Embil; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87004&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.19 If the publisher has a Web site that Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 17 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 18 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The 16
44 Foodborne Illness
offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with foodborne illness, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “foodborne illness” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “foodborne illness” (hyperlinks lead to article summaries): ·
An outbreak of food poisoning among children attending an international sports event in Johannesburg. Author(s): Karas JA, Nicol MP, Martinson N, Heubner R. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2001 May; 91(5): 417-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11455807&dopt=Abstract
Vocabulary Builder Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Arrhythmia:
Any variation from the normal rhythm of the heart beat,
PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
Studies 45
including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU]
Encephalitis: Inflammation of the brain. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endonucleases: Enzymes that catalyze the hydrolysis of the internal bonds and thereby the formation of polynucleotides or oligonucleotides from riboor deoxyribonucleotide chains. EC 3.1.-. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Herpes:
Any inflammatory skin disease caused by a herpesvirus and
46 Foodborne Illness
characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Kinetic: Pertaining to or producing motion. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Ovalbumin: An albumin obtained from the white of eggs. It is a member of the serpin superfamily. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteobacteria: A class of bacteria consisting of the purple bacteria and their relatives which form a branch of the eubacterial tree. This group of predominantly gram-negative bacteria is classified based on homology of equivalent nucleotide sequences of 16S ribosomal RNA or by hybridization of ribosomal RNA or DNA with 16S and 23S ribosomal RNA. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]
Books 47
CHAPTER 4. BOOKS ON FOODBORNE ILLNESS Overview This chapter provides bibliographic book references relating to foodborne illness. You have many options to locate books on foodborne illness. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on foodborne illness include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ).
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search
48 Foodborne Illness
LOCATORplus.” Once you are in the search area, simply type “foodborne illness” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:20 ·
Bacteria and anti-bacterial agents. Author: John Mann and M. James C. Crabbe; Year: 1996; Oxford: Spektrum; Sausalito, Calif.: University Science Books, c1996; ISBN: 0716745089 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0716745089/icongroupin terna
·
Bacteria and cancer. Author: edited by J. Jeljaszewicz, G. Pulverer, W. Roszkowski; Year: 1982; London; New York: Academic Press, 1982; ISBN: 0123838207 http://www.amazon.com/exec/obidos/ASIN/0123838207/icongroupin terna
·
Bacteria and human disease. Author: J. M. Slack and I. S. Snyder; Year: 1978; Chicago: Year Book Medical Publishers, c1978; ISBN: 0815177003 http://www.amazon.com/exec/obidos/ASIN/0815177003/icongroupin terna
·
Bacteria and mineral cycling. Author: T. Fenchel and T. H. Blackburn; Year: 1979; London; New York: Academic Press, 1979; ISBN: 012252750X http://www.amazon.com/exec/obidos/ASIN/012252750X/icongroupi nterna
·
Bacteria and plants. Author: edited by Muriel E. Rhodes-Roberts and F.A. Skinner; Year: 1982; London; New York: Academic Press, 1982; ISBN: 0125870809 http://www.amazon.com/exec/obidos/ASIN/0125870809/icongroupin terna
·
Biological nomenclature today: a review of the present state and current issues of biological nomenclature of animals, plants, bacteria, and viruses: papers presented at ICSEB III, July 9, 1985, Brighton, United Kingdom. Author: edited by W.D.L. Ride and T. Yo; Year: 1986; Eynsham, Oxford, UK: Published by IRL Press on behalf of the ICSU
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
20
Books 49
Press, Miami, Fla., USA for the International Union of Biological Sciences, Paris, France, 1986; ISBN: 1852210168 (pbk.) http://www.amazon.com/exec/obidos/ASIN/1852210168/icongroupin terna ·
Biological regulation of vectors: the saprophytic and aerobic bacteria and fungi: a conference report. Author: sponsored by the National Institute of Allergy and Infectious Diseases; conference chairman and scientific editor, John D. Briggs; Year: 1976; Bethesda, Md.: U. S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health; Washington: for sale by Supt. of Docs., U. S. Govt. Print. Off., [1976?]
·
Clinical skin microbiology: pathogenic bacteria and pathogenic viruses. Author: by Raza Aly and Howard I. Maibach; Year: 1978; Springfield, Ill.: Thomas, c1978; ISBN: 0398037574 http://www.amazon.com/exec/obidos/ASIN/0398037574/icongroupin terna
·
Clinican's dictionary guide to bacteria and fungi. Author: by Dorothy M. Mikat and Kurt W. Mikat; Year: 1978; Indianapolis, Ind.: Eli Lilly, [1978]
·
Definition of the domains archaea, bacteria, and eucarya in terms of small subunit ribosomal RNA characteristics [microform]. Author: S. Winker and C.R. Woese; Year: 1994; [Argonne, Ill.?: Argonne National Laboratory?, 1994?]
·
Fungi and bacteria in indoor air environments: health effects, detection, and remediation: proceedings of the international conference, Saratoga Springs, New York, October 6-7, 1994. Author: editors, Eckardt Johanning, Chin S. Yang; Year: 1995; Latham, NY: Eastern New York Occupational Health Program, 1995; ISBN: 0964730707 http://www.amazon.com/exec/obidos/ASIN/0964730707/icongroupin terna
·
Germs, bacteria and viruses. Author: by Leslie Jean LeMaster; Year: 1985; Chicago: Childrens Press, 1985; ISBN: 0516019376 http://www.amazon.com/exec/obidos/ASIN/0516019376/icongroupin terna
·
Immunoassays for food-poisoning bacteria and bacterial toxins. Author: G.M. Wyatt; with contributions from H.A. Lee and M.R.A. Morgan; Year: 1992; London: James & James; London; New York: Chapman & Hall, 1992; ISBN: 0412408104 http://www.amazon.com/exec/obidos/ASIN/0412408104/icongroupin terna
50 Foodborne Illness
·
Immunomodulation by bacteria and their products. Author: edited by Herman Friedman, Thomas W. Klein, and Andor Szentivanyi; Year: 1981; New York: Plenum Press, c1981; ISBN: 0306408856 http://www.amazon.com/exec/obidos/ASIN/0306408856/icongroupin terna
·
Inflammatory cells and bacteria in mucoid middle ear effusion of patients with secretory otitis media. Author: Pekka Sipilä; Year: 1982; Oulu: University of Oulu, 1982; ISBN: 9514213025 (pbk.)
·
Interactions between bacteria and human iron binding proteins. Author: door Jan Hendrik Marcelis; Year: 1979; [Utrecht?: s.n., 1979?]
·
Intestinal bacteria and health: an introductory narrative. Author: Tomotari Mitsuoka; translated by Syoko Watanabe; Year: 1978; Tokyo, Japan: Harcourt Brace Jovanovich, c1978; ISBN: 4833765071
·
Opportunistic intracellular bacteria and immunity. Author: edited by Lois J. Paradise and Herman Friedman, and Mauro Bendinelli; Year: 1999; New York: Plenum Press, c1999; ISBN: 0306458942 http://www.amazon.com/exec/obidos/ASIN/0306458942/icongroupin terna
·
Textbook of fungi, bacteria and viruses. Author: H. C. Dube; Year: 1978; New Delhi: Vikas, 1978; ISBN: 0706905873 http://www.amazon.com/exec/obidos/ASIN/0706905873/icongroupin terna
Chapters on Foodborne Illness Frequently, foodborne illness will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with foodborne illness, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and foodborne illness using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “foodborne illness” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books.
Books 51
General Home References In addition to references for foodborne illness, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
52 Foodborne Illness
Vocabulary Builder Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Enterohepatic: Of or involving the intestine and liver. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried. [NIH]
Multimedia 53
CHAPTER 5. MULTIMEDIA ON FOODBORNE ILLNESS Overview Information on foodborne illness can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on foodborne illness. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Bibliography: Multimedia on Foodborne Illness The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in foodborne illness (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on foodborne illness. For more information, follow the hyperlink indicated: ·
Bacterial flagellum, nature's rotary motor. Source: Medical Arts and Photography Branch, National Center for Research Resources; Year: 1994; Format: Videorecording; [Bethesda, Md.: National Institutes of Health, 1994]
54 Foodborne Illness
·
Balancing the energy checkbook : energy utilization in health and illness. Source: University of Wisconsin-Milwaukee, School of Nursing; a Television Services production, University of Wisconsin-Milwaukee; Year: 1985; Format: Videorecording; [Philadelphia, Pa.]: Lippincott, c1985
·
Food borne illness and prevention techniques . Year: 1999; Format: Electronic resource; Charleston, WV: Cambridge Research Group, c1999
·
Gram stain : training and competency assessment. Source: University of Washington Department of Laboratory Medicine; authors, Brad T. Cookson ... [et al.]; Year: 2002; Format: Electronic resource; Seattle, WA: The Dept.: MTS, c2002
·
Health and illness : new perspectives. Source: a production of Media for Nursing, Inc; Year: 1980; Format: Videorecording; Brooklyn, N.Y.: Media for Nursing, c1980
·
How to prepare bacterial smears and use methylene blue and gram stains. Source: Project Biotech, AIBS; Year: 1975; Format: Slide; [Washington]: American Institute of Biological Sciences; [Tarrytown, N. Y.: for sale by Prentice-Hall Media], c1975
·
Humans and bacteria. Source: a presentation of Films for the Humanities & Sciences; Spektrum Videothek; Year: 1994; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
·
Illness and its effect on history. Source: [presented by] the Emory Medical Television Network and Emory University School of Medicine of the Woodruff Health Sciences Center; Year: 1991; Format: Videorecording; Atlanta, Ga.: The University, c1991
·
Physiological characteristics of bacteria. Source: produced by Delbert Schoenhard, in cooperation with Instructional and Public Television Services; Year: 1979; Format: Videorecording; [East Lansing, Mich.]: Michigan State University Television, c1979
·
Prospective health care : health risk assessment and illness prevention. Source: [presented by the Society for Healthcare Planning and Marketing of the American Hospital Association and the Information and Resource Center of National Cassette S; Year: 1996; Format: Sound recording; Front Royal, VA: National Cassette Services, [1996]
·
Psychological factors and physical illness. Source: a production of Alvin H. Perlmutter, Inc., in association with Toby Levine Communications, Inc; Year: 1991; Format: Videorecording; [New York, N.Y.]: A.H. Perlmutter: T. Levine Communications, c1991
·
Viruses and bacteria. Source: Cyber Ed Inc; Year: 1997; Format: Electronic resource; Paradise, Calif.: CyberEd, c1997
Multimedia 55
Vocabulary Builder Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH]
Physicians Guidelines and Database 57
CHAPTER 6. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
58 Foodborne Illness
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.21 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:22 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 22 See http://www.nlm.nih.gov/databases/databases.html. 21
Physicians Guidelines and Database 59
·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
·
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
·
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat foodborne illness, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and foodborne illness using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “foodborne illness” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with foodborne illness. The following is a sample result:
60 Foodborne Illness
The NLM Gateway23 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.24 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.25 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “foodborne illness” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343118 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349164
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 25 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 23 24
Physicians Guidelines and Database 61
HSTAT26 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.27 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.28 Simply search by “foodborne illness” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists29 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.30 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.31 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 28 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 29 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 30 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 31 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 26 27
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
Specialized References The following books are specialized references written for professionals interested in foodborne illness (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna
Physicians Guidelines and Database 63
· Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
65
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with foodborne illness and related conditions.
Researching Your Medications 67
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with foodborne illness. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for foodborne illness. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of foodborne illness. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
68 Foodborne Illness
Your Medications: The Basics32 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of foodborne illness. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with foodborne illness take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for foodborne illness. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
32
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 69
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for foodborne illness). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the
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medications your doctor has recommended for foodborne illness. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.33 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of foodborne illness. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to foodborne illness:
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
33
Researching Your Medications 71
Cephalosporins ·
Systemic - U.S. Brands: Ancef; Ceclor; Ceclor CD; Cedax; Cefadyl; Cefizox; Cefobid; Cefotan; Ceftin; Cefzil; Ceptaz; Claforan; Duricef; Fortaz; Keflex 20; Keftab 20; Kefurox; Kefzol; Mandol; Maxipime; Mefoxin; Monocid; Omnicef; Rocephin; Suprax; Tazicef; Tazidime; Vantin; Velo http://www.nlm.nih.gov/medlineplus/druginfo/cephalosporinss ystemic202119.html
Clindamycin ·
Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/clindamycinvag inal202700.html http://www.nlm.nih.gov/medlineplus/druginfo/diphtheriaandte tanustoxoidsand202911.html
·
Systemic - U.S. Brands: Tetramune http://www.nlm.nih.gov/medlineplus/druginfo/diphtheriaandte tanustoxoidsand202911.html
Metronidazole ·
Vaginal - U.S. Brands: MetroGel-Vaginal http://www.nlm.nih.gov/medlineplus/druginfo/metronidazolev aginal202704.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html.
72 Foodborne Illness
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with foodborne illness--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat foodborne illness or potentially create deleterious side effects in patients with foodborne illness. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause
Researching Your Medications 73
unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with foodborne illness. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with foodborne illness. The FDA warns patients to watch out for34: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
34
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to foodborne illness. Finally, at the conclusion of this chapter, we will provide a list of readings on foodborne illness from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?35 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 35
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?36 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
36
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.37
37
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Foodborne Illness Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for foodborne illness. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to foodborne illness and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “foodborne illness” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to foodborne illness: ·
Acute diarrhea: a practical review. Author(s): Aranda-Michel J, Giannella RA.
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Source: The American Journal of Medicine. 1999 June; 106(6): 670-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10378626&dopt=Abstract ·
Adjunctive hyperbaric oxygen in the treatment of bilateral cerebrorhino-orbital mucormycosis. Author(s): De La Paz MA, Patrinely JR, Marines HM, Appling WD. Source: American Journal of Ophthalmology. 1992 August 15; 114(2): 20811. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1642297&dopt=Abstract
·
Adult-type systemic varicella in a female patient in course of treatment of her so-called reactive lymphocytic (T-cell) hyperplasia. Author(s): Kasahara M, Mizoguchi Y, Kuroda M, Miki Y, Yamamoto N, Horibe Y, Fujita K, Watanabe H, Hondo R, Aoyama U. Source: Acta Pathol Jpn. 1984 January; 34(1): 169-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6328862&dopt=Abstract
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An outbreak of Pontiac fever related to whirlpool use, Michigan 1982. Author(s): Mangione EJ, Remis RS, Tait KA, McGee HB, Gorman GW, Wentworth BB, Baron PA, Hightower AW, Barbaree JM, Broome CV. Source: Jama : the Journal of the American Medical Association. 1985 January 25; 253(4): 535-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3968786&dopt=Abstract
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Antioxidants in vegan diet and rheumatic disorders. Author(s): Hanninen, Kaartinen K, Rauma AL, Nenonen M, Torronen R, Hakkinen AS, Adlercreutz H, Laakso J. Source: Toxicology. 2000 November 30; 155(1-3): 45-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11156742&dopt=Abstract
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Comparison of a rice-based, mixed diet versus a lactose-free, soyprotein isolate formula for young children with acute diarrhea. Author(s): Maulen-Radovan I, Brown KH, Acosta MA, Fernandez-Varela H.
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Source: The Journal of Pediatrics. 1994 November; 125(5 Pt 1): 699-706. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7965421&dopt=Abstract ·
Cultural factors in the epidemiology of filariasis due to Brugia malayi in an endemic community in Malaysia. Author(s): Riji HM. Source: Southeast Asian J Trop Med Public Health. 1983 March; 14(1): 349. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6612423&dopt=Abstract
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Decrease in anti-Proteus mirabilis but not anti-Escherichia coli antibody levels in rheumatoid arthritis patients treated with fasting and a one year vegetarian diet. Author(s): Kjeldsen-Kragh J, Rashid T, Dybwad A, Sioud M, Haugen M, Forre O, Ebringer A. Source: Annals of the Rheumatic Diseases. 1995 March; 54(3): 221-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7748020&dopt=Abstract
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Disseminated Salmonella arizona infection associated with rattlesnake meat ingestion. Author(s): Bhatt BD, Zuckerman MJ, Foland JA, Polly SM, Marwah RK. Source: The American Journal of Gastroenterology. 1989 April; 84(4): 4335. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2929568&dopt=Abstract
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Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley Lake region. Author(s): Birmingham ME, Lee LA, Ndayimirije N, Nkurikiye S, Hersh BS, Wells JG, Deming MS. Source: Lancet. 1997 April 5; 349(9057): 981-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9100624&dopt=Abstract
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Fate of Campylobacter jejuni in butter. Author(s): Zhao T, Doyle MP, Berg DE.
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Source: Journal of Food Protection. 2000 January; 63(1): 120-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10643781&dopt=Abstract ·
Foodborne Sporothrix schenckii: infectivity for mice by intraperitoneal and intragastric inoculation with conidia. Author(s): Kazanas N. Source: Mycopathologia. 1986 July; 95(1): 3-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3762657&dopt=Abstract
·
Hantavirus in the southwestern United States: epidemiology of an emerging pathogen. Author(s): Sands L, Kioski C, Komatsu K. Source: J Am Osteopath Assoc. 1993 December; 93(12): 1279-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8307808&dopt=Abstract
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Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. Author(s): Jacobs J, Jimenez LM, Malthouse S, Chapman E, Crothers D, Masuk M, Jonas WB. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2000 April; 6(2): 131-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10784270&dopt=Abstract
·
Incidence of Salmonella in fish and seafood. Author(s): Heinitz ML, Ruble RD, Wagner DE, Tatini SR. Source: Journal of Food Protection. 2000 May; 63(5): 579-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10826714&dopt=Abstract
·
Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Legionella micdadei. Author(s): Goldberg DJ, Wrench JG, Collier PW, Emslie JA, Fallon RJ, Forbes GI, McKay TM, Macpherson AC, Markwick TA, Reid D. Source: Lancet. 1989 February 11; 1(8633): 316-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2563467&dopt=Abstract
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·
Managing sore throat: a literature review. II. Do antibiotics confer benefit? Author(s): Del Mar C. Source: Med J Aust. 1992 May 4; 156(9): 644-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1625619&dopt=Abstract
·
Marshmallows cause an outbreak of infection with Salmonella enteritidis phage type 4. Author(s): Lewis DA, Paramathasan R, White DG, Neil LS, Tanner AC, Hill SD, Bruce JC, Stuart JM, Ridley AM, Threlfall EJ. Source: Commun Dis Rep Cdr Rev. 1996 December 6; 6(13): R183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8990574&dopt=Abstract
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Microbial methylation of metalloids: arsenic, antimony, and bismuth. Author(s): Bentley R, Chasteen TG. Source: Microbiology and Molecular Biology Reviews : Mmbr. 2002 June; 66(2): 250-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12040126&dopt=Abstract
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Nationwide outbreak of human salmonellosis in Germany due to contaminated paprika and paprika-powdered potato chips. Author(s): Lehmacher A, Bockemuhl J, Aleksic S. Source: Epidemiology and Infection. 1995 December; 115(3): 501-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8557082&dopt=Abstract
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Neurocognitive disorders seen in HIV disease. Author(s): Ungvarski PJ, Trzcianowska H. Source: Issues in Mental Health Nursing. 2000 January-February; 21(1): 51-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10839052&dopt=Abstract
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Non-absorbable antibiotics in the treatment of diverticular disease of the colon. Author(s): Papi C, Camarri E.
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Source: Ital J Gastroenterol. 1992 November-December; 24(9 Suppl 2): 1922. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1336684&dopt=Abstract ·
Novel association of haemophagocytic syndrome with Kaposi's sarcoma-associated herpesvirus-related primary effusion lymphoma. Author(s): Pastore RD, Chadburn A, Kripas C, Schattner EJ. Source: British Journal of Haematology. 2000 December; 111(4): 1112-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11167749&dopt=Abstract
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Prevalence of Staphylococcus aureus and staphylococcal enterotoxins in raw pork and uncooked smoked ham--a comparison of classical culturing detection and RFLP-PCR. Author(s): Atanassova V, Meindl A, Ring C. Source: International Journal of Food Microbiology. 2001 August 15; 68(12): 105-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11545209&dopt=Abstract
·
Rattlesnake capsule-associated Salmonella arizona infections. Author(s): Riley KB, Antoniskis D, Maris R, Leedom JM. Source: Archives of Internal Medicine. 1988 May; 148(5): 1207-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3365088&dopt=Abstract
·
Risk factors for fatal childhood diarrhea: a case-control study from two remote Panamanian islands. Author(s): Ryder RW, Reeves WC, Sack RB. Source: American Journal of Epidemiology. 1985 April; 121(4): 605-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2990200&dopt=Abstract
·
Salmonella arizona infections in Latinos associated with rattlesnake folk medicine. Author(s): Waterman SH, Juarez G, Carr SJ, Kilman L. Source: American Journal of Public Health. 1990 March; 80(3): 286-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2305906&dopt=Abstract
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·
Soluble plasma antigen in experimental Salmonella typhimurium infection in mice. Author(s): Butler T, Rolfe RD, James GM, Hentges DJ. Source: Fems Immunology and Medical Microbiology. 1994 October; 9(4): 325-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7866354&dopt=Abstract
·
Superficial and systemic illness related to a hot tub. Author(s): Kosatsky T, Kleeman J. Source: The American Journal of Medicine. 1985 July; 79(1): 10-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3925779&dopt=Abstract
·
Supplementation of oral nutrition with pancreatic enzymes improves the nutritional status of aged endotoxemic rats. Author(s): Farges MC, Vasson MP, Davot P, Villie F, Meunier MT, Marcollet M, Cynober L. Source: Nutrition (Burbank, Los Angeles County, Calif.). 1996 March; 12(3): 189-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8798223&dopt=Abstract
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Survival of enterohemorrhagic Escherichia coli O157:H7 in retail mustard. Author(s): Mayerhauser CM. Source: Journal of Food Protection. 2001 June; 64(6): 783-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11403126&dopt=Abstract
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The etiology of community-acquired pneumonia at an urban public hospital: influence of human immunodeficiency virus infection and initial severity of illness. Author(s): Park DR, Sherbin VL, Goodman MS, Pacifico AD, Rubenfeld GD, Polissar NL, Root RK. Source: The Journal of Infectious Diseases. 2001 August 1; 184(3): 268-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11443551&dopt=Abstract
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The treatment of rhinovirus infections: progress and potential. Author(s): Turner RB.
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Source: Antiviral Research. 2001 January; 49(1): 1-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11166856&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder Antibiotic: A chemical substance produced by a microorganism which has
Researching Alternative Medicine 89
the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antimony: A metallic element that has the atomic symbol Sb, atomic number 51, and atomic weight 121.75. It is used as a metal alloy and as medicinal and poisonous salts. It is toxic and an irritant to the skin and the mucous membranes. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Bilateral: Having two sides, or pertaining to both sides. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Brugia: A filarial worm of Southeast Asia, producing filariasis and elephantiasis in various mammals including man. It was formerly included in the genus wuchereria. [NIH] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Dermatitis: Inflammation of the skin. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with
90 Foodborne Illness
regurgitation of gastric juice into the esophagus. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Legionella: Gram-negative aerobic rods, isolated from surface water, mud, or thermally polluted lakes or streams. It is pathogenic for man and it has no known soil or animal sources. [NIH] Legionellosis: Infections with bacteria of the genus legionella. [NIH] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU]
Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Proteus: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in the intestines of humans and a wide variety of animals, as well as in manure, soil, and polluted waters. Its species are pathogenic, causing urinary tract infections and are also considered secondary invaders, causing septic lesions at other sites of the body. [NIH] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Sporothrix: A mitosporic Ophiostomataceae fungal genus, whose species Sporothrix schenckii is a well-known animal pathogen. The conidia of this soil fungus may be inhaled causing a primary lung infection, or may infect independently via skin punctures. [NIH]
Finding Medical Libraries 91
APPENDIX C. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.38
38
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):39 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
39
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 93
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
94 Foodborne Illness
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 95
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
96 Foodborne Illness
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 97
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
NIH Consensus Statement on Travelers’ Diarrhea 99
APPENDIX
D. NIH CONSENSUS TRAVELERS’ DIARRHEA
STATEMENT
ON
Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.40 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”41 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in January 1985.42
40 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 41 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 42 Travelers’ Diarrhea. NIH Consens Statement Online 1985 Jan 28-30 [cited 2002 February 19]; 5(8):1-19. http://consensus.nih.gov/cons/048/048_statement.htm.
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What Is Travelers’ Diarrhea? Diarrhea is by far the most frequent health problem of travelers to developing countries. Of the estimated 300 million international travelers who will cross the world’s frontiers this year, at least 16 million persons from industrialized countries, including more than 8 million U.S. residents, will travel to developing countries. Approximately one-third of these travelers to developing countries will get diarrhea. The economic impact of travelers’ diarrhea (TD) is substantial, because fear of sickness is one of the major deterrents to tourism. International tourists worldwide spend over $100 billion annually, and the economies of many nations depend on this travel. For educational, recreational, political, and financial reasons, this international exchange should be fostered. The incidence of TD varies markedly by destination and may depend in part on the number of dietary indiscretions made by the traveler and on the style of travel. TD is caused by a variety of infectious agents, and the spectrum of clinical illness varies considerably. However, this illness in travelers is usually not severe; high fever, vomiting, or bloody stools occur only in a minority of cases. Dietary prudence and hygienic measures are safe and simple preventive techniques, but they do not eliminate entirely the risk of diarrhea. Prophylactic measures such as antidiarrheal drugs and oral antimicrobial agents have been used. TD is treated with a variety of regimens, including oral electrolyte solutions, antidiarrheal compounds, and antimicrobial drugs, prescribed either singly or in combination. There continues to be a debate concerning whether the risk of antimicrobial agents is worth the benefit; whether early therapy of ill travelers is preferable to daily prophylaxis of all travelers; whether all currently employed treatment strategies are useful; and whether given groups of travelers, such as vacationers, students, or business travelers, should be selectively advised to follow special regimens. To resolve some of these questions, the NIH Office of Medical Applications of Research and the National Institute of Allergy and Infectious Diseases convened a Consensus Development Conference on Travelers’ Diarrhea on January 28-30, 1985. After 1 1/2 days of expert presentation of the available data, a consensus panel of epidemiologists, biostatisticians, microbiologists, pediatricians, internists, infectious diseases specialists, travel experts, and lay representatives considered the evidence and agreed on answers to the following questions:
NIH Consensus Statement on Travelers’ Diarrhea 101
·
What is the epidemiology of travelers’ diarrhea, and why is it important?
·
What causes travelers’ diarrhea?
·
What prevention measures are effective for travelers’ diarrhea?
·
What treatment measures are effective for travelers’ diarrhea?
·
What should be the direction of future research?
Epidemiology of Travelers’ Diarrhea Travelers’ diarrhea is a syndrome characterized by a twofold or greater increase in the frequency of unformed bowel movements. Commonly associated symptoms include abdominal cramps, nausea, bloating, urgency, fever, and malaise. Episodes of TD usually begin abruptly, occur during travel or soon after returning home, and are generally self-limited. Within this context, travelers at risk are defined as individuals from industrialized countries visiting for a period of up to 1 month a region or country where there is an increased risk of developing diarrhea. The public health and medical importance of TD is related to the large numbers of travelers who place themselves at risk each year. Furthermore, TD is but a mild reflection of the severe underlying problem of diarrhea among children in the tropics. The most important determinant of risk is the destination of the traveler. Attack rates in the range of 20 to 50 percent are commonly reported, but recent data are available from relatively few countries. The best available estimates of country-specific attack rates have been reported for Swiss travelers. Examples of high-risk destinations include most of the developing countries of Latin America, Africa, the Middle East, and Asia. Intermediate risk destinations include most of the Southern European countries and a few Caribbean islands. Low risk destinations include Canada, Northern Europe, Australia, New Zealand, the United States, and a number of the Caribbean islands. TD is slightly more common in young adults than in older people. The reasons for this difference are unclear, but may include a lack of acquired immunity, more adventurous travel styles, and different eating habits. Attack rates are similar in men and women. The most common onset of TD is usually within the first week, but onset may occur at any time during the visit, and even after returning home. TD is acquired through ingestion of fecally contaminated food and/or water. Both cooked and uncooked foods may be implicated if improperly handled.
102 Foodborne Illness
Especially risky foods include raw vegetables, raw meat, and raw seafood. Tap water ice, unpasteurized milk and dairy products, and unpeeled fruits are associated with increased risk of TD; bottled carbonated beverages (especially flavored beverages), beer, wine, hot coffee or tea, or water boiled or appropriately treated with iodine or chlorine are safe. The eating place appears to be an important variable, with private homes, restaurants, and street vendors listed in order of increasing risk. TD typically results in four to five loose or watery stools per day. The median duration of diarrhea is 3 to 4 days. Ten percent of the cases persist longer than 1 week, approximately 2 percent longer than 1 month, and less than 1 percent longer than 3 months. Persistent diarrhea is thus quite uncommon and may differ considerably from acute TD with respect to etiology and risk factors. Travelers may experience more than one attack of TD during a single trip. Approximately 15 percent experience vomiting, and 2 to 10 percent may have diarrhea accompanied by fever or bloody stools, or both. Rarely is TD life-threatening. In an extensive survey of several hundred thousand Swiss travelers, no deaths could be attributed to TD.
What Causes Travelers’ Diarrhea? Infectious agents are the primary cause of TD. This statement is based on investigations designed to isolate known infectious organisms from diarrheal stools of tourists and on studies that demonstrated the efficacy of antibacterial agents. In addition, induced disease in volunteers has confirmed the causal role of the putative bacterial and viral agents in producing TD. All travelers from industrialized countries going to developing countries quickly develop a rapid, dramatic change in their intestinal flora. These new organisms often include the potential enteric pathogens. Those who develop diarrhea have ingested an inoculum of virulent organisms sufficiently large to overcome individual defense mechanisms, resulting in symptoms.
Enteric Bacterial Pathogens Enterotoxigenic Escherichia coli (ETEC) are the most common causative agents of TD in all countries where surveys have been conducted. The discovery and understanding of the mechanisms of action of cholera enterotoxin led to investigations that demonstrated enterotoxins in E. coli
NIH Consensus Statement on Travelers’ Diarrhea 103
and other bacteria. These organisms adhere in the small intestine, where they multiply and produce an enterotoxin (either heat stable or heat labile) that causes fluid secretion and diarrhea. Identification of the ETEC is a difficult task, requiring sophisticated techniques that remain somewhat insensitive. Other E. coli have different virulence traits. These have been termed enteroadherent, enteroinvasive, and enteropathogenic E. coli. No systematic search for these other E. coli has been conducted in patients with TD. Limited data suggest that they are a minor cause of TD. Salmonella gastroenteritis is a well-known disease that occurs throughout the world. In the industrialized nations, this large group of organisms is the most common cause of outbreaks of food-associated diarrhea. In the developing countries, the proportion of cases of TD caused by salmonellae varies but is not high. Salmonellae also can cause dysentery characterized by bloody mucus-containing small-volume stools. Shigellae are well known as the cause of bacillary dysentery. They cause TD in about 5 to 15 percent of travelers in a few countries. Few of the infected travelers had dysentery, but most had watery diarrhea. Campylobacter jejuni is a common cause of diarrhea throughout the world. Recent, limited data have shown that C. jejuni is responsible for a small percentage of the reported cases of TD, some with bloody diarrhea. Additional studies are needed to determine how frequently it causes TD. Vibrio parahaemolyticus is associated with the ingestion of raw or poorly cooked seafood and has caused TD in Japanese people traveling in Asia. How frequently it causes disease in other areas of the world is unknown. Other potential bacterial pathogens, including Aeromonas hydrophila, Yersinia enterocolitica, Pleisiomonas shigelloides, Vibrio cholerae (non-01), and Vibrio fluvialis, are known to cause diarrhea in children and adults. In Thailand, Aeromonas and Pleisiomonas have been isolated from stools of Peace Corps volunteers who had TD. A better appreciation of the importance of each of these bacteria as causative agents of TD requires a more intensive search for them, using appropriate selective isolation media or rapid diagnostic techniques.
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Viral Enteric Pathogens--Rotavirus and Norwalk-Like Virus Along with the newly acquired bacterial flora, many viruses also are acquired. In six studies, for example, 0 to 36 percent of diarrheal illnesses (median 22 percent) were associated with rotaviruses in the stools. However, a comparable number of asymptomatic travelers also had rotaviruses, and up to 50 percent of symptomatic rotavirus infections were associated with nonviral pathogens. Ten to 15 percent of travelers develop a serologic conversion to Norwalk-like viruses. The roles of adenoviruses, astroviruses, coronaviruses, enteroviruses, or other viral agents in causing TD are even less clear. Although viruses are commonly acquired by travelers, they do not appear to be frequent causes of TD in adults.
Parasitic Enteric Pathogens The few studies that have included an examination for parasites reveal that 0 to 9 percent have Giardia lamblia or Entamoeba histolytica. Cryptosporidium has recently been recognized in sporadic cases of TD. Dientamoeba fragilis, Isospora belli, Balantidium coli, or Strongyloides stercoralis may cause occasional cases of TD. While not major causes of acute TD, these parasites should be sought in persisting, unexplained cases.
Unknown Causes No data have been presented to support noninfectious causes of TD such as changes in diet, jet lag, altitude, and fatigue. Current evidence indicates that in all but a few instances (e.g., drug-induced or preexisting gastrointestinal disorders) an infectious agent or agents cause diarrhea in tourists. Even with the application of the best current methods for detecting bacteria, viruses, and parasites, in various studies 20 to 50 percent remain without recognized etiologies. The unrecognized causes may be attributed to: ·
Recognized pathogens that were not uniformly sought in every study (such as Campylobacter, Aeromonas, Yersinia, Pleisiomonas, Vibrios, viruses, and parasites like sp;Cryptosporidium).
·
Unrecognized pathogens.
·
Known bacterial pathogens that were not detected. Our best methods for detecting enterotoxigenic E. coli and Shigella, for example, are insensitive and miss 30 to 40 percent of cases in outbreak or volunteer studies.
NIH Consensus Statement on Travelers’ Diarrhea 105
Effective Prevention Measures There are four possible approaches to prevention of TD. They include instruction regarding food and beverage preparation, immunization, use of nonantimicrobial medications, and prophylactic antimicrobial drugs. Data indicate that meticulous attention to food and beverage preparation, as mentioned above, can decrease the likelihood of developing TD. Most travelers, however, encounter great difficulty in observing the requisite dietary restrictions. No available vaccines and none that are expected to be available in the next 5 years are effective against TD. Several nonantimicrobial agents have been advocated for prevention of TD. Available controlled studies indicate that prophylactic use of difenoxine, the active metabolite of diphenoxylate (Lomotil), actually increases the incidence of TD, in addition to producing other undesirable side effects. No antiperistaltic agents (e.g., Lomotil and Imodium) are effective in preventing TD. No data support the prophylactic use of activated charcoal. Bismuth subsalicylate, taken in liquid form as the active ingredient of PeptoBismol (2 oz four times daily), has decreased the incidence of diarrhea by 60 percent in one study. Available data are not extensive enough to exclude a risk to the traveler from the use of such large doses of bismuth subsalicylate over a period of several weeks. In patients already taking salicylates for arthritis, large concurrent doses of bismuth subsalicylate can produce toxic serum concentrations of salicylate. On the basis of its modest potential benefit achieved with large doses, together with its uncertain risks, bismuth subsalicylate is not recommended for prophylaxis of TD. Controlled data are available on the prophylactic value of several antimicrobial drugs. Entero-vioform and related halogenated hydroxyquinoline derivatives (e.g., clioquinol, iodoquinol, Mexaform, Intestopan, and others) are not helpful in preventing TD, may have serious neurological side effects, and should never be used for prophylaxis of TD. Carefully controlled studies have indicated that two agents, doxycycline and trimethoprim/sulfamethoxazole (TMP/SMX), when taken prophylactically, are consistently effective in reducing the incidence of TD by 50 to 86 percent in various areas of the developing world. One study shows that trimethoprim alone is also effective.
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The benefits of widespread prophylactic use of doxycycline or TMP/SMX or TMP alone in several million travelers must be weighed against the potential drawbacks. The known risks include allergic and other side effects (such as common skin rashes, photosensitivity of the skin, blood disorders, StevensJohnson syndrome, and staining of the teeth in children) as well as other infections that may be induced by antimicrobial therapy (such as antibioticassociated colitis, Candida vaginitis, and possibly salmonella enteritis). Because of the uncertain risk of widespread administration of these antimicrobial agents, their prophylactic use is not recommended. Nor is there any basis for recommending their use prophylactically for special groups of travelers. For example, the physician should not recommend an agent for prophylactic use by a business traveler and deny such use by a honeymoon couple. Furthermore, there is no documented evidence that there are any groups of disease entities that are worsened sufficiently by an episode of TD to risk the rare undesirable side effects of prophylactic antimicrobial drugs. The selective pressure of prophylactic use of antimicrobial agents on the genetic pool of antimicrobial resistance is of concern, but may be insignificant in light of the widespread use of over-the-counter antimicrobial agents in many developing countries. The increasing frequency of resistance to multiple antimicrobial agents (including both doxycycline and TMP/SMX) will limit the effectiveness of these agents in many areas. Available data support only the instruction of travelers in regard to sensible dietary practices as a prophylactic measure. On the basis of apparent risk/benefit ratios, prophylactic antimicrobial agents are not recommended for travelers. This recommendation is justified by the excellent results of early treatment of TD as outlined below. By avoiding prophylactic antimicrobial agents, only those people traveling to high-risk areas who develop moderate to severe TD (less than 30 percent of travelers at risk) will be exposed to the side effects of antimicrobial agents, and the exposure will be restricted to 3 days or fewer in those individuals. Some travelers may wish to consult with their physician and may elect to use prophylactic antimicrobial agents for travel under special circumstances, once the risks and benefits are clearly understood.
Effective Treatment Measures The individuals with TD have two major complaints for which they desire relief--abdominal cramps and diarrhea. Many agents have been proposed to
NIH Consensus Statement on Travelers’ Diarrhea 107
control these symptoms, but few have been demonstrated to be effective by rigorous clinical trials.
Nonspecific Agents A variety of “adsorbents” have been used in the treatment of diarrhea. For example, activated charcoal has been found ineffective in the treatment of diarrhea. Kaolin and pectin have been widely used for diarrhea. The combination appears to give the stools more consistency but has not been shown to decrease cramps and frequency of stools nor to shorten the course of infectious diarrhea. Lactobacillus preparations and yogurt have also been advocated, but no evidence supports these treatments for TD. Bismuth subsalicylate preparation (1 oz every 30 minutes for eight doses) decreased the rate of stooling by one-half in a study of travelers with diarrhea when compared with a placebo group. However, there was no difference between the two groups in stool output in the first four hours of the study. There is concern about taking, without supervision, large amounts of bismuth and salicylate, especially in individuals who may be intolerant to salicylates, who have renal insufficiency, or who take salicylates for other reasons.
Antimotility Agents Antimotility agents are widely used in the treatment of diarrhea of all types. Natural opiates (paregoric, deodorized tincture of opium, and codeine) have long been used to control diarrhea and cramps. Synthetic agents, diphenoxylate and loperamide, come in convenient dosage forms and provide prompt symptomatic but temporary relief. However, they should not be used in patients with high fever or with blood in the stool. These drugs should be discontinued if symptoms persist beyond 48 hours. Diphenoxylate and loperamide should not be used in children under the age of 2.
Oral Fluids Most individuals with TD do not develop serious dehydration. Fluid and electrolyte balance can be maintained by potable fruit juices, caffeine-free
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soft drinks, and salted crackers. The individual with TD should avoid alcohol and caffeine-containing beverages. Dairy products aggravate diarrhea in some people and should be avoided. Individuals with severe dehydration may require special fluid and electrolyte replacement in the form of oral replacement solutions such as those recommended by the World Health Organization.
Antimicrobial Treatment Travelers who develop diarrhea with three or more loose stools in an 8-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools, may benefit from antimicrobial treatment. A typical 3- to 5-day illness can be shortened to 1 to 1 1/2 days by effective antimicrobial agents. Those best studied to date are TMP/SMX, 160 mg TMP and 800 mg SMX, or TMP alone, 200 mg taken twice daily. Preliminary evidence suggests that doxycycline taken 100 mg twice daily is also effective. Three days of treatment is recommended, although 2 days or fewer may be sufficient. Nausea and vomiting without diarrhea should not be treated with antimicrobial drugs.
Precautions in Children and Pregnant Women Although children do not make up a large proportion of travelers to highrisk areas, some children do accompany their families. Teenagers should follow the advice given to adults, with possible adjustment of doses of medication. Physicians should be aware of the risks of tetracyclines to children under 12 years. There is a paucity of data available about usage of antidiarrheal drugs in children. Drugs should be prescribed with caution for pregnant women and nursing mothers. Summary Recommendation for Treatment TD is usually a mild, self-limited disorder, with complete recovery even in the absence of therapy; hence, therapy should be considered optional. ·
Fluids should be taken as described above.
·
If rapid relief of symptoms is desired after one or two unformed stools accompanied by cramps, nausea, or malaise, diphenoxylate or loperamide may be taken. An alternative is to start bismuth subsalicylate (1 oz every 30 minutes for eight doses). Although this regimen decreases
NIH Consensus Statement on Travelers’ Diarrhea 109
the number of stools and increases their consistency, the beneficial activity of bismuth subsalicylate is somewhat slower than that of antimotility drugs. ·
If it is important to shorten the course or decrease the severity of moderate to severe TD, antimicrobial agents may be taken. After 3 or more loose stools with symptoms, consideration can be given to a short course of TMP/SMX or TMP alone or doxycycline.
·
A small percentage of travelers have persisting diarrhea with serious fluid loss, fever, and blood or mucus in the stools. This suggests that a more serious illness is involved, and such individuals should seek medical attention.
In conclusion, travelers to areas of high risk should obtain an antimotility drug or bismuth subsalicylate for milder forms of TD, and an antimicrobial agent (TMP/SMX or TMP alone or doxycycline) for more severe TD. Advice concerning side effects of these drugs and various aspects of hygiene and dietary precautions should be obtained. By obtaining the proper drugs in advance, the beleaguered traveler might avoid buying over-the-counter drugs abroad with potentially dangerous ingredients.
Directions of Future Research Although much has been learned about TD over the past 25 years, there is considerable need for additional research on this important syndrome.
Epidemiology ·
Epidemiologic data are needed from well-designed surveys and prospective studies, especially among travelers to countries and regions not previously examined. These investigations should be expanded to include young and elderly travelers, for whom few data exist.
·
Case-control studies should be designed to identify independent risk factors and specific etiologic agents. Such studies should apply all available microbiologic techniques to determine systematically the risk of TD attributable to specific microorganisms in various countries.
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Etiology ·
The development of rapid diagnostic techniques (e.g., hybridization techniques and use of monoclonal antibodies) would facilitate all clinical and epidemiologic research.
·
Additional information should be sought regarding the pathogenesis of TD, which should lead to more specific therapeutic interventions.
·
There is a need for careful monitoring of increasing resistance to antimicrobial drugs, especially among the enterotoxigenic E. coli, in different intermediate and high-risk destinations.
·
There is a particular need to assess the frequency, risk factors, and microbiology of persistent diarrhea following travel. Better approaches to diagnosis in these patients are needed. Prevention and Treatment
·
Newer approaches to vaccine development should be applied to the causal microorganisms of TD.
·
Randomized prospective studies or carefully controlled observational studies should be conducted to determine the true efficacy of dietary restrictions.
·
All agents effective in prevention and treatment of TD should be investigated in larger populations traveling to as-yet-unstudied destinations. Such populations should include children and elderly travelers.
·
Large-scale drug surveillance studies are required to identify important but uncommon toxicities or side effects of various drugs.
·
Minimal effective doses and duration for preventing and treating TD remain to be determined for general therapeutic agents.
·
The active agents and mode of action of bismuth subsalicylate remain to be elucidated, and the tablet form of the drug requires further evaluation.
·
A better understanding of the neurohumoral control of intestinal secretion and its potential interaction with microbial enterotoxins may help in the design of more rational therapeutic strategies for TD. Further study of antisecretory and absorption-enhancing agents may improve pharmacologic therapy and enhance the efficacy and acceptability of oral replacement solutions. Improved understanding of the components of motility that will enhance but not impede absorption may help in the design of rational antimotility therapy.
NIH Consensus Statement on Travelers’ Diarrhea 111
Summary and Conclusions Diarrhea is the major health problem in travelers to developing countries. Travel to high-risk areas in Latin America, Africa, the Middle East, and Asia is associated with diarrhea rates of 20 to 50 percent. The syndrome is caused by an infection acquired by ingesting fecally contaminated food or beverages. Escherichia coli, a common species of enteric bacteria, is the leading pathogen, although a host of other bacteria, viruses, and protozoa have been implicated in some cases. Prudent dietary and hygienic practices should be followed, and they will prevent some, but not all, diarrhea. Antimicrobial agents are not recommended for prevention of TD. Such widespread usage in millions of travelers would cause many side effects, including some severe ones, while preventing a disease that has had no reported mortality. Instead of universal antimicrobial prophylaxis, a more sensible approach is rapid institution of effective treatment that can shorten the disease to 30 hours or less in most people. For mild diarrhea, an antimotility drug such as diphenoxylate or loperamide could be taken. Alternatively, bismuth subsalicylate, which works somewhat slower, can be used. For more severe diarrhea, an antimicrobial drug may be used for treatment, and trimethoprim/sulfamethoxazole, trimethoprim alone, and doxycycline are among the choices. These drugs could be carried by the traveler for use in the event of illness. Oral rehydration should be instituted when necessary. The millions of Americans who travel annually to developing countries and their physicians must be warned of the potential risks of prophylactic antimicrobial drugs, with the attendant side effects in otherwise healthy individuals, and should be informed of the alternative method of prompt, effective treatment for diarrhea.
Vocabulary Builder Aeromonas: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs singly, in pairs, or in short chains. Its organisms are found in fresh water and sewage and are pathogenic to humans, frogs, and fish. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work
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against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Balantidium: A genus of protozoa parasitic in the digestive tract of vertebrate or invertebrate hosts. Asexual multiplication is accomplished by transverse binary fission. Its organisms are ovoidal in shape and have a ciliated covering over the entire body. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Clioquinol: A potentially neurotoxic 8-hydroxyquinoline derivative long used as a topical anti-infective, intestinal antiamebic, and vaginal trichomonacide. The oral preparation has been shown to cause subacute myelo-optic neuropathy and has been banned worldwide. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cryptosporidium: A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. [NIH] Dientamoeba: A genus of minute protozoa that are characterized by the preponderance of binucleate over uninucleate forms, the presence of several distinct granules in the karyosome, and the lack of a cystic stage. It is parasitic in the large intestine of humans and certain monkeys. [NIH] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include
NIH Consensus Statement on Travelers’ Diarrhea 113
chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Iodoquinol: One of the halogenated 8-quinolinols widely used as an intestinal antiseptic, especially as an antiamebic agent. It is also used topically in other infections and may cause CNS and eye damage. It is known by very many similar trade names world-wide. [NIH] Isospora: A genus of protozoan parasites found in the intestines of birds, amphibians, reptiles, and mammals, including man. The oocysts produce two sporocysts, each with four sporozoites. Many species are parasitic in wild and domestic animals. [NIH] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Metabolite:
Any substance produced by metabolism or by a metabolic
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process. [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few - morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: sarcomastigophora, Labyrinthomorpha, apicomplexa, microspora, Ascetospora, Myxozoa, and ciliophora. [NIH] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used
NIH Consensus Statement on Travelers’ Diarrhea 115
for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Strongyloides: A genus of parasitic nematodes widely distributed as intestinal parasites of mammals. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH]
Online Glossaries 117
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to foodborne illness and keep them on file. The NIH, in particular, suggests that patients with foodborne illness visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Bacteria and Foorborne Illness Food poisoning Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001652.htm Food poisoning risks Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001981.htm
·
Signs & Symptoms for Bacteria and Foorborne Illness Abdominal cramping Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Blood in stools Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
Online Glossaries 119
Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm ·
Background Topics for Bacteria and Foorborne Illness Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Electrolyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Shellfish Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002851.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 121
FOODBORNE ILLNESS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Aeromonas: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs singly, in pairs, or in short chains. Its organisms are found in fresh water and sewage and are pathogenic to humans, frogs, and fish. [NIH] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-
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lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antimony: A metallic element that has the atomic symbol Sb, atomic number 51, and atomic weight 121.75. It is used as a metal alloy and as medicinal and poisonous salts. It is toxic and an irritant to the skin and the mucous membranes. [NIH] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Balantidium: A genus of protozoa parasitic in the digestive tract of vertebrate or invertebrate hosts. Asexual multiplication is accomplished by transverse binary fission. Its organisms are ovoidal in shape and have a ciliated covering over the entire body. [NIH] Bilateral: Having two sides, or pertaining to both sides. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Brugia: A filarial worm of Southeast Asia, producing filariasis and elephantiasis in various mammals including man. It was formerly included in the genus wuchereria. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to
Glossary 123
infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Chronic: Persisting over a long period of time. [EU] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clioquinol: A potentially neurotoxic 8-hydroxyquinoline derivative long used as a topical anti-infective, intestinal antiamebic, and vaginal trichomonacide. The oral preparation has been shown to cause subacute myelo-optic neuropathy and has been banned worldwide. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Cryptosporidium: A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a
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paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dermatitis: Inflammation of the skin. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dientamoeba: A genus of minute protozoa that are characterized by the preponderance of binucleate over uninucleate forms, the presence of several distinct granules in the karyosome, and the lack of a cystic stage. It is parasitic in the large intestine of humans and certain monkeys. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU]
Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Encephalitis: Inflammation of the brain. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the
Glossary 125
cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endonucleases: Enzymes that catalyze the hydrolysis of the internal bonds and thereby the formation of polynucleotides or oligonucleotides from riboor deoxyribonucleotide chains. EC 3.1.-. [NIH] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Enterohepatic: Of or involving the intestine and liver. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic
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sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU]
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Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Iodoquinol: One of the halogenated 8-quinolinols widely used as an intestinal antiseptic, especially as an antiamebic agent. It is also used topically in other infections and may cause CNS and eye damage. It is known by very many similar trade names world-wide. [NIH] Isospora: A genus of protozoan parasites found in the intestines of birds, amphibians, reptiles, and mammals, including man. The oocysts produce two sporocysts, each with four sporozoites. Many species are parasitic in wild and domestic animals. [NIH] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Legionella: Gram-negative aerobic rods, isolated from surface water, mud, or thermally polluted lakes or streams. It is pathogenic for man and it has no known soil or animal sources. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Lithium: Lithium. An element in the alkali metals family. It has the atomic
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symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few - morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal,
Glossary 129
and antispasmodic. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU]
Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Ovalbumin: An albumin obtained from the white of eggs. It is a member of the serpin superfamily. [NIH] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Pathogen: Any disease-producing microorganism. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteobacteria: A class of bacteria consisting of the purple bacteria and their relatives which form a branch of the eubacterial tree. This group of predominantly gram-negative bacteria is classified based on homology of
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equivalent nucleotide sequences of 16S ribosomal RNA or by hybridization of ribosomal RNA or DNA with 16S and 23S ribosomal RNA. [NIH] Proteus: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in the intestines of humans and a wide variety of animals, as well as in manure, soil, and polluted waters. Its species are pathogenic, causing urinary tract infections and are also considered secondary invaders, causing septic lesions at other sites of the body. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Rheumatoid: Resembling rheumatism. [EU] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and
Glossary 131
mammals, including humans. Transmission environmental contamination. [NIH]
is
horizontal
and
by
Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporadic:
Neither endemic nor epidemic; occurring occasionally in a
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random or isolated manner. [EU] Sporothrix: A mitosporic Ophiostomataceae fungal genus, whose species Sporothrix schenckii is a well-known animal pathogen. The conidia of this soil fungus may be inhaled causing a primary lung infection, or may infect independently via skin punctures. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strongyloides: A genus of parasitic nematodes widely distributed as intestinal parasites of mammals. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thoracic: Pertaining to or affecting the chest. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transfusion: The introduction of whole blood or blood component directly
Glossary 133
into the blood stream. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried. [NIH] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to
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more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
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INDEX A Abdominal .......15, 17, 20, 101, 106, 108, 113, 126 Abortion ...................................16, 28, 133 Aerobic ..............45, 49, 90, 122, 127, 130 Anaerobic ...26, 27, 28, 90, 111, 121, 125, 130, 131, 132, 133 Antibacterial.............27, 74, 102, 123, 131 Antibiotic ................27, 106, 115, 131, 132 Antibodies............................110, 111, 121 Antibody.....................44, 45, 82, 121, 123 Antigen ....................................44, 86, 121 Antimicrobial .......100, 105, 106, 108, 109, 110, 111, 112, 124 Antimony................................................84 Arrhythmia .....................................45, 122 Asymptomatic ........................89, 104, 125 B Bilateral..................................................81 Bismuth..84, 105, 107, 108, 109, 110, 111 C Cardiac ............................45, 52, 125, 132 Causal .........................................102, 110 Chlorine ...............................................102 Cholera ........................8, 28, 82, 102, 133 Chronic ..................................................19 Clioquinol.............................................105 Clostridium...............................................6 Codeine ...............................................107 Collapse.................................................20 Contamination .................15, 18, 114, 131 Cutaneous .....................46, 114, 129, 133 D Dehydration ...............15, 17, 89, 107, 123 Dermatitis ................................................7 Diarrhea..... 15, 16, 17, 20, 80, 81, 83, 85, 89, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 125 Digestion........................................28, 132 Diphenoxylate..............105, 107, 108, 111 Dizziness ...............................................17 Doxycycline .........105, 106, 108, 109, 111 Dysentery ............................................103 E Effusion........................................7, 50, 85 Electrolyte..............................17, 100, 107 Endemic...................82, 89, 115, 123, 131 Enterotoxins.............85, 89, 102, 110, 125 Enzyme..........................................45, 125 Epidemic......................................115, 131 Escherichia ..........................................6, 7
F Fatal ................................ 17, 85, 112, 123 Fatigue .......................................... 17, 104 Feces ...................................... 17, 26, 127 G Gastroenteritis ..... 5, 7, 27, 103, 114, 130, 131 Gastrointestinal .. 17, 26, 28, 43, 104, 126, 133 H Hematology........................................... 14 Herpes .......................................... 46, 126 Hybridization ......................... 46, 110, 130 Hygienic ...................................... 100, 111 Hyperbaric............................... 81, 90, 126 Hyperplasia ........................................... 81 I Immunity ........................... 16, 21, 50, 101 Immunization ........ 26, 105, 115, 127, 131 Inflammation .. 17, 89, 112, 113, 124, 125, 126 Ingestion ................. 27, 82, 101, 103, 129 Intestinal ....... 6, 16, 21, 25, 89, 102, 110, 112, 113, 115, 122, 123, 125, 126, 127, 132 Iodine .................................................. 102 Iodoquinol ........................................... 105 L Labile .................................................. 103 Legionellosis ......................................... 83 Lethal ............................................ 26, 125 Lethargy ................................................ 17 Lithium .......................................... 55, 128 Lymphocytic .......................................... 81 Lymphoma .............................. 85, 90, 128 M Malaise........................................ 101, 108 Microbiology.................................. 49, 110 Microorganism ................ 27, 88, 121, 129 Molecular 14, 28, 46, 52, 58, 61, 121, 130, 132 Mucus ......................... 103, 109, 112, 124 N Nausea.................. 20, 101, 108, 113, 126 Necrosis ........................................ 89, 126 Neurologic............................................. 17 Neurology.............................................. 26 Nosocomial ................................... 46, 128 O Opium ................................. 107, 114, 128 Orbital ................................................... 81
Index 137
Otitis ......................................................50 P Pallor .....................................................17 Pancreas .................................17, 27, 129 Parasitic ..26, 45, 112, 113, 115, 122, 124, 125, 126, 127, 132 Pathogen .........................83, 90, 111, 132 Pharmacist.......................................68, 73 Pharmacologic.......................28, 110, 132 Photosensitivity....................................106 Pneumonia ....................................6, 7, 86 Poisoning....6, 7, 24, 27, 44, 49, 113, 118, 126, 131 Prophylaxis ..........................100, 105, 111 Proteins .....44, 45, 50, 113, 122, 123, 126 Protozoa .....111, 112, 113, 114, 122, 124, 125, 126, 128 Pseudomonas..........................................6 Pulse......................................................17 R Radioactivity ..........................................19 Receptor ........................................44, 122 Rehydration .........................................111 Rheumatoid ...........................................82 Rhinovirus..............................................86 Rotavirus .............................................104 S Salicylates ...................................105, 107 Saliva .....................................................17 Salmonella.......................................5, 106 Sarcoma ................................................85
Secretion............. 103, 110, 114, 128, 131 Seizures ........................................ 27, 131 Serum ................................. 105, 114, 131 Species ...... 25, 26, 27, 28, 45, 46, 89, 90, 111, 112, 113, 115, 122, 123, 124, 125, 126, 127, 130, 131, 132, 133 Spectrum......................... 14, 28, 100, 133 Spices ................................................... 19 Sporadic.............................................. 104 Staphylococcus................................... 6, 7 Steroid........................................... 46, 130 Stomach.................. 15, 26, 113, 126, 129 Systemic ........................... 46, 81, 86, 133 T Tetracycline................................. 112, 124 Tolerance ............................................ 132 Toxicology....................................... 14, 59 Toxin ................................................... 132 U Urology.................................................. 14 V Vaccine ............................. 8, 46, 110, 133 Vaginal ........................................ 112, 123 Vaginitis .......................................... 7, 106 Varicella ................................................ 81 Viral......................................... 8, 102, 104 Virulence ............................... 52, 103, 132 Viruses . 15, 17, 20, 21, 46, 48, 49, 50, 52, 89, 104, 111, 114, 115, 128, 133 Y Yeasts ........................................... 52, 133
138 Foodborne Illness
Index 139
140 Foodborne Illness
