Food poisoning of a bacterial nature. Summary: Food poisoning

Among bacterial food poisoning, toxic infections are the most widespread in all countries of the world. The name itself shows the dual nature of these pathological conditions, caused, on the one hand, by the massive penetration of pathogens into the body, and on the other, by a complex of clinical phenomena typical of intoxication. The etiology of these poisonings is most often associated with some representatives of Salmonella - S. typhi murium, S. enteridis, S. cholerae suis, etc. In addition, in this respect, certain strains of opportunistic bacteria are of some importance ( coli, proteus, Cl. perfrmgens) and streptococci.

When conducting special studies it was found that the main role in the pathogenesis of toxicoinfection is played by the entry of living microbes into the gastrointestinal tract, and products, even abundantly contaminated with salmonella, after careful heat treatment do not cause disease. Possessing only a limited degree of pathogenicity in relation to a person, the causative agents of these poisonings die rather quickly with the release of endotoxin, therefore, the symptoms of intoxication dominate in the clinical picture.

After an incubation period, usually 6-12 hours (in some cases up to 24-48 hours), the victims develop symptoms acute enteritis, and in 80% of cases there is a mild form of the disease, accompanied by diarrhea, vomiting, abdominal pain, worsening general condition and often fever. Usually all these symptoms disappear on the 2nd - 3rd day and full recovery. A severe form of this poisoning is relatively rare, characterized by collapse, general severe condition and dehydration. Finally, in young children, salmonellosis can be complicated by sepsis, which is accompanied by high mortality. On this basis, some authors consider it appropriate to separate salmonella diseases into a group of foodborne infections.

The transmission of the infectious principle is mainly carried out through infected food products. In many cases, infection occurs by eating the meat of sick animals or bacillus carriers, in which bacteremia was provoked by severe trauma, starvation, severe fatigue, etc. intestine falls on its surface. Rodents suffering from salmonellosis are also of some importance in this regard. Finally, a great danger for contact infection of food products is the bacillus carrier among the staff of public catering establishments.

Prevention of toxic infections requires the establishment of strict veterinary and sanitary control at livestock farms and slaughterhouses and compliance with general hygiene rules at catering establishments. Measures to prevent the massive reproduction of microorganisms in food products include sufficient cooling and the rapid sale of finished products, excluding their delay in warm rooms kitchens. As for bacterial contamination, the only way to eliminate it is intensive heat treatment of products. It must be borne in mind that Salmonella can withstand temperatures of 60°C for an hour. Taking into account the low thermal conductivity of meat, its disinfection can only be guaranteed when cooking for 1 1/2 hours in pieces weighing no more than 400 g and up to 9 cm thick.

A special type of bacterial food poisoning are toxicoses - diseases caused, in contrast to toxic infections, by the penetration of not living microbes into the body, but only their toxins. These poisonings include staphylococcal intoxications caused by certain strains of white and Staphylococcus aureus, the main sources of which can be dairy cattle and humans. In the first case, the cause, as a rule, is the consumption of milk from cows with mastitis, in the second case, infection is caused by various purulent skin lesions and tonsillitis. In this regard, it must always be remembered that a small abscess on a cook's hand can cause a large outbreak of food poisoning.

Often these intoxications are associated with the consumption of dairy products or products made from them, in particular ice cream and especially custard, the latter serving as a reservoir of toxins.

The clinical picture of poisoning with staphylococcal toxin is characterized by a short incubation period - an average of 2-4 hours, after which the victims develop nausea, vomiting, sharp pains in the epigastric region and diarrhea. The temperature usually does not rise, and sometimes it even decreases. Recovery, despite the external severity of the disease, usually occurs within the first day.

In view of the fact that staphylococcal enterotoxin is heat-resistant and withstands 30-minute boiling, the basis of preventive measures is high level sanitary improvement of food enterprises, eliminating the risk of bacterial contamination of equipment, products and finished products. It is also very important to remove from work at food facilities persons suffering from pustular diseases skin and acute catarrhs of the upper respiratory tract. Finally, milk, dairy products, cream cakes should be stored at a low temperature until they are sold.

One of the most severe food poisoning is botulism, cases of which are recorded in all countries of the world. It has been proven to be very dangerous disease caused by a toxin of an anaerobic bacillus, a long-term inhabitant of the soil. In its own way biological activity it surpasses all known toxins of other microbes.

According to the clinical picture, botulism is a kind of disease with a nerve paralytic syndrome of a bulbar nature. After an incubation period averaging 12–24 hours (but sometimes lengthening up to several days), typical neuromotor and secretory disorders develop. Early symptoms of intoxication usually include ophthalmoplegia in the form of dilated pupils, diplopia, lack of reaction to light, etc. Later, paralysis of the muscles of the soft palate, tongue, pharynx and larynx may occur, which upsets speech, acts of swallowing and chewing. Continuing 4 - 8 days, the disease is characterized by high mortality (up to 67%), and death is associated with respiratory or cardiac arrest. Currently used specific serum therapy, when applied early, reduces mortality to about 13%.

AT various countries botulism diseases are often predominantly associated with the consumption of certain foods. Yes, in Western Europe most of these intoxications were due to the consumption of smoked and salted meat products. In the United States, about 70% of cases of botulism were caused by canned vegetables, which, apparently, was due to both contamination of the soil with the relevant microbes and insufficiently thorough sterilization. AT pre-revolutionary Russia these diseases have almost exclusively been associated with salted red sturgeon fish. Finally, one of the universal causes of botulism can be home canning. various products carried out without sufficient disinfection. The hermetic closure of the container creates anaerobic conditions that favor the reproduction of this microbe, especially when the medium is low in acidity.

When carrying out preventive measures to combat botulism, it is necessary first of all to take into account the low heat resistance of its toxin, which begins to break down already at a temperature of 50 ° C, but when heated to 100 ° C, it is inactivated within 15 minutes. At the same time, the sanitary improvement of fisheries plays a very important role, with perhaps more wide application refrigeration equipment and improving fishing methods that reduce the possibility of injury to fish, providing quick removal viscera and accelerating its processing.

Mycotoxicoses

Microbial food poisoning also includes the so-called mycotoxicoses, which are diseases caused by the waste products of microscopic fungi. A classic example of this group of poisonings is ergotism caused by the consumption of certain foods. plant origin, infected with ergot mycotoxin. Most often, this microscopic fungus affects rye, less often wheat and barley, and its poisonous beginning is a group of alkaloids (ergotamine, ergometrine, ergobazine, etc.), which are resistant to heat and retain their toxicity when baking bread.

Clinically, ergotism can manifest itself in an acute, convulsive form, accompanied by tonic convulsions of various muscle groups and giving a fairly high percentage of mortality. With a longer consumption of bread containing a smaller amount of ergot, subacute poisoning may develop, characterized by damage to the vascular-nervous apparatus, circulatory disorders and possible development gangrene.

The main preventive measure to prevent ergotism is the cleaning of seed grain from ergot, and its content in flour should not exceed 0.05%.

Among the food poisoning caused by microscopic fungi, the group of fusariotoxicoses, in particular, alimentary-toxic aleukia, should also be included. This serious disease occurs when grains of cereals overwintered on the vine, intensively infected with fungi of the genus Fusarium, are consumed.

The basis of this pathological condition is the defeat of the central nervous system, causing a violation of tissue trophism and a sharp disorder in the activity of the hematopoietic organs. As a result, the victims develop inhibition of hematopoiesis, followed by aleukia and severe anemia. External signs diseases can serve as necrotic (septic) tonsillitis and other severe complications due to the unresponsiveness of the organism.

The main measure for the prevention of alimentary-toxic aleukia is the immediate withdrawal from the diet of the population of grain that has overwintered in the field.

Another, less dangerous, type of fusariotoxicosis is poisoning with "drunken bread", which is based on the defeat of cereals by a special type of microscopic fungus. The use of such bread causes symptoms resembling a state of alcoholic intoxication, which is expressed in excitement, euphoria, impaired coordination of movements, etc. With prolonged use of it, anemia and mental disorder may develop. Preventive measures include strict adherence to the rules for grain storage, eliminating the possibility of its moisture and mold.

Very great attention health authorities are currently attracted by aflatoxicoses caused by specific toxins with the strongest hepatotropic and carcinogenic effects. Aflatoxins are formed by microscopic fungi, mainly belonging to the genus Aspergillus. It has been established that their dangerous concentrations can be contained in many foodstuffs and feeds, mainly in the countries of the tropical zone. For example, aflatoxins have been found in peanuts, coconuts, grain products and even coffee. There are also reports of their presence in bread, cheese, wine and some other foods.

When conducting special studies, it was found that aflatoxins cause severe liver damage, up to its necrosis, and also have carcinogenic activity, significantly exceeding the activity of benzpyrene. Given this circumstance, the temporarily established allowable dose for aflatoxin is taken to be 0.25 µg/kg.

Food poisoning is not microbial origin make up 5–8% of total number intoxications, often occur with severe symptoms and, if first aid is not provided, sometimes lead to death. To avoid such a situation, you should be careful about the choice of products and not risk your own health.

Reasons for the development of the disease

There are several factors that can lead to damage to the body:

Poisoning of non-microbial etiology occurs when knowingly toxic components are eaten.
Intoxication is often diagnosed if the menu contained products that were considered conditionally unsuitable, for example, as a result of improper cooking.
The clinical picture manifests itself if the usual and completely safe ingredients are “stuffed” with chemical compounds, hormones, antibiotics to improve the appearance and extend the shelf life.

When purchasing ingredients, you should carefully familiarize yourself with their composition, avoid “random” purchases, and if necessary, do not hesitate to ask the seller for a certificate.

Features of clinical manifestations

Food poisoning is not bacterial origin it is not uncommon to appear within minutes of ingesting the suspect product and can vary considerably depending on the nature of the ingredient.

Group	Characteristic
Toxic Ingredients	Lead to damage to the gastrointestinal tract, nervous system, internal organs. Food intoxication is accompanied by profuse vomiting, pain in the stomach, increased formation of gases, intestinal colic, and diarrhea. Some representatives provoke hallucinations, loss of consciousness, saliva flow, convulsions, coma, impaired coordination, numbness of the skin, paresis and paralysis.
Toxic under certain conditions	Possible flatulence, sore throat, specific taste, dry cough, diarrhea, drop in blood pressure, increased heart rate.
Saturated with nutritional supplements	The usual signs of poisoning are repeated vomiting, watery diarrhea, cephalgia, abdominal cramps, convulsions, and unconsciousness.

Already with the appearance of the first symptoms of non-microbial poisoning, it is necessary to provide assistance to the victim. Otherwise, the risk of death increases significantly.

Intoxication with products that are poisonous in nature

Damage occurs as a result of human inattention, use food components dubious origin.

herbal products

This group is divided into several characteristic species.

Classification:

mushrooms;
wild crops;
edible;
weedy.

It is worth considering carefully when and for what reasons non-bacterial poisoning develops after the use of such plants.

poisonous mushrooms

Food intoxication of non-microbial origin ranks first in terms of frequency of manifestations and ends tragically in 50% of cases. Fans of the autumn collection and their families are at particular risk. Sometimes, going into the forest, a person has little idea which representatives of this species should be avoided.

Pale toadstools and fly agarics are considered especially dangerous, but conditionally toxic ones, for example, morels, which contain gelvellic acid, can also be poisoned. It is destroyed only with prolonged heating or drying, and with insufficient heat treatment, symptoms of poisoning occur.

How the clinical picture proceeds depends on the product. Most frequent signs become nausea and vomiting, diarrhea. But in some cases, there is yellowness of the skin, loss of consciousness, hallucinations.

If in doubt, do not eat. But even suitable mushrooms should be pre-soaked and boiled for a long time - they perfectly absorb salts. heavy metals, for example, mercury, which saturates the atmosphere near large cities.

wild poisonous plants

Seductively ripe berries growing in forests and parks often carry the threat of food poisoning of non-microbial origin - they contain alkaloids, hydrocyanic or oxalic acid, saponins, glycosides in a decent amount.

The severity of food intoxication in this case is determined by the amount eaten. As a rule, a person complains of nausea, vomiting, headache. With a serious lesion, loss of consciousness is noted, death is possible.

Often, symptoms appear in children who, while walking, taste unknown berries or parts. poisonous plants- hemlock, belladonna, milestone, henbane.

More often, death occurs as a result of respiratory arrest.

cultivated plants

It would seem that one can not be afraid of food poisoning of non-microbial origin if vegetables and fruits grown by one's own hands or purchased in a store are present in the diet. However, improper handling of chemicals, non-compliance with storage conditions make these safe products poisonous.

weeds

Farmland, summer cottages often overgrown with rather toxic herbs. Their seeds and other parts can accidentally get into the harvested crop and lead to non-microbial poisoning of both humans and animals. In this case, ordinary pastries can be fatal if grains of pubescent heliotrope or gray trichodesma are added to the wheat.

The cause of non-microbial poisoning is often the inhabitants of rivers, lakes and seas.

marinka caviar

Milk and caviar

Without sufficient experience, you should also not resort to self-cooking. Cutting the carcass, you can damage the film, which will lead to the spread of poison to other areas.

Pufferfish

This fish contains dangerous tetrodotoxin even in muscle tissue. In Asia, experienced chefs are allowed to cook, but after extensive training and obtaining the appropriate certificate.

Some types of shellfish

If the smallest algae dinoflagellates are present in the body of a gastropod, saxitoxin is produced. This poison is immune to any cooking. Poisoning of non-microbial origin can be determined by characteristic feature- paralysis of the nasolabial triangle and mouth. When the respiratory center is affected, death occurs.

Poisoning by poisonous products under certain conditions

Food intoxication of non-microbial origin can also be obtained by using completely edible components.

herbal products

This group includes ingredients that correct use are considered useful.

Bitter stone fruit kernels

When buying almonds, apricots and peaches, you need to make sure that children do not get carried away with the bones of delicious fruits. Only 200 g is enough to show a strong poisoning of non-microbial origin.

Clinical picture:

lack of air;
blue skin;
dyspnea;
convulsions.

Death leads to respiratory arrest.

raw beans

The occurrence of food intoxication is practically ensured if you use uncooked beans. Fortunately, a fatal outcome with this type of poisoning is excluded, but unpleasant symptoms are guaranteed.

sprouted potatoes

Such a vegetable is saturated with the glycoalkaloid solanine, a toxic substance that can also cause death if it enters the body in large quantities. The clinical picture is classic - nausea, vomiting, diarrhea.

Animal products

Non-microbial ailments are provoked by the inhabitants of freshwater rivers and lakes, seas, as well as honey, valuable for human health.

Liver, caviar, fish milk

All these products provoke poisoning if stored incorrectly. For example, even in the refrigerator it is forbidden to keep them for a long time. Fresh components do not pose a threat.

Honey from poisonous plants

It becomes dangerous if a person has a tendency to allergies or when bees collect nectar from flowers containing toxins. Therefore, it is not recommended to purchase the product if the apiary is located in a place where there are many plants that pose a threat.

Intoxication with chemical additives

In this case, poisoning of non-microbial origin is provoked by the means by which unscrupulous manufacturers generously stuff seemingly safe components.

Toxic impurities in food

Preservatives, dyes, flavor enhancers are used to improve the quality and extend the shelf life. But sometimes such components cause elevated temperature, diarrhea, vomiting. Even a bird can become poisonous if it is stuffed with toxins.

Pesticides used in agriculture

Plant products are often loading dose chemicals before harvest. Manufacturers use pesticides, sometimes not observing the norm. If toxic substances remain in the product, a person is faced with severe poisoning of non-infectious origin. Constant use causes encephalopathy.

First aid for intoxication

If food components are damaged, you need to call an ambulance. Poisoning, which does not have a microbial nature, develops rapidly. Until the doctors arrive, they resort to several procedures to alleviate the symptoms and prevent complications.

Cleansing the stomach

Timely washing is important. To cleanse the body, proceed as follows:

Have a drink warm water in a volume of 0.5–1 l.
Press fingers on the root of the tongue.
Discard what they eat.

Perform until the vomit becomes transparent.

Prohibited in the absence of consciousness, swelling of the tissues of the pharynx, esophagus. If the contents of the stomach have become black, there is bleeding and it is dangerous to resort to manipulation.

It is undesirable to add potassium permanganate to the solution, since the substance provokes a burn of the mucous membranes and worsens the patient's condition.

Cleansing enema

In case of poisoning of non-microbial origin, they also resort to washing the intestines. Use a rubber pear, the tip is lubricated with baby cream or petroleum jelly. Take as a solution boiled water room temperature. Perform several times.

Preparations from the group of sorbents

Medicines will help to counter unpleasant symptoms:

activated or white charcoal;
Atoxil;
Polysorb;
Smecta;
Sorbex;
Enterosgel.

In order for the remedy to benefit, follow the dosage and the rules of administration indicated in the instructions.

Plentiful drink

Vomiting and diarrhea cause dehydration. Therefore, in case of poisoning of microbial origin, it is necessary to provide a sufficient volume of liquid. It is recommended to drink even sweet tea and non-carbonated mineral water. This will help maintain the balance of trace elements and prevent sharp decline concentration of glucose, remove toxins.

Actions in case of seizures

Such a syndrome manifests itself in non-microbial poisoning, if the chemical damage has led to damage to the central nervous system. Outwardly, the seizure resembles an epileptic one. The main help is to hold the person's head.

Sometimes there is advice to stick an object, such as a pencil, between the teeth so that the victim does not damage the tongue. It is a risky business - the patient in this state is able to bite off the finger of the one assisting or break his own teeth.

What to do in case of loss of consciousness

In this case, the patient is laid with his back on a flat surface and his head is turned to one side - if vomiting starts, it will not choke. It is necessary to monitor breathing and pulse rate. In a critical situation, the skills of a closed heart massage will come in handy.

Medical care and treatment

Doctors do everything possible to maintain or improve the condition:

Assess the clinical picture.
Stabilize heart rate and breathing.
Connect a dropper with a solution that prevents further development of symptoms and dehydration.
Collect information that will help determine the type of poisoning.

AT as soon as possible the patient is taken to a medical facility.

Treatment is carried out on the basis of pathogenesis:

First of all, you need to make sure that food intoxication is not bacterial. Until that time, the person is in the infectious diseases department. Microbiology today offers a number of methods to identify the pathogen. If the test results are negative, the patient is transferred to another hospital.
It is also necessary, upon admission of a pregnant woman, to separate toxicosis from malaise of a food, chemical or unidentified nature.
They take measures to remove poisons, reduce the risk of complications, and correct the functionality of internal organs.
Be sure to use an antidote, which is selected depending on the provocateur.
In severe cases, hemodialysis is prescribed.

The faster the patient is delivered to the clinic, the higher the positive prognosis.

Effects

A feature of food poisoning of non-microbial origin is the defeat of most internal organs:

Loss of fluid as a result of profuse vomiting and diarrhea leads to dehydration, which is manifested by a decrease in blood pressure, tachycardia, and convulsions.
Likely kidney failure leading to swelling, yellowness of the skin, lack of urine.
Poor liver function is characterized by severe discomfort in the right hypochondrium, general intoxication.
If manifested acute pancreatitis, purple spots appear in the navel area. The patient complains of severe girdle pain.
When food intoxication is provoked by nitrates or pesticides, the risks of gastrointestinal bleeding increase. In this case, vomit and stool contain impurities of scarlet color or are painted black.

To avoid such consequences, it is desirable not to treat, but to prevent poisoning.

Prevention

Warn food intoxication of non-microbial origin is easy if you adhere to hygiene and pay attention to purchases:

Do not purchase products in places that are not established by law.
Do not use plants and berries of a dubious nature.
Rinse the ingredients thoroughly before cooking - the same fruits and vegetables can contain chemicals on the surface. It is advisable to cut off the skin.
If you are passionate about collecting mushrooms, study which of them are poisonous.
Do not violate the recommended heat treatment rules.

Prevention will help to avoid poisoning. But if this happens, you need to urgently call the doctors to separate non-microbial food intoxication from bacterial and get professional help.

Poisonings of non-bacterial origin are not widespread, specific gravity they are small, but more often than poisonings of bacterial origin, they are more severe and sometimes end in death. These include poisoning with poisonous mushrooms, plants, metals, insectofungicides.

poisonous mushrooms. Food poisoning can cause the following types mushrooms: pale grebe, fly agaric, lines, if the latter are used without special treatment (Fig. 24, 25, 26). Due to the external similarity of morels (edible and harmless mushrooms) and lines and the difficulty of their differentiation, all marsupials are considered as conditionally suitable. Morels and stitches can be consumed after boiling for 5-7 minutes. The toxic gelvellic acid contained in the lines passes into the decoction, so it cannot be used as food. Mushrooms after boiling must be squeezed out, washed thoroughly, after which they can be used for frying and cooking. Mushrooms can also be neutralized by drying, followed by storage until use within 2-3 weeks.

Symptoms of poisoning appear 9-11 hours after eating mushrooms and consist in acute gastrointestinal upset, with pain in the epigastric region; jaundice and coma develop.

Rice. 24. Poisonous fungus pale toadstool.

Rice. 25. Poisonous fly agaric mushroom.

Rice. 26. Poison mushroom lines.

Preventive actions are reduced to a wide familiarization of the population and workers of procurement points with the main types of poisonous mushrooms.

Solanine poisoning. In sprouted and green potatoes, it increases in the content of poisonous glucoside - solanine. The disease occurs a few hours after eating potatoes and is manifested by gastroenteritis, vomiting, diarrhea, and headache. After 1-2 days, the disease ends with recovery.

Solanine is contained mainly in the outer layers of the tuber, therefore, when cleaning, about 1/3 of it is removed. The subsequent boiling of peeled potatoes also reduces the content of solanine, as it passes into the water. When potatoes are cooked in their skins, all the solanine remains in the tuber.

Preventive measures include not eating sprouted potatoes; in addition, it is necessary to store potatoes in a dark room and remove green tubers.

Metal poisoning. Of the substances in this group, salts of lead, copper, and zinc are of the greatest practical importance; they can get into food when it is stored or cooked in poor-quality dishes.

For heavy metal poisoning incubation period very short - from several minutes to 2-3 hours, after which gastroenteritis appears: pain in the abdomen, vomiting, diarrhea. Body temperature remains normal. A metallic taste in the mouth is characteristic.

Zinc poisoning is caused by improper use of galvanized cookware. Galvanized utensils can only be used for storing dry foods and water, since water-soluble zinc salts are formed in an acidic environment.

Copper poisoning is observed only with gross violations of sanitary rules, when the surface of copper utensils long time exposed to an acidic liquid. Coating the inner surface of the dishes with tin eliminates the risk of poisoning. You can use untinned copper utensils only when cooking jams and syrups.

The source of lead poisoning is the glaze used to cover pottery, dishes, which sometimes contain a significant amount of lead, which turns into acidic products. When using new pottery, a preliminary study of the glaze for lead content is carried out.

According to sanitary regulations, it is forbidden to use tin containing more than 1% lead for tinning dishes.

Insecticide and fungicide poisoning. In recent years, our country has been widely used in agriculture pesticides for combating pests and diseases of various agricultural crops, destroying weeds, etc. Their use increases productivity, but they are dangerous both for people working with them and for the country's population due to their possible contamination of food products.

Studies have shown that when cows are fed DDT-treated feed, DDT is found in their milk, lard, and meat.

If a nursing woman eats foods containing residual DDT, it may pass into milk and subsequently poison the child.

Thiophos and other organophosphate preparations have high insecticidal properties, but are a strong poison. The presence of residual amounts of it on plant products is dangerous to humans. Therefore, plant products that have been treated with insecticides should be thoroughly washed before use.

The milk of cows treated with chemicals to combat gadfly can be delivered to children's institutions only a week after treatment. Treatment of crops with insecticides should be stopped 24 days before harvest. Meat, dairy and vegetable products should be sent for laboratory control.

In order to prevent poisoning among workers who have contact with pesticides, manual dressing of seeds and pollination of plants is prohibited. Factory-made devices should be used. All work must be carried out in overalls.

Food poisoning of non-bacterial origin is less common than bacterial, their causes are more numerous, and therefore the clinical and forensic diagnosis of such poisoning is more difficult.

poisoning poisonous products animal origin. They include certain species of fish, mollusks and endocrine glands of slaughtered cattle.

Of the poisonous fish, some are always and completely poisonous, others acquire poisonous properties only during the spawning period, and only caviar and milk are poisonous at this time. Certain species of fish, usually suitable for food, sometimes become toxic in a number of water bodies due to special reasons. Currently, about 300 species of poisonous fish are known, most of which live in the Caribbean. Pacific and Indian Oceans.

Among the poisonous fish that live in the Pacific Ocean and, in particular, off the coast of the Russian Federation, one can name the pufferfish, fugu. Poisonous properties are possessed by caviar, milk, liver and blood of these fish.

Fugu poison, tetraodotoxin, neurotropic poison, it acts on the neuromuscular synapses of the respiratory muscles. Later on to peripheral paralysis paralysis of the smooth muscles of the walls of blood vessels joins, which is associated with a drop in blood pressure. It is important to note that at the same time there is a depression of the respiratory center. Poisoning with this poison is accompanied by a high degree of mortality.

Among freshwater poisonous fish, one should name the marinka that lives in the reservoirs of Central Asia. Its meat is quite suitable for food, only caviar, milk and black peritoneum are poisonous. Therefore, freshly caught and gutted fish is suitable for food. Marinka venom has a neurotropic effect (gastroenteritis, headache, paralysis of peripheral muscles, incl. and respiratory) Possible deaths from asphyxia. Special processing neutralizes the product and makes it possible to eat it.

Poisoning by plant products. Among the poisonings of plant products, poisonous mushrooms (pale toadstool, fly agaric, lines, etc.) are in the first place. Poisonings are seasonal and occur in autumn and spring.

Pale grebe poisoning most often occurs in the fall. This is an agaric mushroom, some of its varieties resemble champignons, others - russula and honey mushrooms. Unlike champignon, the pale grebe has a vagina (Volva) at the base of the leg, its plates are always white, while in champignons the plates are white only in young specimens, then they become pink and brown. At the same time, the pale grebe has many varieties that make it difficult to recognize it even by specialists. Pale grebe poisoning is accompanied by high mortality. Some authors indicate that even one specimen of the pale grebe can cause poisoning of a family of 5-6 people.

A family of 5 people ate soup from champignons bought at the market. 30-40 hours after ϶ᴛᴏgo, all family members fell ill: nausea, vomiting, and diarrhea appeared. In 4 adults, the disease proceeded in mild form, a 3-year-old girl began to vomit blood after a long remission. The child died with signs of heart failure. At autopsy, they found dystrophic changes parenchymal organs, in particular fatty degeneration of the liver. During the investigation, it was found that during the cleaning of champignons, one of the mushrooms aroused suspicion by its resemblance to a pale toadstool. At the same time, the ϶ᴛᴏt fungus was not seized and, apparently, was the cause of poisoning.

The main active principle of the pale grebe mushroom is the strongest destructive poison - amanitatoxin. This fungus also contains another poison - amaditehemolysin, which is destroyed when heated to 70 ° or from exposure to digestive juices. Therefore, the effect of amanitehemolysin is often obscured by the influence of a stronger poison - amanitatoxin.

Signs of poisoning with pale toadstool will wake up a few hours after ingestion of mushrooms. These are acute pains in the abdomen, vomiting, diarrhea, sometimes constipation, often anuria. Sometimes the phenomena of acute gastroenteritis resemble cholera. Rapidly developing general weakness, cyanosis, sometimes jaundice, drop in body temperature. Death occurs in a coma, children often have convulsions. Sometimes there are nervous mental disorders: delirium, agitation, loss of consciousness. Protein and blood are detected in the urine.

At the autopsy, there will be a sharp dehydration of the corpse, the phenomena of acute gastroenteritis, the absence of rigor mortis and significant dystrophic changes in organs, especially fatty degeneration of the heart, liver, and kidneys. If the action of amanitohemolysin persists, then hemolyzed blood in the corpse and hemolytic nephrosis take place. Along with the described signs, there are multiple petechial hemorrhages under the serous membranes, hemorrhages in the mucous membrane of the stomach and intestines.

Fly agaric poisoning is rare, since these mushrooms are isolated by their species, and their poisonous properties are well known to the population. Amanitas contain a strong poison - muscarine. The latter excites the endings of the vagus nerve, as a result of which there is increased secretory activity of the glands (salivation, sweat, lacrimation), spasms of smooth muscles (nausea, vomiting) will occur, and pupillary constriction is noted. There is a slowdown in the pulse, breathing accelerates and becomes difficult, there will be dizziness, confusion, sometimes hallucinations and delirium. The toxicity of fungi, and therefore their lethal dose, depends on many conditions and, in particular, on growing conditions (terrain, weather) The lethal dose of pure muscarine is very small (about 0.01 g)

Among spring mushrooms, which can cause food poisoning, lines should be mentioned that are very similar to edible morel mushrooms.
It is worth noting that the main difference between the lines will be the cellular structure on the cut, while the morels on the cut have a uniform structure. The lines contain a strong poison - gelvellic acid, which causes hemolysis. In mild cases of poisoning, 1-8 hours after taking the mushrooms, there will be nausea, vomiting with bile, abdominal pain, weakness; in severe form, jaundice joins these phenomena, sometimes convulsions, indicating a poor prognosis. It is important to note that headache, loss of consciousness, delirium develop simultaneously.

At forensic research corpses of persons who died from poisoning with lines, icteric staining of the skin and mucous membranes, multiple hemorrhages under the serous membranes attract attention; the blood is thick, dark; under the endocardium of the left ventricle, hemorrhages are sometimes noted. On the part of parenchymal organs, there are phenomena of fatty degeneration; in particular, the liver is very sharply enlarged, acquiring a lemon-yellow color. In the kidneys - a picture of hemoglobinuric nephrosis.

Helvellic acid is extracted from mushrooms when boiled. After 10 minutes of boiling and removing the broth, the mushrooms become harmless. It should be remembered that mushroom poisons (amanitatoxin, muscarine, gelvellic acid) are not determined chemically.

For the diagnosis of mushroom poisoning, a botanical examination of the contents of the stomach and intestines is important to detect the remains of the fungus in them.

Poisoning with bitter kernels of stone fruits (apricots, peaches, cherries, bitter almonds) These kernels contain amygdalin glucoside, which, under the action of enzymes in the intestine, is broken down into glucose, benzoic aldehyde and hydrocyanic acid.

Poisoning can occur from different amounts of grains eaten. Fatal poisoning of an adult was observed from 40 pieces of apricot kernels, although about 0.5 cups of peeled seeds are considered a lethal dose.

Clinically, in severe cases of stone fruit poisoning, in addition to nausea, vomiting, diarrhea, there is a rapid manifestation of cyanosis of the face and mucous membranes, shortness of breath, clonic and tonic convulsions. Death occurs from paralysis of the respiratory center. Poisoning can occur not only when taking fresh kernels, but also from using liqueurs and compotes made from these fruits, which have been stored for a long time.

At autopsy, a picture of acute death is observed: plethora of internal organs, liquid cherry-red blood (from the formation of cyangemoglobin), pink color of the mucous membrane of the gastrointestinal tract, the remains of nuclei in the contents of the stomach and intestines. In a chemical study, the presence of hydrocyanic acid can be detected.

Poisoning bleached, dope and belladonna. The active principle of these plants will be atropine-containing substances (hyocyamine, atropine and scopolamine). It is worth noting that they ᴏᴛʜᴏϲᴙ are attached to cardio-paralytic poisons, first sharply excite the central nervous system, and then paralyze it.

Poisoning in this case often occurs when children eat leaves and berries. Ignorance of these plants leads to the fact that similar poisonings are observed in the presence of adults. Symptoms of poisoning come on very quickly, within 10-20 minutes, and are characterized by anxiety, sudden excitement, confusion. There will be delusions and hallucinations of a frightening nature (“henbane overeat”) The vessels of the skin of the face, and then the neck and chest expand. The pulse rises sharply bladder paralyzed. Then a coma develops and death occurs from respiratory paralysis and cardiac activity. Material published on http: // site
In children, fatal poisoning can occur after eating 4-5 belladonna berries.

At autopsy, apart from a sharp dilation of the pupils, nothing characteristic is found. Diagnosis is based on clinical findings and botanical examination of plant remains found in the stomach and intestines.

Poisoning with hemlock (water hemlock) is observed when the roots of the ϶ᴛᴏ plant, which grows along the banks of reservoirs and in damp swampy places, are ingested. The fleshy rhizome of hemlock has a sweetish taste and appearance resembles edible root vegetables. A distinctive feature of it will be the presence of cavities in the section. Poison (cicutotoxin) is found not only in the rhizome, but also in other parts of the plant.

Cicutotoxin, like strychnine, will be a convulsive poison. It stimulates reflex functions spinal cord, incl. and the center of the vagus nerve. Poisoning is characterized rapid development symptoms: agitation, vomiting, cyanosis, severe convulsions, salivation, foaming at the mouth. Death occurs in a state of collapse from paralysis of the centers medulla oblongata. No specific changes were noted at autopsy. Sometimes it is possible to detect in the stomach the remains of a rhizome, which has a characteristic cellular structure.

Aconite poisoning occurs in the Caucasus, where ϶ᴛᴏ a plant from the ranunculus family is quite widespread. Inept use of aconite preparations (infusions, decoctions, etc.) as a means traditional medicine leads to severe poisoning.

The active substance (aconitine) is an extremely poisonous alkaloid found in all parts of the plant. The lethal dose of pure aconitine is 0.003-0.004 g. It is worth noting that it is used to control predators and rodents, and also as an insecticide. Aconitine belongs to the group of cardio-paralytic poisons. It is worth noting that it first excites and then paralyzes the central nervous system and the motor nodes of the heart. It is important to note that simultaneously with paralysis of the motor nodes of the heart, the vagus nerve endings are excited, which leads to cardiac arrest in the diastolic phase. Poisoning proceeds very quickly, within 2-4 hours, accompanied by tingling sensations in the tongue, pharynx, esophagus, stomach, then develop profuse salivation and pruritus changing to numbness. The pulse and breathing are first quickened, and then shortness of breath and bradycardia occur. Consciousness is usually preserved, convulsions are rare. The lethality is very high. At autopsy, nothing characteristic is determined.

Poisoning spotted hemlock. The rhizome of the ϶ᴛᴏth plant resembles horseradish, and the leaves resemble parsley. Active ingredient there will be coniine, an alkaloid that causes paralysis of motor nerve endings. In the clinical picture, paralysis will be characteristic, which occurs first in the legs. At high doses, death occurs from paralysis of the respiratory center. Note that the course of poisoning is very fast - 1-2 hours; lethal dose 0.5-1 g. Autopsy findings are negative.

Poisoning by plants that acquire toxic effects. Poisonous can sometimes be ordinary edible plants, for example, potatoes, in which, with strong germination, poisonous glucosite - solanine accumulates. It is appropriate to note that tubers, although not germinated, but having a green peel, will be dangerous due to the high content of solanine. In a normal potato, solanine is contained in an amount of 0.001%, with an increase in its content to 0.002%, symptoms of poisoning (bitter taste in the mouth, burning tongue, nausea, sometimes diarrhea) can already develop. No deaths are observed.

Ergotism is determined by the action of ergot. The mycelium of the ergot fungus has the appearance of purple grains located on the ears. The admixture of ergot to flour, from which bread is baked, makes it poisonous.

Poisoning will remain in the form of two forms: convulsive and gangrenous. In the convulsive form, there are gastrointestinal disorders and changes in the nervous system: general arousal, convulsions ("black cramp"), mental disorders, hallucinations. In severe cases, the picture of poisoning resembles tetanus. In the gangrenous form, in addition, there is necrosis of the fingers, auricles, the tip of the nose, accompanied by sharp pains.

Alimentary-toxic aleukia is associated with the fact that grain (millet, wheat), overwintered under the snow, germinates with fungi. At first, the disease, resembling sepsis, was called septic tonsillitis. The disease will stay in fever, sore throat, necrotic sore throat. The leading symptoms will be damage to the hematopoietic organs and the development of severe aleukia. Mortality is high (from 30 to 80%)

Food toxicity can also be associated with accidental ingestion of poisonous impurities of chemical or vegetable origin. These contaminants sometimes get into products due to improper storage, processing or otherwise, such as processing for pest control, etc. Today, the most common impurities chemical origin, most of which are addicted to pesticides.

Poisoning with pesticides. Pesticides (pesticides) are chemicals used in agriculture to control pests and diseases of cultivated plants, weeds, pests of grain and food stocks, as well as for pre-harvest leafing of certain crops.

Today, more than 500 pesticides are known (and there are more than 1000 of their preparations) designed to combat harmful insects (insecticides), weeds (herbicides), fungal diseases (fungicides), rodents (zoocides), etc. The huge number of produced pesticides is increasing every year. It should be borne in mind that all pesticides used in agriculture are to some extent toxic to both animals and humans. The only difference is that, having selective action, some of them will be more toxic to humans, while others will be less. Due to the widespread use of pesticides, the number of poisonings caused by them is steadily growing.

By chemical composition pesticides can be divided into following groups: organochlorine (dexachloran, chlorindan, etc.), organophosphorus (thiophos, chlorophos, karbofos, etc.), mercury-organic (data elmerkurphosphate, granosan, etc.), arsenic preparations (sodium arsenite, Parisian greens, ratsid, etc.), copper preparations (copper sulfate, Bordeaux liquid), hydrocyanic acid preparations (cyanide, sodium cyanide), alkaloids (anabazine sulfate, nicotine sulfate), etc. The mechanism of action of various pesticides on the human body is extremely diverse. With ϶ᴛᴏm, it should be taken into account that various organs and tissues are not equally sensitive to the action of poisons, and various poisons can selectively affect certain organs or systems.

For the diagnosis of poisoning with pesticides, preliminary information, the clinical picture of poisoning, the results of laboratory tests, and in the event of death of the victims, morphological changes in the internal organs should be used. Diagnosis of poisoning is especially difficult in cases where the circumstances of the incident are unknown, since the clinical picture and morphological changes in poisoning with many pesticides are uncharacteristic, and methods for determining pesticides in biological materials have not yet been developed enough. It is worth saying that in recent years, pesticides and their transformation products have been used to determine pesticides and their transformation products in biological material. latest methods research: spectrophotometry, gas chromatography, polarography, etc. Among pesticides, in terms of the number of drugs used in agriculture and the frequency of cases of poisoning, organophosphorus and organochlorine pesticides are in first place.

Phosphorus organic compounds. It is worth noting that they very sharply lower the activity of cholinesterase, which leads to the accumulation of acetylcholine in the body.

It is important to note that one of the most common organophosphorus pesticides will be thiophos (NIUIF-100). The pure preparation is a colorless transparent oily liquid with a slight unpleasant odor. Thiophos compounds are widely used for pollination and spraying of plants.

In terms of toxicity, thiophos is not inferior to such strong poisons as hydrocyanic acid and strychnine. According to foreign authors, the lethal dose of thiophos for humans will be 6.8 mg/kg, i.e. about 0.5 g for an adult. Poisoning occurs not only by ingestion, but also by inhalation of vapors and contact with the drug on the skin and mucous membranes.

Symptoms of thiophos poisoning are very diverse: general weakness, vomiting, abdominal pain, shortness of breath, headaches, and in severe cases, generalized convulsions and coma. Death comes from paralysis respiratory center. An external examination of the corpse shows a sharp severity of cadaveric spots, rigor mortis, as well as a significant constriction of the pupils.

An autopsy reveals cerebral edema, sometimes with petechial hemorrhages in its substance, small foci catarrhal, catarrhal-hemorrhagic pneumonia, catarrhal inflammation of the mucous membrane of the stomach and intestines, plethora of internal organs and a sharp specific smell from the contents of the stomach, reminiscent of the smell of rotting hay. It is worth saying to establish poisoning great importance have a forensic chemical study and determination of cadaveric blood cholinesterase activity.

organochlorine compounds. "entrance gate" for organochlorine pesticides, Besides gastrointestinal tract, there will be skin, mucous membranes and Airways. It is important to know that most of the organochlorine preparations are lipid-soluble substances. It is worth noting that they accumulate in adipose tissue and act toxically on the nervous system. Symptoms of acute poisoning depend on the route of its introduction into the body. If the poison enters the stomach, then nausea, vomiting, headaches, a feeling of constriction in the chest develop, the body temperature rises to 38-40 ° C. In the future, general weakness, paresthesia, tremor, convulsions, delusional state join. Protein, erythrocytes, granular cylinders are found in the urine. It is worth saying that for poisoning through the skin, reddening of the skin and dermatitis of varying intensity are additionally characteristic. Poisoning through the respiratory tract is accompanied by shortness of breath and cough. At chronic poisoning drugs of the ϶ᴛᴏ group are observed loss of appetite, insomnia, fatigue, trembling and convulsive pain in the limbs, paresthesia, dizziness, headaches, hepatitis, gastritis, etc. The lethal dose is from 0.5 to 30 g.

Among other impurities of chemical origin, nitrites, salts of nitrous acid, should be mentioned. It is worth noting that they are used in the preparation of ham and sausages. In appearance, nitrites resemble table salt and may be mistakenly used as food. It is worth noting that they are highly toxic (lethal dose 0.3 - 0.5 g)

The clinical picture with the ϶ᴛᴏm form of poisoning is characterized by cyanosis, which is associated with the formation of methemoglobin in the blood. Shortness of breath, a fall in cardiac activity and death develop. At autopsy, brown coloration is noteworthy. cadaveric spots and blood, in which methemoglobin is detected during a spectral study.

Poisoning by toxic impurities of plant origin is also called weed toxicosis, since it is caused by the seeds of poisonous weeds. Lawyers should remember that a wide variety of clinical picture numerous food poisonings, their sources and causes leads to the fact that in lifetime diagnostics food poisoning has been observed many bugs.
From one point of view, disorders of the gastrointestinal tract that mimic food poisoning may be a reflex reaction in various diseases, incl. with abdominal myocardial infarction. On the other hand, a number of food poisonings are accompanied by symptoms of a serious disorder. of cardio-vascular system(feeling of tightness in the chest, pain in the region of the heart, drop in blood pressure, etc.) It is worth noting that they lead to significant changes in the electrocardiogram. It must be remembered that such disorders in food poisoning can be complicated by severe coronary insufficiency and even myocardial infarction. This circumstance should be taken into account by forensic experts when establishing the cause of death at the autopsy.

As you know, the task of a forensic medical examination is to identify medical errors, incl. and in cases of food poisoning. The main reasons for such diagnostic errors will be the following:

insufficient knowledge by doctors of the food poisoning clinic;

reassessment of anamnestic data ("poor quality" food);

atypical clinical course of the disease with pronounced symptoms simulating food poisoning;

inadequate examination of the patient due to his short stay in the hospital, the severity of the disease, as a result of the inexperience or negligence of the doctor.

Poisonings of non-bacterial origin are not widespread, their proportion is small, but they are more likely than poisonings of bacterial origin, they are more severe and sometimes end in death. These include poisoning with poisonous mushrooms, plants, metals, insectofungicides.

Poison mushrooms. Food poisoning can be caused by the following types of mushrooms: pale grebe, fly agaric, lines, if the latter are used without special treatment (Fig. 24, 25, 26). Due to the external similarity of morels (edible and harmless mushrooms) and lines and the difficulty of their differentiation, all marsupials are considered as conditionally suitable. Morels and stitches can be consumed after boiling for 5-7 minutes. The toxic gelvellic acid contained in the lines passes into the decoction, so it cannot be used as food. Mushrooms after boiling must be squeezed out, washed thoroughly, after which they can be used for frying and cooking. Mushrooms can also be neutralized by drying, followed by storage until use within 2-3 weeks.

Symptoms of poisoning appear 9-11 hours after eating mushrooms and consist in acute gastrointestinal upset, with pain in the epigastric region; jaundice and coma develop.

Rice. 24. Poisonous fungus pale toadstool. Rice. 25. Poisonous fly agaric mushroom. Rice. 26. Poison mushroom lines.

Preventive measures are reduced to a wide familiarization of the population and workers of procurement points with the main types of poisonous mushrooms.

Solanine poisoning. In sprouted and green potatoes, it increases in the content of poisonous glucoside - solanine. The disease occurs a few hours after eating potatoes and is manifested by gastroenteritis, vomiting, diarrhea, and headache. After 1-2 days, the disease ends with recovery.

Preventive measures include not eating sprouted potatoes; in addition, it is necessary to store potatoes in a dark room and remove green tubers.

Metal poisoning. Of the substances in this group, salts of lead, copper, and zinc are of the greatest practical importance; they can get into food when it is stored or cooked in poor-quality dishes.

With heavy metal poisoning, the incubation period is very short - from several minutes to 2-3 hours, after which gastroenteritis appears: pain in the abdomen, vomiting, diarrhea. Body temperature remains normal. A metallic taste in the mouth is characteristic.

Copper poisoning is observed only with gross violations of sanitary rules, when the surface of copper utensils is exposed to an acidic liquid for a long time. Coating the inner surface of the dishes with tin eliminates the risk of poisoning. You can use untinned copper utensils only when cooking jams and syrups.

According to sanitary regulations, it is forbidden to use tin containing more than 1% lead for tinning dishes.

Insecticide and fungicide poisoning. In recent years, pesticides have been widely used in agriculture in our country to control pests and diseases of various crops, destroy weeds, etc. Their use increases productivity, but they are dangerous both for people working with them and for the population of the country due to possible food contamination.

Studies have shown that when cows are fed DDT-treated feed, DDT is found in their milk, lard, and meat.

If a nursing woman eats foods containing residual DDT, it may pass into milk and subsequently poison the child.

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Non-bacterial food poisoning

The group of food poisoning includes:

poisoning with poisonous products,

Poisoning by products that are poisonous under certain conditions,

Poisoning caused by chemical impurities.

Poisoning by poisonous products of plant and animal origin is poisoning by mushrooms, wild plants, fish and endocrine glands of slaughter animals.

Mushroom poisoning most often occurs in children and adults who do not know the differences between edible mushrooms and their poisonous counterparts. The most common poisoning with pale toadstool is confused with russula and champignons, lines - confused with morels, fly agaric - confused with russula, false mushrooms - confused with edible mushrooms (Fig. 5.4).

Pale grebe causes poisoning with a mortality rate of 50% or more. Toxins have hepatotropic and neurotropic effects. The incubation period is 10-12 hours, then a violent violation gastrointestinal functions, taking on a cholera-like character, with indomitable vomiting, diarrhea, dehydration of the body, after which jaundice, cessation of urination, coma and death develop.

Lines - spring mushrooms (April-May), are conditionally edible mushrooms, since after 15 minutes of boiling, removing the broth and washing, they become harmless.

Poisoning from poisonous plants is also common in children and people who confuse wild plants with edible garden and edible forest crops; for example, they confuse poisonous root with parsley root, horse sorrel with sorrel, buckthorn fruits with bird cherry fruits, crow's eye with blueberries, lily of the valley fruits with edible wild berries, henbane and dope seeds with poppy, etc.

Poisoning with poisonous animal products

There are some poisonous types of fish:

fugu living in the Sea of Japan,

marinka - in the Syrdarya and Amudarya rivers,

Sevan chromula,

barbel and some others.

The adrenal glands and pancreas of slaughtered animals are also poisonous; it is not recommended to eat them.

Less common are food poisoning from plant and animal products that are poisonous under certain conditions.

Solanine is found in potatoes, especially in sprouted and green ones stored in the light. Poisoning by them is rare, but possible with the use of a large amount of such potatoes, boiled in their skins. Poisoning is accompanied by nausea, vomiting, intestinal dysfunction.

Fasin is included in the structure of raw beans and is destroyed when heated. Poisoning is manifested by dyspeptic symptoms when raw beans are consumed, in case of insufficient heat treatment and the use of bean flour in the diet under the same conditions.

Amygdalin is found in bitter almonds, kernels of stone fruits (apricots, peaches, etc.), and during hydrolysis it splits off hydrocyanic acid. In mild cases, poisoning is manifested by headache and nausea, in severe cases (with the use of 60-80 g of bitter kernels) it can be fatal.

Fagin is found in raw beech nuts. Roasted nuts are not dangerous. Poisoning is manifested by headache, nausea and intestinal dysfunction.

Poisoning by temporarily poisonous organs of fish. During spawning (spawning) caviar, milk and liver of many fish (burbot, pike, mackerel, etc.) become poisonous. Poisoning is characterized by the phenomena of acute gastroenteritis, sometimes taking a cholera-like course.

Mussel poisoning. These molluscs become poisonous in the summer when they feed on thriving plankton that contain a strong neurotoxin. Poisoning is manifested by weakness, nausea, dizziness, numbness of the tongue, lips, difficulty breathing, paralysis of the respiratory center may occur.

poisoning bee honey. The danger is honey collected by bees from poisonous plants (marsh rosemary, rhododendron, azalea, dope, henbane, etc.). Poisoning is acute, the clinical picture depends on the type of poison.

Food poisoning caused by impurities in foods of chemicals. The causes of this group of food poisoning are food additives, pesticide residues and chemicals that enter products from equipment, containers, inventory and the environment. With prolonged intake of small amounts of these substances with food, chronic food poisoning can develop.

Nitrite poisoning. They manifest themselves in the form of chronic alimentary nitrate-nitrite methemoglobinemia when using sausages and smoked meats (nitrites are added to them to give the products an appetizing pink-red color and delay the development of botulinum bacilli), as well as vegetables - beets, potatoes, radishes, carrots, zucchini, lettuce, spinach, cauliflower, greens, which may contain nitrites and nitrates with an excess of mineral nitrogen fertilizers in the soil. In the blood, under the influence of nitrites, methemoglobin is formed, which is not involved in the transfer of oxygen.

Poisoning by pesticide residues.

The widespread use of pesticides (toxic chemicals) in agriculture to control plant pests has made it possible for cases of poisoning by their residual amounts in food products.

Pesticides are divided according to the degree of toxicity, the ability to accumulate and the degree of persistence in the environment.

against insects - insecticides,

against fungi - fungicides,

against rodents - zoocides,

against weeds - herbicides;

by chemical structure

organochlorine - HOS,

organophosphorus - FOS,

organomercury - ROS,

carbamates, etc.)

From a hygienic point of view, the most acceptable pesticides are those that, having fulfilled their purpose, decompose into environmentally friendly components.

COS poisoning, COS includes heptachlor, keltan, hexachlorocyclohexane, etc. Their effect on the body is to damage the central nervous system, parenchymal organs (liver, etc.), endocrine and cardiovascular systems. In acute poisoning, disorders of the nervous system predominate, and in chronic poisoning, the liver and kidneys.

FOS poisoning. These include karbofos, chlorophos, methadione, etc. They are highly effective as insecticides and quickly decompose in the environment, so they are widely used.

Clinical picture acute poisoning: vomiting, pain in the abdomen, diarrhea, lacrimation, dizziness, anxiety, convulsions, decreased cardiac activity, respiratory paralysis.

Food poisoning with chemical impurities. Salts of heavy metals - lead, copper, zinc, etc. can get into food. - from utensils, food containers and equipment.

Lead is contained in tin used for tinning copper and iron utensils (cauldrons), as well as in the enamel of pots and the glaze of pottery. Chronic lead poisoning is possible when eating food from dishes containing high concentrations of lead for a long time. The main symptoms of lead poisoning are anemia, a lead border on the edge of the gums, abdominal pain, and dysfunction of the nervous system.

Copper. Copper poisoning is rare, but possible when acidic food is stored in copper dishes with broken half-day. Copper salts cause acute poisoning, having a cauterizing effect on the mucous membranes. digestive tract cause colicky abdominal pain, diarrhea, severe weakness.

Zinc. It is allowed to store only cold water in galvanized dishes. When using such utensils for cooking, especially acidic, acute zinc poisoning is possible. Clinical manifestations are acute in nature: the incubation period is short - from several minutes to several hours (2-3), the taste of metal in the mouth, vomiting, diarrhea, blood in the vomit and feces.

Prevention of non-bacterial food poisoning:

avoid contact with food and prepared foods harmful impurities;
avoiding the use of poisonous products in food and those that have become poisonous under certain conditions;
dissemination among the population of knowledge about poisonous mushrooms, plants, fish and other poisonous products;
hygienic education of employees of food facilities.

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27.3. Food poisoning of non-bacterial origin

Poisoning with poisonous products of animal origin. These include some species of fish, shellfish, and the endocrine glands of slaughter animals.

Among the poisonous fish that live in the Pacific Ocean and, in particular, off the coast of the Russian Federation, one can name the pufferfish, fugu. Caviar, milk, liver and blood of these fish have poisonous properties.

Poisoning with bitter kernels of stone fruits (apricots, peaches, cherries, bitter almonds). These nuclei contain the glucoside amygdalin, which, under the action of enzymes located in the intestine, is broken down into glucose, benzoic aldehyde and hydrocyanic acid.

Poisoning bleached, dope and belladonna. The active principle of these plants are atropine-containing substances (hyocyamine, atropine and scopolamine). They belong to the cardio-paralytic poisons, first sharply excite the central nervous system, and then paralyze it.

Phosphorus organic compounds. They very sharply lower the activity of cholinesterase, which leads to the accumulation of acetylcholine in the body.

Among other impurities of chemical origin, nitrites, salts of nitrous acid, should be mentioned. They are used in the preparation of ham and sausages. In appearance, nitrites resemble table salt and can be mistakenly used in food. They are highly toxic (lethal dose 0.3 - 0.5 g).

insufficient knowledge by doctors of the food poisoning clinic;

reassessment of anamnestic data ("poor quality" food);

atypical clinical course of the disease with pronounced symptoms simulating food poisoning;

inadequate examination of the patient due to his short stay in the hospital, the severity of the disease, as a result of the inexperience or negligence of the doctor.

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Food poisoning of non-bacterial origin

Food poisoning of non-bacterial origin is less common than bacterial, their causes are more numerous, and therefore the clinical and forensic diagnosis of such poisoning is more difficult.

Poisoning by poisonous products of animal origin. These include certain types of fish, shellfish and the endocrine glands of slaughter livestock.

Among the poisonous fish that live in the Pacific Ocean, in particular, off the coast of the Russian Federation, one can name the pufferfish, fugu. Caviar, milk, liver and blood of these fish have poisonous properties.

Fugu poison, tetraodotoxin, neurotropic poison, it acts on the neuromuscular synapses of the respiratory muscles. In the future, paralysis of the smooth muscles of the walls of blood vessels joins peripheral paralysis, which is associated with a drop in blood pressure. At the same time, the respiratory center is depressed. Poisoning with this poison is accompanied by a high degree of mortality.

Among freshwater poisonous fish, one should name the marinka that lives in the reservoirs of Central Asia. Its meat is quite suitable for food, only caviar, milk and black peritoneum are poisonous. Therefore, freshly caught and gutted fish is suitable for food. Marinka venom has a neurotropic effect (gastroenteritis, headache, paralysis of peripheral muscles, including respiratory). Death from asphyxia is possible. Special processing neutralizes the product and makes it possible to eat it.

Poisoning by plant products. Among the poisonings of plant products, poisoning with poisonous mushrooms (pale toadstool, fly agaric, lines, etc.) is in the first place. Poisonings are seasonal and occur in autumn and spring.

Pale grebe poisoning most often occurs in the fall. This is an agaric mushroom, some of its varieties resemble champignons, others - russula and honey mushrooms. Unlike champignon, the pale grebe has a vagina (Volva) at the base of the leg, its plates are always white, while in champignons the plates are white only in young specimens, then they become pink and brown. However, the pale grebe has many varieties that make it difficult to recognize even by specialists. Pale grebe poisoning is accompanied by high mortality. Some authors point out that even one copy of the pale grebe can cause poisoning of a family of 5-6 people.

A family of 5 people ate soup from champignons bought at the market. After 30-40 hours after that, all family members fell ill: nausea, vomiting, and diarrhea appeared. In 4 adults, the disease proceeded in a mild form, in a 3-year-old girl, after a long remission, hematemesis began. The child died with signs of heart failure. An autopsy revealed dystrophic changes in parenchymal organs, in particular fatty degeneration of the liver. During the investigation, it was found that during the cleaning of champignons, one of the mushrooms aroused suspicion by its resemblance to a pale toadstool. However, this fungus has not been seized and appears to have been the cause of the poisoning.

The main active principle of the pale grebe mushroom is the strongest destructive poison - amanitatoxin. This fungus also contains another poison - amaditehemolysin, which is destroyed when heated to 70 ° C or from the action of digestive juices. Therefore, the action of amanitehemolysin is often obscured by the influence of a stronger poison - amanitatoxin.

Signs of poisoning with pale toadstool appear a few hours after ingestion of mushrooms. These are acute pains in the abdomen, vomiting, diarrhea, sometimes constipation, often anuria. Sometimes the phenomena of acute gastroenteritis resemble cholera. General weakness, cyanosis, sometimes jaundice, and a drop in body temperature develop rapidly. Death occurs in a coma, children often have convulsions. Sometimes there are neuropsychiatric disorders: delirium, agitation, loss of consciousness. Protein and blood are detected in the urine.

An autopsy reveals a sharp dehydration of the corpse, the phenomena of acute gastroenteritis, the absence of rigor mortis and significant dystrophic changes in organs, especially fatty degeneration of the heart, liver, and kidneys. If the action of amanitohemolysin is manifested, then hemolyzed blood in the corpse and hemolytic nephrosis take place. Along with the described signs, there are multiple petechial hemorrhages under the serous membranes, hemorrhages in the mucous membrane of the stomach and intestines.

Fly agaric poisoning is rare, because these mushrooms are distinguished by their appearance, and their poisonous properties are well known to the population. Amanitas contain a strong poison - muscarine. The latter excites the endings of the vagus nerve, as a result of which there is increased secretory activity of the glands (salivation, sweat, lacrimation), spasms of smooth muscles appear (nausea, vomiting), pupillary constriction is noted. There is a slowdown in the pulse, breathing accelerates and becomes difficult, dizziness, confusion, sometimes hallucinations and delirium appear. The toxicity of fungi, and hence their lethal dose, depends on many conditions and, in particular, on growing conditions (terrain, weather). The lethal dose of pure muscarine is very small (about 0.01 g).

Among spring mushrooms that can cause food poisoning, lines that are very similar to edible morel mushrooms should be mentioned. The main difference between the lines is the cellular structure on the cut, while the morels on the cut have a uniform structure. The lines contain a strong poison - gelvellic acid, which causes hemolysis. In mild cases of poisoning, 1-8 hours after taking the mushrooms, nausea, vomiting with bile, abdominal pain, and weakness appear; in severe form, these phenomena are accompanied by jaundice, sometimes convulsions, indicating a poor prognosis. At the same time, headache, loss of consciousness, delirium develop.

In a forensic medical examination of the corpses of persons who died from line poisoning, attention is drawn to icteric staining of the skin and mucous membranes, multiple hemorrhages under the serous membranes; the blood is thick, dark; under the endocardium of the left ventricle, hemorrhages are sometimes noted. On the part of parenchymal organs, there are phenomena of fatty degeneration; in particular, the liver is very sharply enlarged, acquiring a lemon-yellow color. In the kidneys - a picture of hemoglobinuric nephrosis.

For the diagnosis of mushroom poisoning, a botanical examination of the contents of the stomach and intestines is important to detect the remains of the fungus in them.

Poisoning with bitter kernels of stone fruits (apricots, peaches, cherries, bitter almonds). These kernels contain amygdalin glucoside, which, under the action of enzymes in the intestine, breaks down into glucose, benzoic aldehyde and hydrocyanic acid.

Clinically, in severe cases of stone fruit poisoning, in addition to nausea, vomiting, diarrhea, there is a rapid manifestation of cyanosis of the face and mucous membranes, shortness of breath, clonic and tonic convulsions. Death occurs from paralysis of the respiratory center. Poisoning can occur not only when taking fresh kernels, but also from the use of liqueurs made from these fruits, compotes that have been stored for a long time.

Poisoning bleached, dope and belladonna. The active principle of these plants are atropine-containing substances (hyocyamine, atropine and scopolamine). They are cardio-paralytic poisons, first sharply excite the central nervous system, and then paralyze it.

Poisoning in this case often occurs when children eat leaves and berries. Ignorance of these plants leads to the fact that similar poisonings are observed in the presence of adults. Symptoms of poisoning come on very quickly, within 10-20 minutes, and are characterized by anxiety, sudden excitement, confusion. There are delusions and hallucinations of a frightening nature (“he ate too much”). Vessels of the skin of the face, and then the neck and chest expand. The pulse quickens sharply, the bladder becomes paralyzed. Then a coma develops and death occurs from respiratory paralysis and cardiac activity. In children, fatal poisoning can occur after eating 4-5 belladonna berries.

Poisoning with hemlock (water hemlock) is observed when the roots of this plant, which grows along the banks of reservoirs and in damp marshy places, are ingested. The fleshy rhizome of hemlock has a sweetish taste and resembles edible root vegetables in appearance. Its distinctive feature is the presence of cavities in the section. Poison (cicutotoxin) is found not only in the rhizome, but also in other parts of the plant.

Cicutotoxin, like strychnine, is a convulsive poison. It stimulates the reflex functions of the spinal cord, including the center of the vagus nerve. Poisoning is characterized by the rapid development of symptoms: agitation, vomiting, cyanosis, severe convulsions, salivation, foaming at the mouth. Death occurs in a state of collapse from paralysis of the centers of the medulla oblongata. No specific changes were noted at autopsy. Sometimes it is possible to detect in the stomach the remains of a rhizome, which has a characteristic cellular structure.

Aconite poisoning occurs in the Caucasus, where this plant from the buttercup family is quite widespread. The inept use of aconite preparations (infusions, decoctions, etc.) as traditional medicine leads to severe poisoning.

The active substance (aconitine) is an extremely poisonous alkaloid found in all parts of the plant. The lethal dose of pure aconitine is 0.003-0.004 g. It is used to control predators and rodents, and also as an insecticide. Aconitine belongs to the group of cardio-paralytic poisons. It first excites and then paralyzes the central nervous system and the motor nodes of the heart. Simultaneously with paralysis of the motor nodes of the heart, the vagus nerve endings are excited, which leads to cardiac arrest in the diastolic phase. Poisoning proceeds very quickly, within 2-4 hours, accompanied by tingling sensations in the tongue, pharynx, esophagus, stomach, then profuse salivation and skin itching develop, followed by numbness. The pulse and breathing are first quickened, and then shortness of breath and bradycardia occur. Consciousness is usually preserved, convulsions are rare. The lethality is very high. At autopsy, nothing characteristic is determined.

Spotted hemlock poisoning. The rhizome of this plant resembles horseradish, and the leaves resemble parsley. The active ingredient is coniine, an alkaloid that causes paralysis of motor nerve endings. The clinical picture is characterized by paralysis that occurs first in the legs. At high doses, death occurs from paralysis of the respiratory center. The course of poisoning is very fast - 1-2 hours; lethal dose 0.5-1 g. Autopsy findings are negative.

Poisoning by plants that acquire toxic properties. Ordinary edible plants can sometimes turn out to be poisonous, for example, potatoes, in which poisonous glucosite - solanine accumulates during strong germination. Dangerous due to the high content of solanine are tubers, although not germinated, but having a green peel. In a normal potato, solanine is contained in an amount of 0.001%, with an increase in its content to 0.002%, symptoms of poisoning may already develop (bitter taste in the mouth, burning tongue, nausea, sometimes diarrhea). No deaths have been observed.

Ergotism is determined by the action of ergot. The mycelium of the ergot fungus has the appearance of purple grains located on the ears. The admixture of ergot to the flour from which bread is baked makes it poisonous.

Poisoning manifests itself in the form of two forms: convulsive and gangrenous. In the convulsive form, gastrointestinal disorders and changes in the nervous system are noted: general agitation, convulsions ("black cramp"), mental disorders, hallucinations. In severe cases, the picture of poisoning resembles tetanus. In the gangrenous form, in addition, there is necrosis of the fingers, auricles, and the tip of the nose, accompanied by sharp pains.

Alimentary-toxic aleukia is associated with the fact that grain (millet, wheat), overwintered under the snow, germinates with fungi. At first, this disease, resembling sepsis, was called septic tonsillitis. The disease manifests itself in fever, sore throat, necrotic sore throat. The leading symptoms are damage to the hematopoietic organs and the development of severe aleukia. Mortality is high (from 30 to 80%).

Food toxicity can also be associated with accidental ingestion of poisonous impurities of chemical or vegetable origin. These contaminants sometimes get into products due to improper storage, processing or otherwise, such as processing for pest control, etc. Currently, the most common impurities of chemical origin, most of which are pesticides.

Poisoning with pesticides. Pesticides (pesticides) are chemicals used in agriculture to control pests and diseases of cultivated plants, weeds, pests of grain stocks and food products, as well as for pre-harvest leafing of some crops.

Currently, more than 500 pesticides are known (and their preparations are more than 1000) designed to combat harmful insects (insecticides), weeds (herbicides), fungal diseases (fungicides), rodents (zoocides), etc. The huge number of produced pesticides is increasing every year. It should be borne in mind that all pesticides used in agriculture are to some extent toxic to both animals and humans. The only difference is that, having a selective effect, some of them are more toxic to humans, while others are less. Due to the widespread use of pesticides, the number of poisonings caused by them is steadily growing.

According to the chemical composition, pesticides can be divided into the following groups: organochlorine (dexachloran, chlorindan, etc.), organophosphorus (thiophos, chlorophos, karbofos, etc.), organomercury (ethylmercury phosphate, granosan, etc.), arsenic preparations (sodium arsenite , Parisian greens, krysid, etc.), copper preparations (copper sulfate, Bordeaux liquid), hydrocyanic acid preparations (cyanide, sodium cyanide), alkaloids (anabasine sulfate, nicotine sulfate), etc. The mechanism of action of various pesticides on the human body is extremely diverse. At the same time, it should be taken into account that different organs and tissues are not equally sensitive to the action of poisons, and different poisons can selectively affect certain organs or systems.

For the diagnosis of poisoning with pesticides, preliminary information, the clinical picture of poisoning, the results of laboratory tests, and in the event of death of the victims, morphological changes in the internal organs should be used. Diagnosis of poisoning is especially difficult in cases where the circumstances of the incident are unknown, since the clinical picture and morphological changes in poisoning with many pesticides are uncharacteristic, and methods for determining pesticides in biological materials have not yet been developed enough. Recently, the latest research methods have been used to determine pesticides and their transformation products in biological material: spectrophotometry, gas chromatography, polarography, etc. Among pesticides, in terms of the number of drugs used in agriculture and the frequency of cases of poisoning, organophosphorus and organochlorine pesticides are in the first place.

Phosphorus organic compounds. They very sharply lower the activity of cholinesterase, which leads to the accumulation of acetylcholine in the body.

One of the most common organophosphate pesticides is thiophos (NIUIF-100). Pure drug is a colorless transparent oily liquid with a slight unpleasant odor. Thiophos compounds are widely used for pollination and spraying of plants.

In terms of toxicity, thiophos is not inferior to such strong poisons as hydrocyanic acid and strychnine. According to foreign authors, the lethal dose of thiophos for humans is 6.8 mg/kg, i.e. about 0.5 g for an adult. Poisoning occurs not only by ingestion, but also by inhalation of vapors and contact with the drug on the skin and mucous membranes.

Symptoms of thiophos poisoning are very diverse: general weakness, vomiting, abdominal pain, shortness of breath, headaches, and in severe cases, generalized convulsions and coma. Death occurs from paralysis of the respiratory center. An external examination of the corpse shows a sharp severity of cadaveric spots, rigor mortis, as well as a significant constriction of the pupils.

An autopsy reveals swelling of the brain, sometimes with pinpoint hemorrhages in its substance, small foci of catarrhal, catarrhal-hemorrhagic pneumonia, catarrhal inflammation of the mucous membrane of the stomach and intestines, plethora of internal organs and a sharp specific smell from the contents of the stomach, reminiscent of the smell of decomposed hay. To establish poisoning, forensic chemical research and determination of cadaveric blood cholinesterase activity are of great importance.

organochlorine compounds. "Entrance gates" for organochlorine pesticides, in addition to the gastrointestinal tract, are the skin, mucous membranes and respiratory tract. Most of the organochlorine preparations are lipid-soluble substances. They accumulate in adipose tissue and act toxically on the nervous system. Symptoms of acute poisoning depend on the route of its introduction into the body. If the poison enters the stomach, then nausea, vomiting, headaches, a feeling of constriction in the chest develop, the body temperature rises to 38-40 ° C. In the future, general weakness, paresthesia, tremor, convulsions, delusional state join. Protein, erythrocytes, granular cylinders are found in the urine. For poisoning through the skin, reddening of the skin and dermatitis of varying intensity are additionally characteristic. Poisoning through the respiratory tract is accompanied by shortness of breath and cough. In chronic poisoning with drugs of this group, loss of appetite, insomnia, fatigue, trembling and convulsive pain in the limbs, paresthesia, dizziness, headaches, hepatitis, gastritis, etc. are observed. The lethal dose is from 0.5 to 30 g.

The clinical picture in this type of poisoning is characterized by cyanosis, which is associated with the formation of methemoglobin in the blood. Shortness of breath, a fall in cardiac activity and death develop. At autopsy, attention is drawn to the brown color of cadaveric spots and blood, in which methemoglobin is detected during spectral examination.

Poisoning by toxic impurities of plant origin is also called weed toxicosis, since it is caused by the seeds of poisonous weeds. Lawyers should remember that the wide variety of clinical picture of numerous food poisonings, their sources and causes leads to the fact that there are many errors in the lifetime diagnosis of food poisoning. On the one hand, disorders of the gastrointestinal tract that mimic food poisoning can be a reflex reaction when various diseases, including in the abdominal form of myocardial infarction. On the other hand, a number of food poisonings are accompanied by symptoms of a serious disorder of the cardiovascular system (a feeling of tightness in the chest, pain in the heart area, a drop in blood pressure, etc.). They lead to significant changes in the electrocardiogram. Such disorders in food poisoning can be complicated by severe coronary insufficiency and even myocardial infarction. This circumstance should be taken into account by forensic experts when establishing the cause of death at the autopsy.

As you know, the task of a forensic medical examination is to identify medical errors, including in cases of food poisoning. The main reasons for such diagnostic errors are as follows:

§ Insufficient knowledge by doctors of the food poisoning clinic;

§ reassessment of anamnestic data (“poor quality” food);

§ atypical clinical course of the disease with pronounced symptoms simulating food poisoning;

§ Inadequate examination of the patient due to his short stay in the hospital, the severity of the disease, as a result of the inexperience or negligence of the doctor.

test questions

1. What groups are food poisonings classified into?

2. What are the features of food poisoning of bacterial origin?

3. What are the features of non-bacterial food poisoning?

4. What are the features of food poisoning of an unidentified nature?