The death of a 16-year-old girl, Devananda, following acute food poisoning at Cheruvathur in Kasaragod district, has brought into sharp focus the importance of maintaining utmost hygiene and care when preparing and handling food.

Not just Devananda, over 30 people, mostly schoolchildren, who had consumed the same food item – chicken wrap or shawarma, a dish of Arabic origin – were hospitalized at the same time with symptoms of acute food poisoning.

It is the consumption of contaminated food that causes food poisoning. Contamination can happen when improperly cooked food, especially of animal origin, is kept exposed in air. Keeping raw food along with cooked food can also lead to contamination, apart from the presence of bacteria, viruses or parasites.

Contaminated water used to wash food items or vegetables can also lead to contamination of food.

In Kasaragod, it was shawarma, consumed by children and many others, which has been incriminated in the food poisoning incident. While one child died at the hospital, several others fell seriously ill. Three children had to be admitted to the intensive care unit, with two of them suffering from acute kidney injury (AKI) and another developing cardiac issues.

2012 incident

This is not the first time shawarma is taking the rap for being the prime agent in food poisoning incidents. In 2012, a young student, who had eaten shawarma he had packed as dinner while on a journey from Thiruvananthapuram to Bangalore, died following a severe bout of food poisoning. In subsequent years too, in many food poisoning incidents in the State, food safety officials had zoomed in on shawarma as the agent of food poisoning.

In most cases, officials had pinpointed mayonnaise served with the shawarma to be the culprit in delivering salmonella poisoning, the most common bacterial agent causing food poisoning, to people.

Symptoms of salmonella poisoning start within six to 72 hours and severe dehydration following vomiting and diarrhoea, and it can turn dangerous in some instances.

Many eateries make their own mayonnaise, which is an emulsion of raw eggs and oil and which spoils easily if kept outside the refrigerator, especially in the hot weather. (Store-bought mayonnaise is deemed safe as it contains pasteurized eggs and preservatives).

Meat, poultry and eggs are primary sources of salmonella bacteria and if this is handled carelessly and in an unhygienic manner in the kitchen, cross-contamination can happen in other foods from kitchen surfaces or knives. How food is stored, the temperature maintained in the refrigerator / deep freezer, how deep-frozen meat or poultry products are defrosted are all important to prevent contamination.

In fact, rather than a particular item of food, it is the careless manner in which it is prepared and handled by those engaged in food business that deems the item unsafe for consumption.

The hot and humid weather conditions in Kerala at present also call for better and safe handling of food and its preservation, especially food of animal origin, to prevent food poisoning incidents.

Food poisoning effects

Food poisoning to most people is just vomiting and diarrhoea and while this is true to a large extent, there are occasions when this can turn serious, causing dehydration and kidney failure.

The bacteria entering the body can attach themselves to the lining of the intestines and multiply, releasing toxins. But in most cases, it is the rapid dehydration and lack of access to good and timely care that can lead to AKI rather than the damage caused by toxins per se, points out Noble Gracious, Associate Professor of Nephrology, Thiruvananthapuram Government Medical College.

Diarrhoeal diseases are the most common cause of AKI in children but despite the ubiquitous nature of these diseases, the possibility of dehydration leading to AKI is often not understood.

Children at risk

Large-volume diarrhoea in children becomes dangerous when accompanied by vomiting because then oral fluid intake clearly does not work. If rehydration is not initiated through the administration of fluids intravenously without delay, the rapid dehydration can reduce blood flow to the kidneys, leading to AKI. If not diagnosed and treated, the condition can progress to acidosis, increased potassium levels in blood leading to paralysis or cardiac issues and even death, according to Dr. Gracious.

Once kidneys suffer an injury, how soon dialysis is done to correct the volume depletion becomes important to prevent permanent damage to the kidneys.

Proper diagnosis and timely treatment of acute diarrhoeal diseases is thus extremely important because it is the dehydration that results in complications more than the damage directly caused by the toxins.

Even as the lab results of the water and food samples collected by the Food Safety Department as well as the results of the samples collected from the girl who died of food poisoning are awaited, the Health Department has now found the presence of the bacteria Shigella sonnei in the stool samples collected of children who were hospitalised following food poisoning.

This has perhaps thrown a twist in the story so far, as Shigella infection essentially indicates water contamination, which could have contaminated food that came into contact with it or drinks that were prepared using the contaminated water. Vegetables washed using the contaminated water and served as raw salads can emerge as a possible source of food poisoning.

Shigella infection can be passed on from person to person, if an infected person does not maintain hygiene or wash his hands properly after using the loo. An infected person should not be handling food at all as they can pass on the infection to many others.

Shigella infection would mean that the drinking water sources in the locality – piped or well water – could have been contaminated and this calls for concerted action from the authorities to identify the source of contamination and to initiate de-contamination measures like super chlorination of wells.

There are uncertainties abound and till all epidemiological links are explored and microbiological investigations completed, a clear picture is unlikely to emerge.

The Opposition has blamed the Health Department for lack of food safety inspections. Local-level corruption might be a reason. Perhaps, intense enforcement of hygiene norms might minimize the food poisoning risk in the State.

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