KUALA LUMPUR, Malaysia (AP) – “Police unleashed tear gas and chemical-laced water Saturday at thousands of demonstrators who staged one of Malaysia’s largest street rallies in years, demanding fair rules for national elections expected soon…..”
At about 7:30 a.m…….a large explosion rumbled beneath the streets, blasting the metal sheets high into the air. Flames shot out from underground, some 150 feet high, throughout a 300-yard area. Cars were transformed into fireballs and one was reported to have been thrown 30 feet into the air. Some pedestrians in the area were enveloped by fire; others further away were blown to the ground. Flaming debris hit people up to half of a mile away. The final death toll was 110, with hundreds injured. …..”
Clostridium perfringens is an anaerobic, Gram-positive,2 sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.
2. Nature of Acute Disease:
Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. A more serious but rare illness is also caused by ingesting food contaminated with Type C strains. The latter illness is known as enteritis necroticans or pig-bel disease.
3. Nature of Disease:
The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of those C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. A few deaths have been reported as a result of dehydration and other complications.
Necrotic enteritis (pig-bel) caused by C. perfringens is often fatal. This disease also begins as a result of ingesting large numbers of the causative bacteria in contaminated foods. Deaths from necrotic enteritis (pig-bel syndrome) are caused by infection and necrosis of the intestines and from resulting septicemia. This disease is very rare in the U.S.
Infective dose–The symptoms are caused by ingestion of large numbers (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation. This disease is a food infection; only one episode has ever implied the possibility of intoxication (i.e., disease from preformed toxin).
4. Diagnosis of Human Illness:
Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients.
5. Associated Foods:
In most instances, the actual cause of poisoning by C. perfringens is temperature abuse of prepared foods. Small numbers of the organisms are often present after cooking and multiply to food poisoning levels during cool down and storage of prepared foods. Meats, meat products, and gravy are the foods most frequently implicated.
6. Relative Frequency of Disease:
Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. There were 1,162 cases in 1981, in 28 separate outbreaks. At least 10-20 outbreaks have been reported annually in the U.S. for the past 2 decades. Typically, dozens or even hundreds of person are affected. It is probable that many outbreaks go unreported because the implicated foods or patient feces are not tested routinely for C. perfringens or its toxin. CDC estimates that about 10,000 actual cases occur annually in the U.S.
7. Course of Disease and Complications:
The disease generally lasts 24 hours. In the elderly or infirm, symptoms may last 1-2 weeks. Complications and/or death only very rarely occur.
8. Target Populations:
Institutional feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving is the most common circumstance in which perfringens poisoning occurs. The young and elderly are the most frequent victims of perfringens poisoning. Except in the case of pig-bel syndrome, complications are few in persons under 30 years of age. Elderly persons are more likely to experience prolonged or severe symptoms.
9. Food Analysis:
Standard bacteriological culturing procedures are used to detect the organism in implicated foods and in feces of patients. Serological assays are used for detecting enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The procedures take 1-3 days.
Workers Memorial Day recognizes those workers who have died or sustained work-related injuries or illnesses. In 2010, a total of 4,547 U.S. workers died from occupational injuries (1), and each year, approximately 49,000 deaths are attributed to work-related illnesses (2). For 2010, the Bureau of Labor Statistics reported that approximately 3.1 million workers in private industry and 820,000 in state and local government had a nonfatal occupational injury or illness (3). In 2010, an estimated 2.7 million workers were treated in emergency departments for occupational injuries and illnesses, and approximately 110,000 were hospitalized (CDC, unpublished data, 2012).
Economists are working to calculate the costs associated with occupational injuries and illnesses in the United States. Recent research estimates the cost of fatal injuries at $6 billion and the cost of fatal illnesses at $46 billion. Nonfatal injuries and illnesses are estimated to cost $186 billion and $12 billion annually (4). Additional information on workplace safety and health is available from CDC at http://www.cdc.gov/niosh.
Bureau of Labor Statistics, US Department of Labor. Economic news release: table 2. Fatal occupational injuries by industry and selected event or exposure, 2010 (preliminary). Washington, DC: US Department of Labor, Bureau of Labor Statistics; 2012. Available at http://bls.gov/news.release/cfoi.t02.htm. Accessed April 19, 2012.
Steenland K, Burnett C, Lalich N, Ward E, Hurrell J. Dying for work: the magnitude of US mortality from selected causes of death associated with occupation. Am J Ind Med 2003;43:461–82.
Bureau of Labor Statistics, US Department of Labor. Economic news release: workplace injury and illness summary. Washington, DC: US Department of Labor, Bureau of Labor Statistics; 2011. Available at http://www.bls.gov/news.release/osh.nr0.htm. Accessed April 19, 2012.
Leigh JP. Economic burden of occupational injury and illness in the United States. Millbank Q 2011;89:728–72.