Preventive measures are very important. Educate personnel that having promiscuous sexual behavior and multiple random sexual partners increases the probability of contacting AIDS.
Personnel who are asymptomatic of AIDS but antibody positive should not donate blood, should not be sexually promiscuous, and should be intensively counseled about what this condition means.
Amebiasis
This intestinal infection may be asymptomatic; however, symptoms can include mild abdominal discomfort, chills, fever, diarrhea with blood or mucus, and abscesses of the liver, lung, or brain. The diagnosis is established by microscopic observation of cysts or trophozoites in fresh or preserved stool specimens or by aspirate from abscesses or tissue. The disease occurs worldwide, but is more common in areas with poor sanitation and health education.
The infectious agent is the single-celled intestinal parasite Entamoeba histolytica. The reservoir is an infected person, usually an asymptomatic cyst passer. Outbreaks are usually spread by the soiled hands of food handlers, contaminated water, hand-to-mouth transfer of feces, flies, and contaminated fruits and vegetables. Patients with acute dysentery are not very communicable, as they do not pass cysts in their stools and any trophozoites passed are fragile. The average incubation period is 2 to 4 weeks. Amebiasis is communicable as long as cysts are passed in the stool, sometimes for years. Treatment is with specific antiparasitic drugs.
Preventive measures require (1) sanitary disposal of human feces from patients; (2) proper surveillance and protection of public water systems to prevent fecal contamination (filtration of large water systems; iodine treatment or boiling of small water supplies); (3) education of food handlers and the general public in personal hygiene, particularly handwashing after defecation and before eating or preparing food; (4) control of fly populations with approved insecticides, sanitary disposal of garbage, and preventing access to food by screening; (5) soaking raw fruits and vegetables in approved disinfecting solutions before eating; and (6) indoctrinating known carriers concerning methods to prevent transmission, e.g., washing hands well after defecation.
Management of patients, contacts, and the nearby environment requires (1) isolation of patients with enteric precautions and exclusion of persons with symptoms from food handling or patient care duties; (2) proper disposal of patient feces; and (3) epidemiologic investigation for methods of transmission. (Household members and other close contacts should have stool specimens checked for Entamoeba histolytica.) There are no requirements for quarantine or immunization.
In populations with a large percentage of carriers, a failure of sanitary facilities (e.g., sewage disposal or water treatment) or improper food handling techniques could result in large outbreaks.
Botulism
Botulism is a serious condition caused by poisoning from a bacteria-produced toxin. The clinical course includes the initial symptoms of drooping eyelids, blurred or double vision, sore throat, dry mouth, vomiting, and diarrhea, which may be followed by symmetrical paralysis. There is no fever unless accompanied by an infection. The agent is a toxin produced by Clostridium botulinum.
A diagnosis is made by identification of the toxin in the patient’s stool or serum. The presence of the specific toxin in suspected food supports this diagnosis. Outbreaks of botulism occur worldwide and are usually traced to food preservation techniques, where the spores of Clostridium botulinum are not destroyed in the process. Cases almost never result from consumption of commercially processed foods.
The reservoir is the intestinal tract of animals and fish, soil, and marine sediment. Botulism is thus acquired by eating food containing the toxin of Clostridium botulinum. The incubation period averages about 24 hours. Botulism is not communicable from man to man. Treatment is primarily with an intravenous or intramuscular injection of trivalent botulinal antitoxin.
Preventive measures include (1) surveillance of commercial food processing plants to ensure proper processing and preparation; (2) never consuming or “taste testing” commercially prepared food in deformed containers or with “off-odors”; (3) purchasing of food for the use of the Navy and Marine Corps from establishments listed in the Directory of Sanitarily Approved Food Establishments for Armed Forces Procurement; and (4) education of persons who can food at home concerning time, pressure, and temperature requirements to kill spores of Clostridium botulinum.
