guys this is Mubeen we are continuing our discussion about this Staphylococcus the series that we are working on at this time is the diseases caused by Staphylococcus so let's start with our next disease which is Stef local gastroenteritis as we've discussed before the the pathogen Steffler cocci they produce three kinds of exotoxins these exotoxins in turn caused three types of diseases and we talked about it that we have Stef local gastroenteritis that is one then toxic shock syndrome that is the other one and then scalded skin syndrome all these three are caused by exotoxins we have already discussed this candid skin syndrome and toxic shock syndrome today we are going to be discussing the pathophysiology and management of gastroenteritis so Steph local contamination of the food usually occurs from the food handlers or chefs or food workers hands and these hands may be contaminated by them touching their nose or someone else who has touched their nose or has staphylococci on their hands and then they touch someplace and then this food worker touch that place as well and picked up the staphylococci then what happens is if the food storage is inappropriate let's say the temperature is not corrected the food is stored for a long time the result of that is that the staphylococci are now going to grow on that food and produce the exotoxin and deposit that on the food itself stefano park i produce about 15 kinds of enterotoxins and about 50 percent of these species of staphylococci aureus produce these entero toxins these entero toxins of course these are extra toxins but these are also super antigens just like the other exotoxins the TSST one is a super similarly the the toxin for Scarlett's skin syndrome is a super antigen and this particular toxin in Tara toxins are also super antigens interestingly these entero toxins are heat-stable and these are also resistant to the digestive action of the gut enzymes so these entero toxins actually survive in the gut too cause they're ill effects steffel Okaka produces interro toxins on meats carbohydrates dairy products so they love to produce these entero toxins and deposit them on poultry on other maids on geez on daily products and so on so these are the kind of foods which when we eat can have preformed staphylococcal inteiro toxin which will then cause food poisoning the incubation time so once the staphylococci are deposited on the food the incubation time is anywhere from 1 to 6 hours some people even say they're 2 to 8 hours so in during that incubation time these staphylococci start growing and start depositing the the internet options one clinical note to keep in mind is that most of the time if a restaurant or a food vending place has the staphylococcal outbreak and the food is contaminated then almost everyone who eats that food will become sick once these entero toxins are ingested what they do is they with the intestine into increased peristalsis and you know that increase peristalsis can cause the feeling of nausea can cause vomiting if it is the little peristalsis that starts plus diarrhea so these are the kind of symptoms are start appearing at the same time this entero toxin also can stimulate local nerve receptors which are then going to stimulate the medullary Center and also help produce that feeling of nausea and vomiting let's look at the clinical presentation so what happens is the patient abruptly suddenly develops nausea and profuse vomiting diarrhea is also present or can be present but normally vomiting and nausea is more significant and severe compared to the diarrhea then abdominal pain and sometimes fever remember this is a super antigen it can actually cause the until you ins to be released including interleukin 1 which will cause fever but fever complaint is less common so most common nausea and vomiting then diarrhea then abdominal pain and fever so this episode of nausea vomiting abdominal pain diarrhea fever can continue up to 12 to 24 hours or sometimes even up to 48 hours quick note on the management of the gastroenteritis or food poisoning because of Staphylococcus in Tarot toxin so for management the basic problem is not to eradicate these staff that is present at the food it is the preformed toxin that is present in the food so all we can do is wait for the toxin to be removed or expanded over ejected from the body meanwhile we have to provide supportive therapy so most important things are number one antiemetic so the patient stops having nausea and vomiting and then provide fluid replacements if patient can take water by mouth sure advise them and start having them have water but if patient cannot if they are in a situation where they cannot take water at all as soon as I drink water and the vomit again in that case IV fluid replacements will be necessary if this food was from a vendor from a restaurant or some contractor who supplied the food in that case you have to culture the food for staff and then you have to make the public health authorities aware of the situation as well so that they can make sure that number one they can talk with the vendor to say hey cleanliness and hygiene is important and number two they can make other beware and be ready to make sure that there are going to be more patients so that is the gastroenteritis thank you very much and talk to you later