detectable, but rather the enterotoxin passed through
the gastrointestinal mucous membrane within 15 min
after administration and was detected in the kidney.
Neuronal binding of SEA in the intestinal tract was
not demonstrated; this binding might have been
expected based on the finding that the sensory stimu-
lus for vomiting reaches the vomiting center by way
of the vagus and sympathetic nerves.
Diarrheal Action
0019 Diarrhea is the second most common symptom seen
in staphylococcal food poisoning. In outbreaks in-
volving a large number of people, as many individuals
develop diarrhea as have an emetic reaction. Stimula-
tion of this reaction is not understood because the
mechanism of action is apparently quite different
from that of the so-called diarrheal diseases such as
cholera and Clostridium perfringens and Bacillus
cereus food poisoning. The toxins responsible for
the diarrheal diseases elicit an ileal loop reaction in
rabbits, whereas the staphylococcal enterotoxins do
not. Enterotoxin B (SEB) had no effect on the absorp-
tive mechanism of the rat small intestine, but the
enterotoxin somehow triggered a secretory mechan-
ism that resulted in a net secretion of fluids. The
actual mechanism responsible for stimulating excre-
tion has not been elucidated. (See Bacillus: Food
Poisoning; Clostridium: Food Poisoning by Clostri-
dium perfringens.)
Enteritis
0020 Enteritis is another effect of enterotoxins taken orally,
but it is not easily observed except by special examin-
ation. Pseudomembranous enterocolitis was observed
to be associated with staphylococcal infections in
patients who had been administered antibiotics to
control infection during surgery. Many of these pa-
tients died before the cause of their illness was diag-
nosed. The staphylococci had become resistant to the
antibiotics used and grew prolifically in the intestinal
tracts of these patients because the normal flora had
been eliminated by the antibiotics. These staphylo-
cocci were potent producers of enterotoxin, later
identified as SEA and SEB. Experiments in animals
with SEB revealed that enteritis can be produced in
monkeys, dogs, and chinchillas, with the severity of
enteritis depending on the amount of enterotoxin
given intragastrically. Autopsy of dogs 24 h after
ingesting SEB revealed acute enteritis with edema,
hyperemia, and ulcerations of the mucosa, and
destruction of the surface of the epithelium. Severe
round cell infiltration of the mucosa and destruction
of the surface of the epithelium were observed
by microscopic examination. These observations in
animals were similar to changes characteristic of
acute exogenous gastritis in humans resulting from
staphylococcal food poisoning. These findings, deter-
mined by gastroscopic examination, include patchy
mucosal hyperemia, regional edema, muscular irrita-
tion, erosions, petechiae and purulent exudate.
Examination 48 h later revealed the stomachs had
returned to normal. Acute gastroenteritis was ob-
served in monkeys 2 h after intragastric administra-
tion of SEB, with the most severe changes occurring at
4–8 h postinoculation. The mucosa was again normal
after 72 h postinoculation.
Death
0021Death is uncommon in staphylococcal food poisoning,
hence there is little opportunity to observe the patho-
logical effects of enterotoxin. However, autopsy of
the two children who died after drinking milk from
a mastitic goat revealed a moderate amount of pul-
monary edema marked with congestion of the alveo-
lar vessels and, in a few areas, there appeared to be
hemorrhages into the alveolae. There was a small
amount of leukocytic infiltration in the periportal
areas of the liver. These findings are similar to those
observed in monkeys that received a lethal dose of
enterotoxins by intravenous injection; in these animals
there was a decrease in intravascular fluid volume
with an increase in lung weight. The fluid was con-
fined to the perivascular and peribronchial interstitial
space; the lymphatics in these areas were gorged. The
primary pathological change was degeneration and
necrosis of capillary endothelial cells, with some but
less frequent damage to the endothelium of venules.
Also noted were interstitial hemorrhage and edema, a
histolytic infiltrate, and a striking herniation of capil-
lary endothelium into the vascular lumen. Apparently
these changes were brought about by the enterotoxin
binding to leukocytes with subsequent sequestering of
toxin-bound leukocytes in the lungs.
Treatment and Course of Illness
0022The rapid development of the illness makes it impos-
sible to prevent the symptoms from developing after
the enterotoxin has been ingested; once the symptoms
have occurred there is no treatment that will counter-
act them. In most cases recovery is within a few hours
and no treatment is necessary; however, in severe
cases where vomiting and diarrhea are excessive,
treatment intravenously with fluids is beneficial,
particularly to restore the salt balance.
0023A misunderstanding of the disease by the medical
attendant can lead to unfortunate results. Such was
the case when a young man afflicted with the illness
was given antibiotics, with death as a result. If the
disease was due to the ingestion of the organisms,
STAPHYLOCOCCUS
/Food Poisoning 5559