INTRODUCTION TO

FOODBORNE INFECTIONS AND

INTOXICATIONS:

AN AFRICAN PERSPECTIVE

ERIC SAMPANE-DONKOR
FLEISCHER C. N. KOTEY

SAMUEL DARKWAH
IRENE AMOAKOH OWUSU

PATIENCE B. TETTEH-QUARCOO
NICHOLAS T. K. D. DAYIE

Title: Introduction to Foodborne Infections and Intoxications Subtitle: An
African Perspective

Foodborne infections and intoxications pose a significant global health threat,
especially in Africa and other low-income regions. The goal of this book is to
explore the intricate web of factors that influence foodborne infections in Africa.
It delves into specific aspects of food safety, providing insights into the unique
challenges and opportunities that Africa presents. By integrating disciplines such
as microbiology, epidemiology, veterinary medicine, public health, and food
science, the textbook advocates for a multidisciplinary approach to develop
effective preventive measures, surveillance systems, and interventions.

This electronic textbook was developed through funding from the University of
Ghana Building Stronger Universities Programme III, Office of Research,
Innovation and Development, University of Ghana, Legon, Accra Ghana.

Copyright © Eric Sampane-Donkor, Fleischer C. N. Kotey, Samuel
Darkwah, Irene Amoakoh Owusu, Patience B. Tetteh-Quarcoo and
Nicholas T. K. D. Dayie

Publisher

Office of Research, Innovation and Development,
University of Ghana, Legon, Accra Ghana.
Under the auspices of the University of Ghana Building Stronger
Universities Programme III

Contact: Prof. Richard Boateng. Email: richboateng@ug.edu.gh

Cover Design and Typeset:

Prof. Richard Boateng
Email: richboateng@ug.edu.gh

Printed by:

University of Ghana

Author Contact:

ERIC SAMPANE-DONKOR
Email: esampane-donkor@ug.edu.gh

Ghana Library Cataloguing-in-Publication Data

Sampane-Donkor, Eric Introduction to foodborne infections and
intoxications: an African perspective / Eric Sampane-Donkor[…etal.].

— Accra: Research, Innovation & Development-UG, 2023.
1. Food — Microbiology 2. Foodborne diseases I.
Title DDC 615.954 - - dc 21

ISBN: 978-9988-3-6053-5 (ebook)

GLCN — 314

Dedication

This book is dedicated to the diverse communities of Africa, all who
have devoted earnest efforts to ensuring food safety and the well-being

of their communities, those who have dedicated their lives to
understanding and combating foodborne infections in Africa,

individuals and families who have suffered from the devastating effects
of foodborne infections, as well as to the future generations of Africa —

the young minds who will carry the torch forward, pioneering new
research, and driving transformative change in infectious diseases.

Table of Contents

DEDICATION ..................................................................................................... 3

LIST OF TABLES ................................................................................................ 10

LIST OF FIGURES .............................................................................................. 11

INTRODUCTION .............................................................................................. 16

INTRODUCTION ............................................................................................... 17

CHAPTER 1: ..................................................................................................... 18

STAPHYLOCOCCUS AUREUS ......................................................................... 18

BACKGROUND INFORMATION ON S. AUREUS ......................................................... 19
FOODS ASSOCIATED WITH S. AUREUS .................................................................. 20
PATHOGENESIS OF STAPHYLOCOCCAL FOOD POISONING ..................................... 21
DIAGNOSIS AND MANAGEMENT OF STAPHYLOCOCCAL FOOD POISONING ............. 22
PREVENTION OF STAPHYLOCOCCAL FOOD POISONING ........................................ 23
CASES OF S. AUREUS FOODBORNE DISEASE OUTBREAKS IN AFRICA ......................... 23
SUMMARY OF THE CHAPTER .............................................................................. 25
END OF CHAPTER QUESTIONS ON S. AUREUS ........................................................ 26
REFERENCES ................................................................................................... 28

CHAPTER 2: ..................................................................................................... 30

LISTERIA MONOCYTOGENES ......................................................................... 30

BACKGROUND INFORMATION ON LISTERIA MONOCYTOGENES .............................. 31
FOODS ASSOCIATED WITH L. MONOCYTOGENES .................................................. 32
PATHOGENESIS OF L. MONOCYTOGENES FOODBORNE INFECTIONS ........................ 33
DIAGNOSIS AND MANAGEMENT OF LISTERIA FOODBORNE INFECTIONS .................... 35
PREVENTION OF LISTERIA FOODBORNE INFECTIONS ............................................... 36
CASES OF LISTERIA FOODBORNE OUTBREAKS IN AFRICA ........................................ 37
SUMMARY OF THE CHAPTER .............................................................................. 38
END OF CHAPTER QUESTIONS ON LISTERIA / LISTERIOSIS ......................................... 39
REFERENCES ................................................................................................... 40

CHAPTER 3: ..................................................................................................... 41

SALMONELLA .................................................................................................. 41

OBJECTIVES .................................................................................................. 41

BACKGROUND INFORMATION ON SALMONELLA ................................................... 42
FOODS ASSOCIATED WITH SALMONELLA .............................................................. 43
PATHOGENESIS OF SALMONELLOSIS .................................................................... 44
DIAGNOSIS AND MANAGEMENT OF SALMONELLOSIS ............................................. 46
PREVENTION OF SALMONELLOSIS ........................................................................ 48
CASES OF SALMONELLA FOODBORNE OUTBREAKS IN AFRICA ................................. 49
SUMMARY OF THE CHAPTER ............................................................................... 50
END OF CHAPTER QUESTIONS ON SALMONELLA .................................................... 51
REFERENCES .................................................................................................... 52

CHAPTER 4: .................................................................................................... 54

SHIGELLA ........................................................................................................ 54

BACKGROUND INFORMATION ON SHIGELLA ........................................................ 55
FOODS ASSOCIATED WITH SHIGELLA ................................................................... 56
PATHOGENESIS OF SHIGELLOSIS .......................................................................... 58
DIAGNOSIS AND MANAGEMENT OF SHIGELLOSIS .................................................. 59
PREVENTION OF SHIGELLA FOODBORNE INFECTIONS ............................................. 60
CASES OF SHIGELLOSIS OUTBREAKS IN AFRICA ...................................................... 61
CHAPTER SUMMARY ......................................................................................... 63
END OF CHAPTER QUESTIONS ON SHIGELLA ......................................................... 63
REFERENCES .................................................................................................... 65

CHAPTER 5: .................................................................................................... 66

VIBRIO CHOLERAE ......................................................................................... 66

BACKGROUND INFORMATION ON VIBRIO CHOLERAE ............................................ 67
FOODS ASSOCIATED WITH VIBRIO CHOLERAE ....................................................... 69
PATHOGENESIS OF CHOLERA ............................................................................. 70
DIAGNOSIS AND MANAGEMENT OF CHOLERA ..................................................... 70
PREVENTION OF CHOLERA ................................................................................. 71
CASES OF CHOLERA OUTBREAKS IN AFRICA ......................................................... 71
CHAPTER SUMMARY ......................................................................................... 72
END OF CHAPTER QUESTIONS ON VIBRIO CHOLERAE ............................................. 73
REFERENCES .................................................................................................... 74

CHAPTER 6: .................................................................................................... 75

ESCHERICHIA COLI O157:H7 ........................................................................ 75

BACKGROUND INFORMATION ON ESCHERICHIA COLI O157:H7 ............................ 76
FOODS ASSOCIATED WITH E. COLI O157:H7 FOODBORNE INFECTIONS ................... 77

PATHOGENESIS OF E. COLI O157:H7 FOODBORNE INFECTIONS ............................ 79
DIAGNOSIS AND MANAGEMENT OF E. COLI O157:H7 FOODBORNE INFECTIONS .... 80
PREVENTION AND CONTROL OF E. COLI O157:H7 FOODBORNE INFECTIONS .......... 83
CASES OF E. COLI O157:H7 DISEASE OUTBREAKS IN AFRICA ................................ 84
CHAPTER SUMMARY ........................................................................................ 85
END OF CHAPTER QUESTIONS ON E. COLI O157:H7 FOODBORNE INFECTIONS ........ 87
REFERENCES ................................................................................................... 90

CHAPTER 7: ..................................................................................................... 92

CLOSTRIDIUM ................................................................................................. 92

CLOSTRIDIUM AS A FOOD PATHOGEN ................................................................ 93
C. PERFRINGENS ............................................................................................. 96
C. BOTULINUM .............................................................................................. 105
CASES OF CLOSTRIDIUM FOODBORNE INFECTION OUTBREAKS IN AFRICA .............. 113
CHAPTER SUMMARY ...................................................................................... 114
END OF CHAPTER QUESTIONS ON CLOSTRIDIUM FOODBORNE INFECTIONS ............. 116
REFERENCES ................................................................................................. 121

CHAPTER 8: ................................................................................................... 123

HUMAN NOROVIRUS ................................................................................... 123

BACKGROUND INFORMATION ON HUMAN NOROVIRUS ....................................... 124
TRANSMISSION AND FOODS ASSOCIATED WITH HUMAN NOROVIRUS ..................... 125
DISEASE BURDEN, PATHOGENESIS AND CLINICAL PRESENTATION OF NOROVIRUS

INFECTION .................................................................................................... 127
DIAGNOSIS AND MANAGEMENT OF HUMAN NOROVIRUS INFECTION ..................... 128
PREVENTION OF HUMAN NOROVIRUS INFECTION ................................................ 128
CHAPTER SUMMARY ...................................................................................... 129
END OF CHAPTER QUESTIONS ON HUMAN NOROVIRUS ........................................ 129
REFERENCES ................................................................................................. 131

CHAPTER 9: ................................................................................................... 132

ROTAVIRUS ................................................................................................... 132

BACKGROUND INFORMATION ON ROTAVIRUS ................................................... 133
TRANSMISSION AND FOODS ASSOCIATED WITH ROTAVIRUS .................................. 135
DISEASE BURDEN, PATHOGENESIS AND CLINICAL PRESENTATION OF ROTAVIRUS

INFECTION .................................................................................................... 136
DIAGNOSIS AND MANAGEMENT OF ROTAVIRUS INFECTION .................................. 137
PREVENTION OF ROTAVIRUS INFECTION ............................................................. 137

A CASE OF ROTAVIRUS OUTBREAK IN AFRICA ..................................................... 138
CHAPTER SUMMARY ....................................................................................... 138
END OF CHAPTER QUESTIONS ON ROTAVIRUS ..................................................... 139
REFERENCES .................................................................................................. 141

CHAPTER 10: ................................................................................................ 142

HEPATITIS A VIRUS ........................................................................................ 142

BACKGROUND INFORMATION ON HEPATITIS A VIRUS ........................................... 143
TRANSMISSION AND FOODS ASSOCIATED WITH HEPATITIS A VIRUS .......................... 143
DISEASE BURDEN, PATHOGENESIS AND CLINICAL PRESENTATION OF HEPATITIS A VIRUS

INFECTION ..................................................................................................... 144
DIAGNOSIS AND MANAGEMENT OF HEPATITIS A VIRUS INFECTION ......................... 145
PREVENTION OF HEPATITIS A VIRUS INFECTION .................................................... 146
CHAPTER SUMMARY ....................................................................................... 146
END OF CHAPTER QUESTIONS ON HEPATITIS A VIRUS ............................................ 147
REFERENCES .................................................................................................. 149

CHAPTER 11: ................................................................................................ 150

ENTAMOEBA HISTOLYTICA .......................................................................... 150

BACKGROUND INFORMATION ON ENTAMOEBA HISTOLYTICA ............................... 151
TRANSMISSION AND FOODS ASSOCIATED WITH ENTAMOEBA HISTOLYTICA INFECTIONS

.................................................................................................................... 153
DISEASE BURDEN, PATHOGENESIS AND CLINICAL PRESENTATION OF ENTAMOEBA

HISTOLYTICA INFECTION ................................................................................... 155
DIAGNOSIS AND MANAGEMENT OF ENTAMOEBA HISTOLYTICA INFECTION ............. 157
PREVENTION OF ENTAMOEBA HISTOLYTICA INFECTION ......................................... 157
CHAPTER SUMMARY ....................................................................................... 158
END OF CHAPTER QUESTIONS ON ENTAMOEBA HISTOLYTICA ................................ 158
REFERENCES .................................................................................................. 159

CHAPTER 12: ................................................................................................ 160

GIARDIA LAMBLIA ....................................................................................... 160

BACKGROUND INFORMATION ON GIARDIA LAMBLIA .......................................... 161
TRANSMISSION AND FOODS ASSOCIATED WITH GIARDIA LAMBLIA ......................... 163
DISEASE BURDEN, PATHOGENESIS, AND CLINICAL PRESENTATION OF GIARDIA LAMBLIA

.................................................................................................................... 164
DIAGNOSIS AND MANAGEMENT OF GIARDIA LAMBLIA ........................................ 165
PREVENTION OF GIARDIA LAMBLIA INFECTION ................................................... 165

CHAPTER SUMMARY ...................................................................................... 166
END OF CHAPTER QUESTIONS ON GIARDIA LAMBLIA .......................................... 166
REFERENCES ................................................................................................. 167

CHAPTER 13: ................................................................................................. 168

CRYPTOSPORIDIUM PARVUM ...................................................................... 168

BACKGROUND INFORMATION ON CRYPTOSPORIDIUM PARVUM ........................... 169
TRANSMISSION AND FOODS ASSOCIATED WITH CRYPTOSPORIDIOSIS ..................... 169
DISEASE BURDEN, PATHOGENESIS AND CLINICAL PRESENTATION OF CRYPTOSPORIDIOSIS

................................................................................................................... 171
DIAGNOSIS AND MANAGEMENT OF CRYPTOSPORIDIOSIS .................................... 172
PREVENTION OF CRYPTOSPORIDIUM PARVUM INFECTION ................................... 174
CHAPTER SUMMARY ...................................................................................... 174
END OF CHAPTER QUESTIONS ON CRYPTOSPORIDIUM PARVUM ........................... 175
REFERENCES ................................................................................................. 176

CONCLUSION ............................................................................................... 177

AUTHOR PROFILES ........................................................................................ 178

List of Tables

Table Details Page Number

Table 7.1: Clostridium species of medical
importance and their disease characteristics

Table 7.2: Toxin-type scheme for Clostridium
perfringens strains and their associated disease

Table 7.3: Groups of C. botulinum strains
associated with human food diseases

107

List of Figures
Figure Details Page Number
Figure 1.1: Some potential sources of
staphylococcal food poisoning

Figure 2.1: Potential vehicles for listeriosis
transmission

Figure 3.1: A poultry farm somewhere in Africa 44

Figure 4.1: An example of unhygienic conditions
that could promote Shigella transmission

Figure 5.1: Photomicrograph of a Gram-stained
specimen showing numerous flagellated, Vibrio
cholerae (with distinctive comma shape)

Figure 5.2: Examples of foods associated with
cholera

Figure 6.1: An example of foods that could transmit
E. coli O157:H7 foodborne infections

Figure 6.2: E. coli on MacConkey agar plate (Pinkish
lactose-fermenting colonies), cultured aerobically
for 24 hrs

Figure 7.1: A photomicrograph of numerous Gram-
stained C. perfringens.

Figure 7.2: Biochemical reaction profile of C.
perfringens

103

Figure 7.3: Reverse CAMP test for the identification
of C. perfringens

113

Figure 7.4: A photo-micrograph of gentian violet-
stained C. botulinum and bacterial endospores

106

Figure 7.5: Biochemical reaction profile of C.
botulinum

111

Figure 8.1: Examples of foods that could potentially
transmit norovirus

128

Figure 9.1: Transmission electron micrography
image (mag. 455,882X) revealing some of the
ultrastructural morphology of several rotavirus
icosahedral protein capsid particles

134

Figure 9.2: Examples of foods that could potentially
transmit rotavirus

135

Figure 10.1: An example of foods that could be a
vehicle for hepatitis A virus

144

Figure 11.1: Photomicrograph showing the presence
of an Entamoeba histolytica trophozoite, with
explosive extrusion of a pseudopodium (toward the
left)

152

Figure 11.2: Photomicrograph showing the presence
of an Entamoeba histolytica cyst in iodine
preparation, with clearly defined nuclei (trinucleated
parasitic cyst)

152

Figure 11.3: Examples of foods that could
potentially transmit Entamoeba histolytica

154

Figure 12.1: Flagellated Giardia
lamblia trophozoites from an infected host's small
intestines

162

Figure 12.2: Giardia lamblia cyst in iodine
preparation

162

Figure 12.3: Examples of foods that could
potentially transmit Giardia lamblia

163

Figure 13.1: Vegetables irrigated with water
contaminated with C. parvum oocysts could
potentially transmit cryptosporidiosis

170

Figure 13.2: Examples of ready-to-eat foods that
could potentially transmit cryptosporidiosis

171

Figure 13.3: Modified Ziehl-Neelson-stained oocysts
of Cryptosporidium parvum

173

Preface and Acknowledgments

Foodborne infections and intoxications pose a significant global
health threat, especially in Africa and other low-income regions. This
textbook, "An Introduction to Foodborne Infections and
Intoxications: An African Perspective," sheds light on the complex
dynamics of food safety in Africa. It is the result of extensive
research, collaboration, and practical experience gathered from
experts in various fields.

The goal of this textbook is to explore the intricate web of factors
that influence foodborne infections in Africa. It delves into specific
aspects of food safety, providing insights into the unique challenges
and opportunities that Africa presents. By integrating disciplines
such as microbiology, epidemiology, veterinary medicine, public
health, and food science, the textbook advocates for a
multidisciplinary approach to develop effective preventive measures,
surveillance systems, and interventions.

We recognize that the book is one step towards addressing the
complex issue of foodborne infections in Africa. We hope it
reinforces interest for further research, stimulates discussions, and
provide a foundation for policy development and implementation.

We use this opportunity to thank Alex Odoom, Abdul-Halim Osman,
Raphael Kwadwo Yeboah, Onyansaniba Kweku Ntim, and Wilfred
Ofosu (national service personnel of the Department of Medical
Microbiology, University of Ghana Medical School), and all others
who, in diverse ways, assisted in compiling this textbook.

ERIC SAMPANE-DONKOR
FLEISCHER C. N. KOTEY
SAMUEL DARKWAH
IRENE AMOAKOH OWUSU
PATIENCE B. TETTEH-QUARCOO
NICHOLAS T. K. D. DAYIE

Introduction To Foodborne Infections And Intoxications: An African Perspective

Foreword

Food safety is a critical global concern, making insights on its
complexities essential to safeguarding public health. In recent years,
there has been an increasing recognition of the unique challenges and
perspectives that Africa brings to this field. The textbook before you,
"Foodborne Infections And Intoxications: An African Perspective,"
represents a significant milestone in bridging the knowledge gap and
shining a spotlight on the African context.

Africa is a vast continent, with rich culture, agricultural practices,
and culinary heritage. It is also confronted with distinct socio-
economic, environmental, and infrastructural challenges that impact
food safety. By exploring these diverse approaches to food production
and consumption, this textbook offers valuable insights into the
interconnectedness between culture, foodborne pathogens, and public
health outcomes.

The textbook not only elucidates the challenges, but also highlights
the innovative approaches and solutions emerging from the continent.
From community-driven initiatives to policy advancements and
collaborations, the textbook showcases the resilience, adaptability, and
commitment of African researchers, healthcare professionals, and
policymakers in addressing the complex issue of food safety. Thus,
besides being a valuable resource, this textbook is a call to action. It
emphasizes the urgent need for collaboration, knowledge sharing, and
capacity building to strengthen Africa's capacity to prevent, detect,
and respond to foodborne infections effectively.

The authors are experts in the field, having accumulated deep
knowledge and experience through extensive research and practical
engagement with food safety issues in Africa. Their collective expertise
spans several disciplines, such as microbiology, epidemiology, public
health, and food science, and reflect in their comprehensive and
multidimensional exploration of foodborne infections in Africa. I
applaud them for their dedication, passion, and meticulous work in
bringing this textbook to fruition. Their commitment to advancing food
safety in Africa is evident in the wealth of information, case studies,
and practical recommendations presented.

As you embark on this enlightening journey through this textbook,
I invite you to embrace the knowledge and insights offered. Let this
book be a catalyst for dialogue, innovation, and meaningful change as
we work jointly to ensure safer and healthier food systems for all.

PROFESSOR PATIENCE MENSAH
FORMER REGIONAL ADVISOR ON FOOD SAFETY,
WORLD HEALTH ORGANIZATION — AFRICA REGIONAL OFFICE

Introduction

Introduction to Foodborne Infections and Intoxications: An African Perspective

Introduction

Despite the efforts of governments, international organizations, and
researchers to mitigate the burden of foodborne infections and
intoxications, the menace continues to affect millions of people in
Africa each year. From contaminated water sources to unsanitary
food handling practices, Africa is plagued by several factors that
contribute to the spread of foodborne illness. This textbook brings
to bare, specific challenges and complexities of foodborne
infections in Africa. We explore the causes and consequences of
these illnesses, as well as the strategies and interventions that are
being employed to combat them. Our goal is to provide, from a
microbiological perspective, a comprehensive and insightful outlook
on foodborne infections, which is one of Africa's most pressing
health issues.

The textbook mainly focuses on foodborne infections and
intoxications that commonly occur in Africa, including those caused
by Staphylococcus aureus, Listeria monocytogenes, Salmonella
species, Shigella species, Vibrio cholerae, Escherichia coli O157:H7,
Clostridium species, Human norovirus, Rotavirus, Hepatitis A virus,
Entamoeba histolytica, Giardia lamblia, and Cryptosporidium
parvum.

We believe this textbook will be a valuable resource for public health
professionals, researchers, and anyone interested in matters
regarding foodborne illnesses. It will provide an understanding of
the problem, the efforts being made to address it, and the current
progress. Overall, this textbook supports the ongoing efforts to
combat foodborne infections in Africa, for improved health and
wellness of its people.

Chapter 1:
Staphylococcus

aureus
Objectives

The objectives of the chapter are to provide background
information on Staphylococcus aureus (S. aureus), including its
virulence determinants and the infections it is implicated in. The
chapter also accentuates the public health concerns associated
with S. aureus, including antibiotic resistance and methicillin-

resistant S. aureus (MRSA) spread. Furthermore, it discusses the
pathogenesis of S. aureus in the context of staphylococcal food
poisoning (SFP) and sheds light on foods that can transmit the
bacterium. In addition, it provides a discourse on the laboratory
diagnosis, treatment, prevention, and control of staphylococcal

food poisoning, as well as snapshots of some cases of SFP on the
African continent. Finally, it summarizes key points discussed in

the chapter.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Background information on S.
aureus

The bacterium Staphylococcus aureus (S. aureus) is Gram-positive,
belonging to the genus Staphylococcus. It is spherical-shaped, often
occurring in irregular clusters, with a diameter of approximately 0.5
to 1.5 µm. Its colonies appear fairly large yellow or white on agar
media, and typically exhibit beta-hemolysis zones on blood agar
plates typically owing to hemolysin production. It is also a
facultative anaerobe, meaning it can grow whether or not oxygen is
present, although it prefers environments with low oxygen tension.
It is commonly found in the nasal passages of humans and is a part
of the normal skin and mucous membranes flora. Besides being a
commensal, S. aureus is able to cause several infections, including
skin infections, pneumonia, bloodstream infections, toxic shock
syndrome, and a foodborne infection known as staphylococcal food
poisoning [SFP].

The virulence of S. aureus is largely due to its production of a wide
range of virulence factors, such as toxins, enzymes, and cell-surface
components. Some of the most well-known virulence factors
produced by the pathogen include coagulase (which also aids in the
organism’s identification), the toxic shock syndrome toxin-1 (TSST-
1), the alpha-toxin, and Panton-Valentine leukocidin (PVL). In
addition to these, the bacterium is capable of producing several
types of food poisoning toxins, including enterotoxins and heat-
stable toxins; these make S. aureus a common cause of foodborne
illness and are responsible for the symptoms associated with SFP.
As a composite, though, these virulence factors contribute to the
ability of S. aureus to cause infections and evade the host's immune
response.

A major public health issue concerning S. aureus is its propensity
for developing antibiotic resistance. A case in point is methicillin-
resistant S. aureus (MRSA), a strain of S. aureus that is resistant
to many commonly used antibiotics, including beta-lactams. As is
the case with other S. aureus strains, the spread of MRSA
infections can occur directly via contact with persons who are
infected or indirectly via contact with contaminated objects or
surfaces, or through respiratory droplets in the air, particularly in
healthcare settings. On the whole, MRSA evolution and spread have
revolutionized the virulence of S. aureus, and especially complicated

the management of S. aureus infections, even those originating
from the consumption of contaminated food (staphylococcal food
poisoning).

Foods associated with S. aureus

A wide range of foods is capable of transmitting S. aureus and
potentially causing staphylococcal food poisoning (Figure 1.1).
Those more commonly associated with the pathogen include:

Meat products: Meats such as ham, poultry, beef, and
seafood can be contaminated with S. aureus if not handled
or cooked properly.

Dairy products: Foods like milk, cheese, and cream can also
harbor S. aureus if they are not kept at the right temperature
or if they are made from contaminated milk.

Salad items: Foods such as potato salad, pasta salad, and
coleslaw can be “breeding grounds” for S. aureus if they are
not stored at the appropriate temperature or if they are not
properly washed.

Sandwiches: Sandwiches made with deli meats, cheese, or
mayonnaise can also be associated with S. aureus food
poisoning.

Pastries: S. aureus can survive in high-sugar environments,
making baked goods like cakes, cookies, and pastries
susceptible to contamination.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Figure 1.1: Some potential sources of staphylococcal food
poisoning

Pathogenesis of staphylococcal
food poisoning

Staphylococcal food poisoning results from preformed enterotoxins
of S. aureus. To cause staphylococcal food poisoning, the food or
one of its components must be tainted by a staphylococcal
enterotoxin (SE)-producing S. aureus strain and exposed to
temperatures that support S. aureus growth, often due to
inadequate refrigeration or the need for a growth-permissive
temperature during processing, such as in cheese-making. S. aureus
synthesizes the enterotoxins in the course of the logarithmic growth
phase or as it transits to the stationary phase via the exponential
phase.

SEs, potent exotoxins that act on the gastrointestinal tract (even in
high nanogram to low microgram quantities), are categorized into
nine major serological types (A—J); they are recognized members

of the pyrogenic toxin superantigen family and cause
immunosuppression and non-specific T-cell proliferation. Generally,
the mechanisms via which SEs cause food poisoning remain unclear.
That notwithstanding, the prevailing belief is that SEs stimulate the
emetic center by directly affecting the intestinal epithelium and
vagus nerve, causing emesis. SEs have a high stability index and
are able to withstand proteolytic enzyme activity, drying, freezing,
heat, low pH, and other harsh environmental conditions that typically
kill S. aureus. Hence, they can remain active in the digestive tract
after ingestion.

SFP symptoms — abdominal cramps (sometimes accompanied by
diarrhoea), nausea, and vomiting — could occur within up to eight
hours of ingestion of the contaminated food. Generally, these
symptoms self-resolve within two days following their onset.
However, in severe cases, symptoms may also include fever,
headache, and muscle aches, and may even require hospitalization.

Diagnosis and management of
staphylococcal food poisoning

Diagnosis of staphylococcal food poisoning is based on the
characteristic symptoms and a history of ingesting contaminated
food. Laboratory tests may be performed to confirm the presence
of S. aureus in food samples or to detect the presence of SEs in
the stool or vomit of the affected individual.

Management of SFP is mainly supportive and includes rehydration
and correction of electrolyte imbalances resulting from vomiting and
diarrhoea. Antibiotics are not routinely used to treat SFP, as they
do not shorten the course of the illness and may increase the risk
of complications. In SFP caused by MRSA, however, prompt oral
vancomycin administration is warranted. In severe SFP cases,
hospitalization may be necessary for intravenous hydration and
electrolyte replacement.

In outbreaks of SFP, public health officials may investigate the
source of contamination and implement measures to prevent further
spread, including the recall of contaminated food products and the
closure of food establishments that fail to meet proper hygiene and
storage practices.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Prevention of staphylococcal food
poisoning

Prevention of SFP is crucial and relies on proper food handling and
storage practices. These include avoiding the contamination of food
with S. aureus, proper refrigeration, and heating food to adequate
temperatures to kill any S. aureus present. Good personal hygiene
and hand washing practices, and thorough washing of fruits and
vegetables, are also essential to prevent the spread of S. aureus.

Cases of S. aureus foodborne
disease outbreaks in Africa

Case 1: Zimbabwe (2014)
In August 2014, an outbreak of diarrhoea occurred among
employees who had attended a workshop held in Bulawayo City,
Zimbabwe, a day earlier. A retrospective cohort study was
conducted to investigate the outbreak, involving 74 council
employees. The study found the attack rate to be 71.6% overall,
with abdominal cramps and watery diarrhoea being the predominant
symptoms. Eating the stewed chicken served during the workshop
increased the odds of SFP occurrence, while drinking purified
bottled water reduced the odds. The investigations further revealed
that the hands and nails of the food handlers harboured S. aureus,
indicating a possible source of contamination during food handling
and preparation. The outbreak was thus attributed to food
poisoning caused by S. aureus toxins. The study recommended that
the food handlers are taken through basic microbial food safety
training.

Case 2: Ghana — 2015
In September 2014, a foodborne disease outbreak occurred in
Ghana’s Eastern Region, affecting patrons of a community eatery.
Investigations revealed that “waakye”, a local delicacy prepared
from beans and rice and eaten with “shitor”, a peppery sauce, were
the probable contaminated food items responsible for the outbreak.
Laboratory diagnostic capacity was weak, highlighting the need for

strengthening local response capacity. The study emphasizes the
importance of effective surveillance systems and laboratory capacity
in preventing and controlling foodborne disease outbreaks.

Case 3: South Africa — 2015
In May 2015, an outbreak of gastroenteritis occurred in Pretoria,
South Africa, affecting 51 individuals who had eaten food at a local
hotel. The Tshwane Outbreak-Response-Unit (ORU) conducted an
investigation to determine the cause of the outbreak and gathered
epidemiological data from three affected hospitals. Of the 50
individuals who could have been exposed, 37 were found to be
cases, displaying symptoms such as fever, cramping in the abdomen,
nausea, vomiting, and diarrhoea. The mean age of those impacted
by the outbreak, who were predominantly males, was 23 years. The
investigations further revealed that S. aureus enterotoxin A present
in the chicken component of the meal was responsible for the
outbreak; this was facilitated by poor hand hygiene on the part of
the food handlers.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Case 4: Zambia — 2015
A college in Lusaka, Zambia, recorded an outbreak of an
unidentified source in March 2017. An investigation was conducted
to confirm the outbreak, identify exposures, and implement
preventative measures. Thirty case-patients and seventy-one
controls were interviewed, and laboratory analyses were carried out
on swabs of kitchen surfaces and the hands of the food handlers,
as well as food samples. The findings suggested that the outbreak
was most likely brought on by tainted food served at College A's
supper on March 18. S. aureus and other bacteria were found on
the hands of all food handlers and in the food samples. The
predominant exposures were drinking water provided at the college,
eating beans at the dinner, and eating in the college cafeteria, and
these increased the odds of foodborne disease outbreak by 8.8,
21.6, and 5.8 times, respectively. To stop further outbreaks, the
investigators advised educating food handlers and instituting better
food handling and handwashing procedures.

Summary of the Chapter

In this chapter, we have provided information on the public health
significance of S. aureus via the lens of staphylococcal food
poisoning (SFP). Key takeaway points from the chapter are as
follows:

S. aureus is a major food pathogen and causes
staphylococcal food poisoning (SFP).

Its significance as a food pathogen has been enhanced by
several virulence factors, including staphylococcal
enterotoxins (which are capable of withstanding several
harsh environmental conditions), as well as its capacity for
antibiotic resistance, mainly, methicillin resistance.

A wide range of foods is capable of transmitting S. aureus
and potentially causing SFP, the major ones being meat
products, dairy products, salad items, sandwiches, and
pastries.

Once a SE-producing S. aureus strain is ingested, symptoms
(abdominal cramps, nausea, and vomiting) could occur within

eight days, and may usually self-resolve within two days or
occasionally become serious, requiring hospitalization.

Diagnosis of SFP is based on the characteristic symptoms
and a history of ingesting contaminated food, which may be
confirmed by laboratory testing of food, stool, or vomitus
samples.

SFP management is mainly supportive, but antimicrobial
chemotherapy involving vancomycin may be required in cases
involving MRSA, and its prevention relies on proper food
handling and storage practices.

End of chapter questions on S.
aureus

Multiple Choice Questions

1. Which toxin produced by Staphylococcus aureus is responsible for
causing foodborne illness?
A. Shiga toxin
B. Botulinum toxin
C. Enterotoxin
D. Cholera toxin

2. Which of these food items is most commonly associated with
Staphylococcus aureus foodborne infections?
A. Raw seafood
B. Cooked poultry
C. Unpasteurized milk
D. Deli meats and prepared salads

3. What is the typical incubation period for Staphylococcus aureus
foodborne infection?
A. 6-48 hours
B. 1-6 hours
C. 12-72 hours
D. 2-5 days

Introduction to Foodborne Infections and Intoxications: An African Perspective

4. Which of the following is NOT a common symptom of Staphylococcus
aureus foodborne infection?
A. Nausea
B. Diarrhoea
C. Fever
D. Vomiting

5. Which of the following preventive measures is most effective in
reducing the risk of Staphylococcus aureus foodborne infections?
A. Thoroughly cooking raw meat
B. Washing fruits and vegetables before consumption
C. Proper handwashing and sanitation in food handling
D. Storing food at temperatures below 40°F (4°C)

Essay Type Question:
Discuss the various factors contributing to the growth and toxin
production of Staphylococcus aureus in food and explain the
measures that can be taken to prevent foodborne illnesses caused by
this bacterium.

……………………………………………………………………………………………
…………..………

……………………………………………………………………………………………
………..……...…

……………………………………………………………………………………………
………………….

……………………………………………………………………………………………
…………..………

……………………………………………………………………………………………
………………….

……………………………………………………………………………………………
………….………

References

Ameme DK, Abdulai M, Adjei EY, Afari EA, Nyarko KM, Asante D,
Kye-Duodu G, Abbas M, Sackey S, & Wurapa F. Foodborne
disease outbreak in a resource-limited setting: a tale of missed
opportunities and implications for response. PAMJ. 2018; 29,
100. doi: 10.11604/pamj.2018.29.100.14737

Bencardino D, Amagliani G, Brandi G. Carriage of Staphylococcus
aureus among food handlers: An ongoing challenge in public
health. Food Control. 2021 Dec 1;130:108362.

Grispoldi L, Karama M, Armani A, Hadjicharalambous C, Cenci-Goga
BT. Staphylococcus aureus enterotoxin in food of animal origin
and staphylococcal food poisoning risk assessment from farm
to table. Ital J Anim Sci. 2021; Jan 1;20(1):677-90.

Gumbo A, Bangure D, Gombe NT, Mungati M, Tshimanga M,
Hwalima Z, Dube I. Staphylococcus aureus food poisoning
among Bulawayo City Council employees, Zimbabwe, 2014. BMC
Res Notes. 2015; Sep 28;8:485. doi: 10.1186/s13104-015-
1490-4.

Kapaya, F., Mwansa, F.D., Sakubita, P., Gama, A., Langa, N., Chewe,
O., Mutale, L., Nanzaluka, F., Gershom, C., Chola, M., Kapata,
N., Sinyange, N., Chibuye, S., & Yard, E. A foodborne disease
outbreak investigation experience in a College in Lusaka,
Zambia, 2017. PAMJ. 2018; 30, 36. doi:
10.11604/pamj.2018.30.36.14387

Ntshiqa T, Mpangane H, Mpambane D, Moshime M.. Staphylococcal
foodborne illness outbreak, Tshwane District, Gauteng Province
— South Africa, June 2015 [Poster presentation]. Int J Infect
Dis. 2016; 45(Suppl. 1), 235.
https://doi.org/10.1016/j.ijid.2016.02.528.

Taylor TA, Unakal CG. Staphylococcus aureus. InStatPearls
[Internet] 2022 Jul 18. StatPearls Publishing.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Chapter 2:
Listeria

monocytogenes
Objectives

The objectives of the chapter are to provide
background information on Listeria, including details
about its different species and their importance in
food safety. The chapter also discusses the impact
of Listeria monocytogenes (L. monocytogenes) on

human health, including the symptoms and
consequences of listeriosis. Moreover, it explores

the factors that contribute to Listeria contamination
in food products and describes prevention and

control measures against the spread of the
bacterium. It additionally highlights the importance of

education and awareness for reducing the risk of
Listeria infections and protecting public health.

Moreover, it summarizes key takeaways from the
chapter and emphasizes the need for continued
efforts in preventing and controlling Listeria

contamination.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Background information on Listeria
monocytogenes

Listeria monocytogenes is the most well-known and medically
significant bacterium of the Listeria genus, which also hosts species
such as Listeria newyorkensis, Listeria booriae, Listeria
grandensis, Listeria riparia, Listeria cornellensis, Listeria aquatica,
Listeria floridensis, Listeria fleischmannii, Listeria
weihenstephanensis, Listeria rocourtiae, Listeria marthii, Listeria
grayi, Listeria welshimeri, Listeria innocua, Listeria seeligeri, and
Listeria ivanovii. It is a foodborne pathogen that can cause a severe
and sometimes life-threatening infection known as listeriosis in
humans. It is widely distributed in the environment and can be found
in soil, water, and a variety of animal and plant products, including
ready-to-eat foods, raw meats, dairy products, and smoked salmon.

L. monocytogenes is rod-shaped, Gram-positive, and facultatively
intracellular. It is also oxidase-negative, catalase-positive, and
facultatively anaerobic. Even though it is able to survive at 0 to 45
°C temperatures, it grows best at 30—37 °C. It can adhere to a
variety of surfaces, withstand disinfectants and other harsh
environmental conditions, and even proliferate at refrigerated
temperatures. It is motile at 20—25°C, but not at 37 °C, as it
produces flagella at room temperature.

Based on somatic (O) and flagellar (H) antigens, at least, 13
serotypes of L. monocytogenes have been identified, including
1/2a, 1/2b, 1/2c, 3a, 3b, 3c, 4a, 4ab, 4b, 4c, 4d, 4e, and 7.
Multiplex PCR targeting four marker genes has, however,
heterogeneously placed the majority of these under four distinct
serogroups — IIa (which comprises the 1/2a, 1/2c, 3a, and 3c
serovars), IIb (which comprises the 1/2b, 3b, 4b,4d, and 4e
serovars), IIc (which comprises the 1/2c and 3c serovars), and the
IVb (which comprises the 4b, 4d, and 4e serovars). The 1/2a, 1/2b,
1/2c, and 4b serotypes commonly contaminate food or food
processing plants; owing to their biofilm-forming capacity, they can
remain viable under adverse conditions for extended periods in
these plants, and cause listeriosis following their ingestion in food.

Listeriosis is particularly concerning because it has a higher
mortality rate compared to other foodborne illnesses, and can also

result in severe complications such as stillbirths, miscarriage, and
neonatal infections in pregnant women. The elderly, infants, and
individuals in immunocompromised states (such as cancer patients)
are at a higher risk of developing severe symptoms and
complications from a Listeria infection. Thus, such individuals need
to be wary not only of food potentially contaminated with Listeria
but also of other routes of exposure to listeriosis, including
inhalation or direct contact with infected animals or animal products.

Foods associated with L.
monocytogenes

Some of the foods that are commonly associated with Listeria
contamination (Figure 2.1) include:

Ready-to-eat foods, such as Deli meats, hot dogs, and smoked
salmon

Dairy products, such as raw milk, soft cheese, ice cream, and
cottage cheese

Raw meat products, including poultry, beef, and pork
Produce items, such as leafy greens and sprouts, through
exposure to contaminated water or soil.

Processed foods, such as pre-packaged salads, fruits, and
frozen foods

It is important to note that while these foods are commonly
associated with Listeria contamination, any food product can
become contaminated with the bacterium if proper safety measures
are not followed. Consumers can reduce their risk of Listeria
infection by properly storing and handling food, especially ready-to-
eat products, and thoroughly cooking raw animal products.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Figure 2.1: Potential vehicles for listeriosis transmission

Pathogenesis of L. monocytogenes
foodborne infections

The pathogenesis of Listeria infections involves several stages,
including the ingestion of contaminated food, the colonization of
the intestinal tract, and the spread of the bacterium to other parts
of the body.

Ingestion of contaminated food: The ingestion of
contaminated food products is the most common route of
exposure for listeria infections. L. monocytogenes can persist

and grow in a variety of environments, including refrigerated
temperatures, making it a significant concern in food safety.

Colonization of the intestinal tract: Once the bacterium is
ingested, it is able to colonize the intestinal tract and
penetrate the gut wall, allowing it to spread to other parts of
the body. This stage of the infection is facilitated by the ability
of Listeria to produce virulence factors, such as internalins,
that enable it to evade the host's immune response.

Spread to other parts of the body: Once Listeria has
colonized the intestinal tract, it can spread to other parts of
the body, including the bloodstream, the central nervous
system, and the placenta in pregnant women. The bacterium is
able to spread through the bloodstream due to its ability to
resist phagocytosis or the engulfment and destruction of
pathogens by white blood cells.

Invasion of host cells: Listeria can invade host cells and
replicate within these cells, leading to the formation of
intracellular infections. This stage of the infection is facilitated
by the bacterium's ability to produce actin polymerization-
promoting factors, which enable it to spread within host cells.

The severity of Listeria infections varies depending on the
individual's immune status and the amount of bacterium ingested. In
healthy individuals, listeriosis may result in mild symptoms such as
fever, headache, and gastrointestinal symptoms. However, in
individuals with weakened immune systems, the infection can lead
to severe symptoms and complications, including meningitis, sepsis,
and brain and spinal cord infections.

In pregnant women, Listeria infections can lead to stillbirths,
miscarriages, and neonatal infections. Importantly, individuals need
to take steps to reduce their risk of listeria infection, such as
thoroughly cooking raw animal products and properly storing and
handling food, especially ready-to-eat products.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Diagnosis and management of
Listeria foodborne infections

Listeria foodborne infections can be diagnosed through laboratory
testing of a patient's blood or other bodily fluids, such as
cerebrospinal fluid or placental tissue in pregnant women. To
diagnose listeriosis, a healthcare provider will collect a sample of
the patient's bodily fluids and send it to a laboratory for testing.

Laboratory testing: The laboratory will test the sample for
the presence of Listeria monocytogenes and identify the
strain of the bacterium. This information is used to
determine the appropriate course of treatment and to track
outbreaks of listeriosis.

Antibiotic treatment: Listeria foodborne infections are
treated with antibiotics, such as ampicillin, penicillin, or
erythromycin. The choice of antibiotic depends on the
severity of the infection and the patient's immune status.
Antibiotic treatment is typically administered for a minimum
of two weeks and may be extended depending on the
severity of the infection.

• Supportive care: In addition to antibiotic treatment,

patients with listeriosis may require supportive care, such
as hospitalization, to manage symptoms and prevent
complications. This may include fluid and electrolyte
replacement, as well as measures to prevent secondary
infections, such as prophylactic antibiotics.

Prevention of Listeria foodborne
infections

Listeria foodborne infections can be prevented by following good
food safety practices and taking precautions, especially for
individuals who are at higher risk for infection, such as pregnant
women and individuals with weakened immune systems. The
following are some steps that can help decrease the risk of Listeria
infection:

Thoroughly cooking raw animal products: Raw animal
products, such as meat, poultry, and seafood, should be
thoroughly cooked to kill any bacteria that may be present. This
includes fully cooking steaks and roasts to an internal
temperature of 145 °F (63 °C) and fully cooking poultry to an
internal temperature of 165 °F (74 °C).

Proper storage and handling of food: Food should be stored
at the appropriate temperature to prevent the growth of
bacteria, such as Listeria monocytogenes. Raw animal products
should be stored separately from ready-to-eat foods to prevent
cross-contamination. Food should also be handled properly,
including washing hands before and after handling food, to
prevent the spread of bacteria.

Avoiding high-risk ready-to-eat foods: Certain ready-to-eat
foods, such as deli meats, soft cheeses, and smoked seafood,
have been associated with outbreaks of listeria and should be
avoided, especially by pregnant women and individuals with
weakened immune systems.

Properly cleaning and sanitizing kitchen surfaces: Kitchen

surfaces, such as cutting boards and countertops, should be
properly cleaned and sanitized to prevent the spread of
bacteria.

Monitoring food recalls: It is important to stay informed about
food recalls and to properly dispose of any food products that
have been recalled due to potential contamination with Listeria
monocytogenes.

Introduction to Foodborne Infections and Intoxications: An African Perspective

Cases of Listeria foodborne
outbreaks in Africa

Case 1: South Africa — 2017 to 2018
Between January 2017 and January 2018, South Africa recorded the
biggest outbreak of listeriosis that affected over 1000 people and
resulted in over 200 deaths. In the public and private healthcare
sectors, samples of cerebral spinal fluid (CSF) (23%) and blood
(71%) were taken; 34% of diagnoses came from the private
healthcare sector and 66% from the public healthcare system. The
highest number of cases increased across Kwa Zulu-Natal (7%),
Western Cape (13%), and Gauteng Province (59%). The majority
(96%) of the patients were neonates (and the affected ages ranged
from birth to 93 years) and of the female gender (55%). The source
was traced to processed meat products, which were found to be
contaminated with a highly virulent strain of Listeria
monocytogenes — Sequence Type 6. The outbreak led to
widespread panic, with many South Africans avoiding processed
meat products, and this caused significant economic losses for the
food industry.

Case 2: Nigeria
Generally, surveillance systems for, and documented reports on,
listeriosis are scanty in Nigeria, as is the case with most African
countries. Insights on listeriosis outbreaks in the country have been
limited to a few reports on isolation of L. monocytogenes from
food (mainly fish), the environment (mainly soil and water), animals
(mainly ruminants), and people (mainly neonates and expectant
mothers).

Summary of the chapter

In this chapter, we have discussed the objectives, background
information, foods associated with Listeria, the pathogenesis of
Listeria foodborne infections, diagnosis and management of Listeria
foodborne infections, and prevention of Listeria foodborne
infections. We have also provided Cases of listeria foodborne
outbreaks in Africa to highlight the importance of food safety and
the ongoing efforts to prevent the spread of the bacterium.

Listeria is a foodborne pathogen that can cause serious
infections, especially in individuals with weakened immune
systems, such as pregnant women. It can be found in a variety
of foods, including raw animal products, ready-to-eat foods,
and dairy products. Listeria foodborne infections can be
diagnosed through laboratory testing and treated with
antibiotics.

To prevent Listeria foodborne infections, it is important to
follow good food safety practices, such as thoroughly cooking
raw animal products, properly storing and handling food,
avoiding high-risk ready-to-eat foods, properly cleaning and
sanitizing kitchen surfaces, and monitoring food recalls.

In conclusion, Listeria foodborne infections are a serious
public health concern that requires ongoing efforts to prevent
the spread of the bacterium and protect public health. This
includes implementing and enforcing food safety regulations,
promoting food safety awareness, and investing in the
development of safe and nutritious food products.

Introduction to Foodborne Infections and Intoxications: An African Perspective

End of chapter questions on Listeria
/ listeriosis

1. Which of the following is NOT a common symptom of Listeria
foodborne infections?
A. Diarrhoea
B. Fever
C. Muscle aches
D. Confusion
E. Nausea

2. Which group of individuals is most susceptible to severe listeria
foodborne infections?
A. Healthy adults
B. Children
C. Older adults
D. Pregnant women
E. Athletes

3. Which of the following is NOT a way to prevent listeria foodborne
infections?

A. Thoroughly cooking raw animal products
B. Properly storing and handling food
C. Eating raw animal products
D. Properly cleaning and sanitizing kitchen surfaces
E. Monitoring food recalls

4. Which of the following is NOT a common food source of Listeria
monocytogenes? A. Raw animal products

B. Ready-to-eat foods
C. Fresh fruits and vegetables
D. Dairy products
E. Seafood

5. Which of the following is the most effective way to diagnose listeria
foodborne infections?

A. Blood test
B. Stool test
C. Urine test
D. Throat swab
E. Food sample testing

References

Centers for Disease Control and Prevention. Listeria (Listeriosis).
Retrieved from https://www.cdc.gov/listeria/index.html.
Accessed on February 19, 2023.

European Food Safety Authority. (2020, August 18). Listeria.

Retrieved from
https://www.efsa.europa.eu/en/topics/topic/listeria

European Centre for Disease Prevention and Control. (2021,

September 7). Listeriosis. Retrieved from
https://ecdc.europa.eu/en/listeriosis

Kaptchouang Tchatchouang C-D, Fri J, De Santi M, Brandi G,

Schiavano GF, Amagliani G, Ateba CN. Listeriosis outbreak in
South Africa: A comparative analysis with previously reported
cases worldwide. Microorganisms. 2020; 8(1):135.
https://doi.org/10.3390/microorganisms8010135.

Nwaiwu O. An overview of Listeria species in Nigeria. Int. Food

Res. J. 2015; 22, 2.

NICD. National Institute of Communicable Diseases. Situation

Report on Listeriosis Outbreak; National Health Laboratory
Service (NHLS): Pretoria, South Africa,
2018. https://www.nhls.ac.za/situation-report-on-listeriosis-
outbreak-south-africa-2017/

Introduction to Foodborne Infections and Intoxications: An African Perspective

Chapter 3:
Salmonella

Objectives

The objectives of the chapter are to provide

background information on Salmonella species,
including its virulence determinants and the
infections it is implicated. The chapter also

accentuates the public health concerns associated
with salmonellosis. Furthermore, the chapter

discusses the pathogenesis of salmonellosis and
sheds light on foods that can transmit the

bacterium. In addition, it provides a discourse on
the laboratory diagnosis, treatment, prevention,

and control of salmonellosis, as well as a
summary of some cases of salmonellosis on the

African continent.

KINDLY CONTACT THE
AUTHOR FOR A FULL

COPY OF THIS E-
BOOK

THE AUTHOR’S
DETAILS ARE

LOCATED AT THE
COPYRIGHT PAGE

Foodborne infections and intoxications pose a significant global health threat,
especially in Africa and other low-income regions. This textbook, "An
Introduction to Foodborne Infections and Intoxications: An African Perspective,"
sheds light on the complex dynamics of food safety in Africa. It is the result of
extensive research, collaboration, and practical experience gathered from
experts in various fields.

The goal of this textbook is to explore the intricate web of factors that
influence foodborne infections in Africa. It delves into specific aspects of food
safety, providing insights into the unique challenges and opportunities that
Africa presents. By integrating disciplines such as microbiology, epidemiology,
veterinary medicine, public health, and food science, the textbook advocates for
a multidisciplinary approach to develop effective preventive measures,
surveillance systems, and interventions.

We recognize that the book is one step towards addressing the complex issue of
foodborne infections in Africa. We hope it reinforces interest for further
research, stimulates discussions, and provide a foundation for policy
development and implementation.

Eric Sampane-Donkor is a Fellow of the Royal College of Pathologists, UK, Fellow of the Institute
of Biomedical Science, UK, a Fellow of the Ghana Academy of Arts and Sciences, and a Professor
of Bacteriology and Global Health at the Department of Medical Microbiology, University of Ghana
Medical School.

Fleischer C. N. Kotey is an infectious diseases researcher at the Department of Medical
Microbiology, University of Ghana Medical School, and a member of the American Society for
Microbiology.

Samuel Darkwah is an infectious diseases researcher at the Department of Medical Microbiology,
University of Ghana Medical School.

Irene Amoakoh Owusu is a Research Fellow at the West African Center for Cell Biology of
Infectious Pathogens (WACCBIP), University of Ghana, and a Visiting Scholar at the Microbiology
and Immunology Department, University of Michigan.

Patience B. Tetteh-Quarcoo is an Associate Professor and Molecular Immuno-Microbiologist at the
Department of Medical Microbiology, University of Ghana Medical School.

Nicholas T. K. D. Dayie is an Associate Professor and Medical Molecular Bacteriologist at the
Department of Medical Microbiology, University of Ghana Medical School.