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A few autumns back, an Ohio woman strolling through an apple orchard spotted
a tasty looking red delicious lying on the ground under a tree. The apple was
without bruise or blemish. She picked it up, polished it on her sleeve, and took
a bite. The apple was crisp, sweet and juicy. And deadly. Six hours later, the
woman was in the emergency room, having, as she describes it, "The worst
night of my life."
Doctors suspected that she may have picked up an ecoli bacteria from
orchard soil that had been fertilized with cattle manure. The symptoms of ecoli infection include abdominal cramps as bad as labor pains, bloody diarrhea, and
vomiting, all of which can last as long as 3 to 9 days. Only a few cells of ecoli
in the bloodstream can cause fatal symptoms.
It is estimated that 325,000 people are hospitalized for food-borne illnesses
annually, and that almost 5,000 people die from food borne illnesses every year.
It can happen almost everywhere: at the fanciest restaurants, the
neighborhood pushcart, at a church picnic or in your own kitchen. According to
Joel Richter, M.D., chairman of the Cleveland Clinic’s Department of
Gastroenterology, more than 250 different diseases have been identified that can
be caused by contaminated food or drink. The most common diseases are infections
caused by bacteria, such as Salmonella and Campylobacter. The majority of food
items that cause food borne diseases are raw or undercooked foods from animal
sources, such as meat, milk, eggs, cheese, fish or shellfish. Here’s a brief
overview of the more common food borne diseases.
Campylobacter
Campylobacter has been recognized as the leading cause of chronic diarrhea in
the United States, and is found predominantly in industrialized countries. Most
frequently cattle and poultry are the sources of human infection, but puppies,
kittens, pigs, sheep, rodents, and birds may also serve as carriers.
Transmission usually occurs through ingestion of contaminated food, water or
un-pasteurized milk, or through contact with infected infants, pets or wild
animals.
Symptoms
Campylobacter is characterized by diarrhea (sometimes bloody), nausea,
vomiting, malaise (general uneasiness) and fever. The illness typically lasts
one week. While some Campylobacter infections do not have symptoms, others may
result in arthritis and rarely, meningitis or convulsions with fever.
Treatment
Generally, most people will recover completely within 2 to 5 days and no
treatment is needed. You should drink plenty of fluids to counter the
dehydration from diarrhea. In more severe cases, antibiotics such as
erythromycin or fluoroquinone can be used, and can shorten the length of time
you are sick if they are given early in the illness. Anti-diarrhea medications,
such as loperamide (Imodium), should also be avoided.
Salmonella
Salmonella is an invasive organism that can escape from the intestine and be
carried in the blood to other organs. It can become a chronic infection in some
people, who can be symptom-free yet capable of spreading the disease to others.
Ordinarily, deaths are uncommon except in those who are very young, elderly, or
have weakened immune systems.
Salmonellosis (the disorder caused by Salmonella) may occur in small,
localized outbreaks in the general population or in large outbreaks in
hospitals, restaurants or institutions for children or the elderly.
Salmonellosis is caused most often by drinking un-pasteurized milk or by eating
undercooked poultry and poultry products such as eggs. Any food prepared on
surfaces contaminated by raw chicken or turkey can become contaminated. Less
often, the illness may stem from food contaminated by a food worker.
Symptoms
The disease causes acute intestinal distress with sudden onset of headache,
fever, abdominal pain, diarrhea, nausea and sometimes vomiting. These symptoms,
along with loss of appetite, can persist for several days. Dehydration,
especially in infants, can be severe.
Treatment
Salmonella infections usually go away in 5 to 7 days and often do not
require treatment unless the patient becomes severely dehydrated or the
infection spreads outside of the intestines. People with severe diarrhea may
require re-hydration, often with intravenous fluids. Antibiotics are not usually
necessary unless the infection spreads through the bloodstream into other
organs, and then it can be treated with ampicillin, gentamicin,amethoxazole, or
ciprofloxacin. Unfortunately, some Salmonella bacteria have become resistant to
antibiotics, largely as a result of using antibiotics to promote the growth of
feed animals.
Enterohemorrhagic Escherichia coli infection (Ecoli)
Ecoli is an emerging cause of foodborne illness. An estimated 10,000 to
20,000 cases of Ecoli infection occur in the United States each year. Most ecoli infections have been associated with eating undercooked, contaminated
ground beef. The organism that causes ecoli can be found on a small number of
cattle farms and can live in the intestines of healthy cattle. Meat can become
contaminated during slaughter, and ecoli organisms can be thoroughly mixed
into beef when it is ground. Bacteria present on the cow's udders or on
equipment may get into raw milk. Eating meat, especially ground beef, that has
not been cooked sufficiently to kill ecoli can cause infection. Contaminated
meat looks and smells normal.
Drinking un-pasteurized milk and swimming in or drinking sewage-contaminated
water can also cause infection. Bacteria from stools of infected people can be
passed from one person to another if hygiene or hand-washing habits are
inadequate. This is particularly likely among toddlers who are not toilet
trained. Family members and playmates of these children are at high risk of
becoming infected. Young children typically shed the organism in their feces for
a week or two after their illness resolves.
Symptoms
The ecoli infection causes severe bloody diarrhea and abdominal cramps;
sometimes the infection causes non-bloody diarrhea, a slight fever or no
symptoms at all.
In some people, particularly children under age five and the elderly, the
infection can cause a complication called hemolytic uremic syndrome, in which
the red blood cells are destroyed and the kidneys fail. About 2 to 7 percent of
infections lead to this complication.
Treatment
Most people recover without antibiotics or other specific treatment in 5 to
10 days. There is no evidence that antibiotics improve the course of disease, or
that treatment with some antibiotics may intensify kidney complications. Anti-diarrheal medications, such as loperamide (Imodium), should also be avoided.
General guidelines for preventing food borne illnesses
Make sure that food from animal sources (meat, dairy, eggs) is cooked
thoroughly or pasteurized. Avoid eating these foods raw or undercooked. Check
expiration dates on meats before purchasing and again before preparing.
- Carefully select and prepare fish and shellfish to ensure quality and
freshness.
- If you are served an undercooked meat or egg product in a restaurant, send it
back for further cooking. You should also ask for a new plate.
- Be careful to keep juices or drippings from raw meat, poultry, shellfish or
eggs, from contaminating other foods.
- Do not leave foods, such as eggs, meats, poultry, seafood, or milk, for
extended periods of time at temperatures that permit bacteria to grow. Promptly
refrigerate leftovers and food prepared in advance.
- Wash your hands, cutting boards and knives with antibacterial soap and warm
to hot water after handling raw meat, poultry, seafood, or eggs. Do not use
wooden cutting boards because even when thoroughly cleaned they provide an
environment where bacteria can grow.
- Avoid raw (un-pasteurized) milk or foods made from raw milk.
- Do not thaw foods at room temperature. Thaw foods in the refrigerator and use
them promptly. Do not refreeze foods once they have been completely thawed.
- Wash raw vegetables and fruits thoroughly before eating, especially those
that will not be cooked. Children under five years of age, people with weakened
immune systems, and the elderly should avoid eating alfalfa sprouts until their
safety can be assured. Methods to decontaminate alfalfa seeds and sprouts are
being investigated.
- Drink only pasteurized juice or cider. Commercial juice with an extended
shelf life that is sold at room temperature (juice in cardboard boxes, vacuum
sealed juice in glass containers) has been pasteurized, although this is
generally not indicated on the label. Juice concentrates are also heated
sufficiently to kill pathogens.
- Be aware of proper home-canning procedures. Instructions on safe home canning
can be obtained from county extension services or from the U.S. Department of
Agriculture (www.foodsafety.org/canhome.htm or www.usda.gov)
- If you are ill with diarrhea or vomiting do not prepare food for others,
especially infants, the elderly, and those with weakened immune systems.
- Wash hands with soap after handling reptiles, birds or after contact with pet
feces.
- Mother's milk is the safest food for young infants. Breastfeeding prevents
many food borne illnesses and other health problems.
- Those at high risk, such as pregnant women and people with weakened immune
systems, infants, the elderly should also include the following:
- Avoid soft cheeses such as feta, Brie, Camembert, blue-veined, and
Mexican-style cheese. (Hard cheeses, processed cheeses, cream cheese, cottage
cheese, or yogurt are safe.)
- Cook foods until they are steaming hot, especially leftover foods or
ready-to-eat foods, such as hot dogs, before eating.
- Although the risk of food borne disease associated with foods from deli
counters is relatively low, pregnant women and people with weakened immune
systems may choose to avoid these foods or thoroughly reheat cold cuts before
eating.
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