Not all pathogens are created equal. There are dangerous strains that cause severe illness.
Today’s news headlines often include stories of food poisoning attributed to a variety of viruses, bacteria or parasites.
Whether the outbreak takes place on a cruise ship, within a local community, a healthcare facility, or at a family reunion, there is a short list of pathogens that medical professionals consider when narrowing down the type of outbreak that may be occurring.
Knowledge is the first step to protecting both yourself and your loved ones.
Much of modern foodborne microbiology is devoted to keeping pathogenic bacteria out of food products and preventing their growth if they are present. Salmonella, E. coli O157:H7, Listeria, and Shigella are well known species of foodborne bacteria.
Viruses are thought to be the leading cause of foodborne illness in the United States based on the percentage of people ill, even though there are only a few viruses that are important foodborne pathogens.
There are about 20 different species of parasites that are known to cause illness in humans from contaminated food or water.
I was out of the woods. They knew I would live but it was yet to be determined what effect coding 3 times was going to have on me.
Would I cognitively be okay? After being on a ventilator for 4 weeks, my body had lost muscle and I could barely move. Would all the physical and occupational therapy I needed actually work? Would I ever regain normal muscle function? Over the next weeks, I slowly gained back some muscle function. At first, I couldn’t even hold a pen to write, or move my own legs. Slowly, the therapists worked on getting me to sit on the side of the bed, sitting on a chair, and then standing with a walker, to very SLOWLY taking steps with a walker.
One day, I walked about 30 steps down the hallway with the walker. All the nurses and doctors stopped what they were doing to watch, then they cried and cheered for me! Over the many weeks of my hospitalization the caring staff became like family, to my family and friends, and were just as happy to see my progress.
I still had the trach tube when I was taken off sedation drugs. I couldn’t talk, at all!
... Every person who hears my story says they were totally unaware that E. coli could do this to a person. Whenever I hear a story on the news about an outbreak with E. coli, I get a little angry that this issue even exists!
I remember sitting on the kitchen floor petting my dog when my mom played back the voicemail from the night before ... It was actually the on call doctor at the lab my blood was sent to urging us to get to the emergency room as my blood levels had dropped to an alarming 16 (normal levels are between 35-42).
More tests were done and it was found that my hematocrit levels had dropped even further to 14, and my kidney levels were more than three times the normal limit. My kidneys had gone into acute renal failure, I was profoundly anemic and my red blood cells were fragmenting. The only thing the doctors were waiting on was an open bed.
When I was brought up to the ICU, a swarm of doctors greeted me, bombarding me with question after question. My parents were nowhere in sight and, despite being 18, I began to cry. I didn’t know the answers to these questions- I was in too much pain leading up to this point. I just wanted my mom.
My ICU nurse, lord bless her, was an angel. She got my mom into the room and, when they had to put a catheter central line in my neck, she held my hand and told me stories of when she broke her arm. There was no one allowed in the room but the nurse and attending when this was being done ... I can still remember the feeling of warm blood trickling down my neck. I wasn’t able to wash my hair until two days later. And even then, my mom had to help me.
My blood count was so low that I had to get 2 plasma transfusions and 5 blood transfusions ... During my next plasmapheresis they gave me the medication prior to the start. I don’t remember much of this stay as I was heavily drugged. I am thankful for that because the parts I do remember I was in pain.
My parents ... were extremely calm during the time I was sick and looking back, I am very thankful they stayed strong. They never broke down in front of me and always acted like everything was ok. I never even realized how serious my condition was until about a year after it had all happened. I was 18 years old, I didn’t understand that I could have very easily died.
My diagnosis was Hemolytic Uremic Syndrome (HUS) but doctors were extremely puzzled as my stool cultures had come back negative. NYS went back to my original culture from my first ER visit and had it tested for Shiga-toxin and was somehow able to work their way back to a positive result of E. coli O145.
I was ... a young adult in good health. HUS usually affects children under 5 and the elderly. There were 33 cases total from my outbreak ... All from eating contaminated lettuce.
The most dangerous strains can damage the linings of
your intestines and kidneys.
E. coli (Escherichia coli) are a very large and varied group of bacteria found in the environment, foods, and intestines of people and animals. Most of the 700 strains of E. coli are harmless, but some strains can cause diarrhea, urinary tract infections, pneumonia, and other illnesses.
The most dangerous strains can damage the linings of your intestines and kidneys.
These dangerous types of E.coli come in contact with fruits and vegetables when fecally-contaminated water is used for irrigation, for example when a water source is polluted by cattle runoff.
E. coli infection can also be transmitted from one infected person to another as can occur in daycare centers or nursing homes. Animals can infect humans directly in settings like petting zoos.
These disease causing strains of E. coli produce powerful toxins (Shiga toxins) that can cause life threatening disease. They are called “Shiga toxin producing E.coli” (STEC), or sometimes “Vero toxigenic
E.coli” (VTEC). A common strain implicated in E. coli poisonings is O157:H7, however other STEC strains are emerging and cause even more infections than E.coli O157:H7.
Shiga toxins are among the most potent biological poisons known, categorized by the Department of Homeland Security as a possible bioterrorism agent.
Somehow I managed to drive myself to the ER. The doctors hooked me up to an IV, told me I probably just had food poisoning and that I was dehydrated–no big deal.
They never even checked my stool for what was making me sick. I was given a prescription for pain medication, an antibiotic (which I later found you’re not supposed to take if you have E. coli) and was sent home.
As I walked through the hallway over to the hospital pharmacy, I felt weak and dizzy. While waiting for my prescriptions, I was amazed that I had to go to the bathroom (again!). As I opened the door to leave the bathroom, I had a rush come over me and I blacked out.
I was taken back to the ER and admitted to the hospital for observation. After many tests were performed and several days had passed, I was diagnosed with E. coli O157:H7. By this time the E. coli had begun to take its toll on my organs at a rapid pace. My red blood cells and platelets were dropping quickly.
The pain was excruciating. My mind was out of it. My kidneys were failing.
There are 265,000 E.coli infections each year in the United States. This is only an estimate because many cases do not seek medical care, are never diagnosed or reported, and many labs have yet to test for STEC strains other than E.coli O157:H7.
The most vulnerable are young children, seniors, and those with weakened immune systems. However, people of all ages and health status can be severely affected.
In the United States, HUS is the principal cause of acute kidney failure in children, and most cases of HUS are caused by the strain of STEC, E. coli O157:H7. About 5-10 % of STEC infections lead to HUS.
Other foodborne pathogens such as Shigella dysenteriae and Salmonella Typhi can also cause HUS.
Many cases of HUS never have a stool culture that proves which pathogen caused illness. Often by the time a patient presents with HUS, the pathogen itself can no longer be easily isolated from a stool specimen. For any patient with HUS without a culture-confirmed STEC infection, stool can be sent to a public health laboratory or to the CDC which can use specialized techniques that can increase the sensitivity of the culture. Also, blood samples can be sent through a state public health laboratory to CDC for tests that can reveal antibodies to STEC.
Antibiotics and anti-diarrheal medicines may increase the risk of HUS. The research shows that antibiotics actually increase the production of toxins that lead to more serious disease.
My daughter died from E. coli O157:H7 after being misdiagnosed for five days in three different hospitals.
Many doctors and hospitals failed to diagnose the E. coli, all believing another hospital or doctor had already performed the simple test.
My concerns about the possibility of tainted meat went ignored although Brooke exhibited all the classic symptoms.
Each hospital released her, claiming I was overreacting. My little girl’s life ended, and the music stopped forever.
One of the most common forms of food poisoning found in the United States.
According to the CDC, each year approximately 1.35 million Salmonella illnesses occur, 26,500 people are hospitalized, and 420 people die.
There are many types of Salmonella, including more than 2,500 strains. Nearly 100 of these strains cause infections in humans; and increasingly some of these types are resistant to antibiotics, an increasing public health danger which makes treatment for severe infections more difficult.
Those most vulnerable to Salmonellosis, (Salmonella infection) are children under 5 years old, adults over 65, those with a weakened immune system such as HIV and chemotherapy patients, and those on certain medications to reduce stomach acid.
Diagnosis is obtained by a stool test or blood test. Usually symptoms develop from 6 hours to one week after exposure, but some people can develop symptoms as long as several weeks after infection.
Life threatening complications can occur in those cases when disease spreads outside the intestines. If Salmonella infection enters the bloodstream (Bacteremia) it can infect other tissues throughout the body, including:
Severe Salmonella illness can lead to Reactive Arthritis, sometimes known as Reiter’s Syndrome, which is a painful inflammation in knees and joints that can last for years. Other consequences of Reactive Arthritis are eye irritation and blurred vision, as well as changes to the urogenital tract such as inflammation or pain during urination. Reactive Arthritis is difficult to treat and patients can suffer for years.
For some patients Irritable Bowel Syndrome and Ulcerative Colitis become long-term problems. Between 5% and 30% of salmonellosis patients develop chronic gastrointestinal symptoms after acute infection with Salmonella.
" I remember the agonizing pain my son was in and the fear of the unknown. It was a frightening experience which lasted many months.
It is difficult to diagnose foodborne illness and most illnesses go undiagnosed as who really wants to give a stool sample?!
The time spent in the hospital, with Christopher not getting any better despite treatment, was terrifying. Once finally diagnosed the big question which lasted for way too long was,‘what could have poisoned my son, but didn’t poison me?’
Very scary to think something could be lurking in my home which seriously sickened my child. When the culprit was finally determined, I was outraged that a product like peanut butter crackers, which is in the home of millions, could have poisoned my son.”
Most Salmonella infections (Salmonellosis) resolve on their own within 4-7 days with home care, but up to 20% of cases require hospitalization.
You may be prescribed anti-diarrheal medication for gastroenteritis, an inflammation of the gastrointestinal tract. These medications can help relieve abdominal cramping, but they may also prolong the diarrhea associated with Salmonella infection.
Because the vomiting and diarrhea of Salmonella infection cause dehydration, it’s very important that you replace fluids and electrolytes. Pedialyte, Gatorade, and other oral rehydration solutions can be helpful for children.
If dehydration is not able to managed through home care, hospitalization may be needed so that you can receive intravenous fluids. Signs of severe dehydration are urinating only in small amounts, dry mouth, and sunken eyes.
Severe dehydration, bloody diarrhea, and ongoing fever are symptoms which need immediate medical evaluation and care.
Antibiotics are usually not prescribed for uncomplicated cases (those cases with gastroenteritis only) in patients 12 months to 50 years old because they may lengthen the time period you carry the bacteria and can infect others. Also, antibiotics can increase your risk of relapsing if your infection is uncomplicated.
However, if you are at risk for severe infection, the potential for antibiotics to improve disease or prevent complications seems to outweigh the risks of antibiotic use. Antibiotics are prescribed for the following patients with Salmonella infection:
If your doctor suspects your infection may have spread to your bloodstream or if you are at risk for developing invasive infection, blood tests will be ordered and you will be treated with antibiotics.
In rare cases, infection may spread from the intestines to the bloodstream and then to other parts of the body like tissues around your brain and spinal cord, the lining of your heart or heart valves, bones or bone marrow, the lining of your blood vessels. In these cases, salmonellosis can cause death unless treated on time with antibiotics.
“The thing I remember the most about Ruby’s illness was the fear I was going to lose my daughter.
The doctors looked at me with sadness and said, ‘We gave her antibiotics and we hope they will work.’ I was holding her in my arms and she was burning up even with the constant rotation of ibuprofen and Tylenol.
It was the doctors not knowing that fueled my fear.
They didn’t know what had made her sick,
They didn’t know what would happen next,
They didn’t know if it could be made better.
All I wanted was my baby girl to be okay.”
Campylobacter is globally the most common cause of human gastroenteritis. In developing countries children under 2 are frequently infected, sometimes resulting in death. In the United States, Campylobacter is the primary bacterial cause of diarrheal illness, affecting 1.5 million Americans each year. Many infections are never diagnosed, much less reported to public health departments.
Typical symptoms are diarrhea (sometimes bloody), stomach cramps, nausea, headache, vomiting and fever. Symptoms can begin 2-5 days after infection and continue for a week to 10 days. Most cases resolve on their own with adequate fluids and do not require antibiotics. Some people continue to shed campylobacter for weeks in their stool after they recover.
Some people who have severe illness or who are in a more vulnerable category may need antibiotics.
Very young children, pregnant women, adults 65 and over, and people with weakened immune systems such as HIV, those undergoing chemotherapy, and patients with blood disorders are all more susceptible to developing severe disease.
Complications can include:
"I drank unpasteurized milk from a local eco-dairy. Four days later I experienced two hours of violent vomiting and diarrhea, followed by flu-like symptoms and exhaustion.
Within a week I had pain in my legs and tingling in my hands and feet. The next day my vision blurred and the doctor ordered an MRI. The MRI was normal, and I was sent back home.
My legs were on fire searing with pain that ironically, only hot water helped to soothe. They hurt so much that I retreated to bed, wrapping my legs in warm towels and heating blanket.
During the night, I woke up and realized I could not move.”
Most people with Campylobacter infection (Campylobacteriosis) usually fully recover within one week.
If you have Campylobacter infection you should be especially careful to replace fluids and electrolytes lost to vomiting and diarrhea. Ice chips, water, and fluids like Gatorade and Pedialyte can be helpful to restore electrolytes and avoid dehydration. Severe dehydration may require hospitalization so that you can be given intravenous fluids.
If you feel very sick or have any of the following symptoms, you should seek medical care:
Antibiotics are appropriate in less than half of patients seen for medical care.
Patients with a high fever, bloody diarrhea, or stools more frequent than eight times per day are considered good candidates for antibiotic-treatment.
People with, or at risk for severe illness may need antibiotic treatment. This more vulnerable group includes adults over 65, pregnant women, and anyone with a compromised immune system such as a blood disorder, with HIV, or undergoing chemotherapy.
Shigella causes disease only in humans and primates and is one of the leading causes of diarrhea worldwide.
The various strains of Shigella are genetically closely related to the pathogen, E.coli. Shigella causes dysentery in an estimated 165 million infections across the globe, killing 600,000 each year. In the United States, about 500,000 people report having Shigella infection each year.
Infection with Shigella is diagnosed by culturing a stool sample.
Those most vulnerable are young children, the immunocompromised such as HIV and cancer patients, adults over 65, and men who have sex with men.
Common symptoms of Shigella infection vary in intensity. They include watery, sometimes bloody diarrhea, vomiting, fever, nausea, and abdominal cramps. It takes between 2 days and a week before symptoms appear. Symptoms can last for several days but can continue for weeks. Most cases resolve on their own with adequate hydration and electrolyte solutions. Medicines to relieve diarrhea are not indicated as they can worsen infection.
You should seek care if diarrhea becomes bloody, you have a fever, are dehydrated, or suffer severe abdominal pain.
"Coming from a long-line of culinary enthusiasts, one day my wife and I decided to prepare some Chilean sea bass. After double-checking that the fish was fresh, we took the sea bass home, washed it with cold water and applied lemon juice to kill any parasites.
Then we baked it and enjoyed the meal.
But just 12 hours later, I felt like I was going to die. Suffering from intense gastrointestinal cramping and constant diarrhea and vomiting, for two days I was paralyzed with sickness and spent another three days feeling extremely weak as I recovered.
The cause of my symptoms? Shigella --confirmed by a lab and traced back to the Chilean sea bass we had so carefully prepared.
I'm not prone to stomach problems, but the pain and drain on my energy was nothing short of terrible."
Complications may include:
Those with mild symptoms of Shigellosis usually recover with home care in 5 to 7 days.
Home treatment for mild Shigella infection is similar to that for any foodborne illness:
People who have fever, bloody diarrhea, severe stomach cramping or tenderness, dehydration, weakened immune systems (such as from HIV/AIDS or chemotherapy) are more likely to develop severe disease that requires hospitalization. Children under 5 years, malnourished patients, children after measles, adults over 50 are all more likely to have bad outcomes.
For symptomatic adult patients with documented Shigella infection, many doctors suggest antibiotic therapy. Antibiotics are effective in shortening both the duration of fever and diarrhea and the duration of pathogen shedding in stool which can the risk of person-to-person spread.
Antibiotics are recommended for:
Antibiotic sensitivity tests will be run to make sure that the appropriate antibiotic is used to treat the specific strain of Shigella causing illness. Increasingly, antibiotic resistance is complicating treatment for this infection.
Complications of Shigellosis can include:
"During the night I had severe diarrhea and vomiting, then terrible chills. I went back to bed, but the next morning I was still having diarrhea and nausea.
I asked my husband to take me to the hospital. I could barely walk, and was too weak to get dressed, so I went to the hospital in my nightgown. At the hospital I had very low blood pressure, and a high temperature. Admitted on a 24 hour observation, I received IV fluids, and ice compresses to bring my temperature down. The diarrhea continued. Blood, urine and stool cultures were collected ... 24 hours later I was discharged with "viral gastritis."
After returning home I couldn't keep anything down, and was getting dehydrated again. I was still very weak. On Monday my husband called the doctor, who'd been away over the weekend. He told us to come in.
I was too weak to get dressed, so I went in my PJs. My doctor was concerned that instead of a "stomach virus" I had a bacterial illness. X-raying my abdomen showed my intestines were full of water. The doctor prescribed Flagyl to treat the bacterial infection. I gained a little strength, but still was unable to eat solid food, and I was very tired.
Two weeks later, the results of the cultures taken at the hospital had come in: I had shigellosis. We had never heard of shigella.
I was given an antibiotic more specific to shigella and I finally began to get better."
Regarded as one of the most virulent pathogens, Listeria ranks third
in the number of deaths it causes, with a higher fatality
rate than Salmonella, and botulism.
Listeria monocytogenes causes 1,600 illnesses and 260 deaths each year in the United States.
Among severe cases of invasive infections, 20% will be fatal.
High risk individuals include newborns, pregnant women, people with a weakened immune system, adults 65 and over, diabetics.
The time to develop symptoms after infection ranges from a few days to 3 weeks.
The symptoms are different depending on which part of the body is affected.
People with Listeria infection in the brain and spinal cord can have:
People with Listeria infection in the bloodstream can have:
People with Listeria infection in the digestive system can have:
You should seek medical care if you have any of the symptoms listed above and you are pregnant, older, have a serious medical condition, or take medicines that weaken the immune system.
“For me it was just a case of the runs but I was much more scared for my unborn child when I learned that Listeria likes to take up residence in the placenta and can cause stillbirth.
After consulting with my OB/GYN and two others, I decided that the risk of stillbirth was too great and allowed myself to be admitted to the hospital for 4 days to receive intravenous antibiotics 4 times a day to kill the bacteria but save the baby.
Several weeks later I was relieved to birth a baby that was alive. However, the foodborne illness and resulting treatment ended up affecting my baby.
I had flooded my body and the placenta with antibiotics during his final weeks of development so that he would live past his birth, but in the process the drugs had ravaged his digestion system so that he suffered terribly from colic, stomach pain, constant vomiting, and dysfunctional bowels. After taking him to many medical specialists, looking at his abdominal x-rays, and even mapping his DNA, the medical community realized they couldn’t help him.
When he was 6-and-a-half years old, we found a naturopath who suggested using the MRT test to design a customized anti-inflammatory diet for him. And it worked!
Finally, he growing and sleeping and feeling well. It had taken more than six years to be able to move beyond that foodborne illness in my pregnancy.”
Call a doctor or nurse if your newborn baby:
Tests used to diagnose Listeria infection will depend on your symptoms, whether you are pregnant, and if you have other medical conditions.
They may include:
Pregnant women usually only develop only mild flu like symptoms, but their infection can lead to spontaneous abortion, still birth, or life threatening infections for the newborn. Because of these dangers, pregnant mothers are advised not to eat soft cheeses, raw sprouts, unpasteurized dairy, or luncheon meats.
Listeria infections for people other than pregnant women can involve flu-like symptoms, persistent fever, muscle aches. Symptoms such as stiff neck, headache, confusion, loss of balance, and convulsions require urgent medical care.
Treatment for Listeriosis depends on how serious symptoms are and how healthy the infected person is.
If symptoms are mild (fever, aches and pains, chills, vomiting or diarrhea) and the person is otherwise in good health, treatment may not be necessary. Instead, the doctor may instruct home care with close follow-up. Home treatment for mild Listeria infection is similar to that for any foodborne illness.
Pregnant women, anyone with a medical condition that weakens the immune system (diabetes, cancer, HIV), children and older adults are more likely to have invasive illness.
This means that the bacteria will have spread to the blood (bacteremia). These patients will be hospitalized and treated with IV antibiotics, and the patient will be closely monitored for any complications that might develop.
Invasive cases of Listeriosis have a high mortality rate of between 16-20%.
Any pregnant woman with a fever higher than 100.6°F and signs and symptoms that are consistent with Listeriosis for whom no other cause of illness is known should be tested and treated for presumptive Listeriosis.
Newborn babies with the infection will receive antibiotics as soon as they are born to treat sepsis, a life-threatening illness caused by an immune response to infection, and meningitis.
An infant born with Listeriosis may remain on antibiotics for several weeks while their body fights the infection.
Severe complications of Listeria infection can include:
It’s been 18 years tomorrow since we were diagnosed with listeria.
▲ Two of us were less than one day old
▲ One of us had just delivered twins
▲ Two of us were in the NICU
▲ One in the ICU.
▲ One of us had an APGAR of 1; a temperature couldn’t be registered.
▲ One of us had an APGAR of 4.
▲ One had a temperature drop so low that organs were beginning to shut down.
Seizures, jittery episodes, diarrhea, encephalitis, IV needles coming out of foreheads when no more veins could be found.
▲ Bruises everywhere.
▲ Central line heart surgery.
▲ Silent cries and hoarse voices from intubation.
▲ Early intervention.
▲ Projectile vomiting.
▲ More diarrhea.
▲ Trying to keep medications down when everything wanted to come up.
Praying for milestones to be reached. For healing to happen. Wondering about long-term consequences.
What do we have to say, 18 years later? Thank you ...
Allison Elizabeth was born at 3:13 AM at four pounds and thirteen ounces and covered with meconium. After a nine on the APGAR test, her dad holds her for about three minutes before she is rushed to the Neonatal Intensive Care Unit. Meanwhile, I’m still on the table getting stitched up with my head reeling.
“Why can’t I see my baby!!?” I asked my husband. I had no idea what was going to happen. After recovery and in my room, the hospital’s pediatrician comes in to give us news on Allison. She has Listeria. We never had heard of this before and truly did not know what to expect. The doctor tells us that we can expect Allison to stay in the NICU for four to six weeks. What can we do but pray?
My husband was able to see Allison very soon after her trip to the NICU. He cries to this day remembering what he saw ... Our tiny, new baby hooked up to everything you could imagine. She was under an oxygen dome. She had a tube going up her nose to her stomach for feeding, a tube running into her belly button, one in her arm for antibiotics. He couldn’t even hold her.
I couldn’t see her for forty-eight hours. When I was healed enough to be wheeled to see her, nothing could have prepared me for what I saw. The tubes, the green-lighted blanket, the monitors beeping endlessly. Was this my baby? I couldn’t hold her for two more days. I actually had to leave her there and go home.
How could I leave her now? I have never felt so helpless in my life.
Allison was a fighter. She was off of oxygen in five days and home in two weeks. She was small, but she was strong and healthy. We thank God everyday for our beautiful girl. It is very hard for me, or anyone else, to imagine that me, my child, and family had to go through such hell because of a piece of cheese. Something so trivial, so taken for granted; we had no idea what could happen.
And now we can’t help but think about those families that weren’t as fortunate as us. Their loss is meaningless unless we change the way things are done.
I was one of more than 25 individuals who was sickened by salad at a work-related banquet in a California hotel.
My symptoms of nausea, diarrhea, and painful abdominal cramping were so severe that I went to a hospital emergency room for treatment. This hospital visit was just the beginning of an ongoing battle with food poisoning that I am still fighting ...
I have developed further gastrointestinal issues, likely all related to eating that salad ... I am no longer working. My bloating can be so bad at times that clothes do not fit. I can never be too far from a bathroom.
My life has been completely altered by this preventable tragedy.
I was healthy with no prior complaints of bowel abnormalities before I became a victim of foodborne illness. I do not want anyone else to have to suffer the way that I have. I want the life that I had before food poisoning back.
Stop Foodborne Illness is a 501(c)(3) tax-exempt organization. Donations are tax-deductible to the extent the law allows.
