Eating Dangerously Page 18

  Hepatitis A

  Hepatitis A is an oddball among the common foodborne illnesses, because it is easily—if not cheaply—prevented. There is a highly effective vaccine for this less debilitating strain of hepatitis, proven safe and affording twenty years of immunity. But because it can cost $40 or more, and since nearly everyone who gets Hepatitis A recovers without lingering effects, it is usually recommended only for people traveling to less-sanitary countries, or for those who work in food service and other sensitive roles. Public health officials hesitate to add new mandatory vaccines to the growing list of citizenship requirements, and few players in America’s bloated health care budgets are volunteering to pick up the cost.

  Hepatitis A is commonly passed between carriers and the foods they handle after failing to properly wash their hands. The virus inflames the liver and takes ten to fifty days to incubate, challenging efforts to pin down any foods responsible through a normal traceback operation. Frequent symptoms are fatigue, jaundice or yellowed skin and eyes, abdominal pain, loss of appetite, darkened urine, vomiting, fever, and periodic diarrhea. A medical guide for families from the Philadelphia Children’s Hospital estimates 40 percent of city dwellers in the United States have had the virus, many without ever knowing it. Younger people are often asymptomatic, so a family may not recognize they have a problem until a parent of the virus-carrying child also gets sick and receives a test.

  The illness can last about two months before resolving, though some symptoms may linger on for some patients. Once it resolves, it does not recur, and the body is eventually rewarded for fighting off the virus with the benefit of lifelong immunity. There are no specific treatments for those with a normal case of Hepatitis A, though to protect the compromised liver, patients are told not to drink alcohol and to cut down on fatty foods.

  For those considering the vaccine, remember it takes two weeks afterward to gain full protection. Patients getting over a case should talk to their doctor about protecting others if they have children at home or work in daycare or food service. They may be told to stay away from food contact or take extra precautions for some time.

  Campylobacter

  Campylobacter is a parallel bacteria to Salmonella in many ways, sharing symptoms and some common methods of transmission. Like Salmonella, it likes to ride along in packages of raw chicken and eggs, but it is also common in shellfish and other seafood, and in pigs, goats, and sheep. Not all medical professionals are in the practice of looking for it specifically, even if they suspect a foodborne illness, so it has been one of the more difficult pathogens for public health officials to estimate.

  The incubation period for the most common form, Campylobacter jejuni, is one to seven days, and the illness starts with fever, headache, muscle aches, and abdominal pain. It can progress to vomiting and frequent bloody diarrhea, with as many as ten bowel movements a day. The most severe symptoms are likely to be over in less than a week, though minor symptoms may reappear for weeks. Antibiotics for the treatment of Campylobacter are debated in the medical community, as it is similar to many pathogens that usually run their course without permanent damage in healthier patients. Antibiotics can slow the natural progression of the illness without greatly altering symptoms. Many doctors also recommend against antidiarrheal drugstore remedies: better to let the bacteria pass through the system. A small number of cases can lead to the more serious Guillain-Barré syndrome, a neurological disorder creating nerve tissue damage. Dehydration or diarrhea lasting more than five days usually prompts the testing for a foodborne illness, and more medical attention.

  Shigella

  Shigella targets young children and is one of the major causes of dysentery, or bloody diarrhea, in the United States and around the world. Public health officials suspect hundreds of thousands of cases nationally each year, many of them not formally detected.

  Children twelve months to four years are vulnerable because of the habits of the young: touching everything, including less clean parts of themselves, putting those same fingers or toys in the mouth, and hugging or tumbling with other children. Daycare centers are hotspots for Shigella, as with rotovirus, before the latter was successfully targeted by a popular vaccine. Aiding and abetting the insidiousness of Shigella is the tiny amount needed for an infection, with only a few cells required for transmittal. Pediatricians in Philadelphia warned in their Shigella guide that toilet paper is not a thick enough barrier to stop transmission, making thorough hand-washing all the more essential in kid-care settings. People can be carrying infectious levels in their intestines without getting sick themselves, distributing the potential mystery without knowing it.

  “Shigella is so infectious that you could catch it from an infected person who loaned you his pen just long enough for you to sign your name,” according to the Philadelphia manual. Shigella can also be picked up while swimming in dirty water, as with E. coli.

  The incubation period with Shigella is two to four days, but it has been known to be shorter or longer. Symptoms range from a barely remarked upon case of diarrhea to frequent bloody or mucus-laden diarrhea, along with fever and severe cramps. Most providers will test for a range of pathogens once diarrhea becomes bloody, but it can take five days for Shigella to grow in the testing lab. Shigella is one of the few pathogens for which doctors agree on antibiotics and prescribe them, in part because they can help stop the shedding of the bacteria to others. You should ask your doctor, though, about local instances of antibiotic resistance and how the prescribed medicine for Shigella matches up with those trends. The antibiotics should make a difference in two to three days. In rare cases, Shigella produces a toxin that causes seizures; in other rare cases, it can settle into joints and cause lifetime arthritis issues.

  Even without treatment, the illness should last no longer than two to seven days. Shigella wins nastiness points by failing to provide lifetime immunity after a case; yes, you can get it more than once. Some medical advisors will push for the whole family of a Shigella victim to get tested in order to slow the spreading of the easily communicated disease.

  Listeria

  Listeria is a smaller but deadlier entry in the list of foodborne pathogens.

  The bacteria is common in the environment, and it spreads to food by anything from dirty factory equipment to birds leaving droppings across a farm field. Listeria monocytogenes from just one packing shed at one farm was the culprit in the 2011 outbreak involving Colorado cantaloupe, killing at least thirty-three people and eventually becoming the worst food-illness disaster in modern U.S. recordkeeping. It can cling to the netted rind of cantaloupe, or hide between slices of deli ham; perhaps most insidious of all, it loves cool weather and will multiply rather than retreat in the refrigerator, just where consumers think they are safely storing their food.

  Listeriosis kills one in four people who get the illness because it attacks at the ends of the spectrum: elderly people with wilting immune systems or who may be fighting off cancer or other problems, and young pregnant women and their babies, whose immune systems partially shut down in order to avoid rejecting the growing fetus. Miscarriage and deaths of recent newborns are two of the sadder consequences of Listeria. A long incubation period also complicates identification and treatment—listeriosis can appear as long as seventy days after eating contaminated food, with the average onset in about three weeks.

  Symptoms tend to mock influenza at the beginning, making it a challenge for unsuspecting doctors to diagnose in isolated occurrences. Fever, chills, sore throat, headache, and muscle ache lead off the reaction. Elderly patients can descend into meningitis and sepsis. Like other healthy adults, pregnant women may have ingested Listeria without knowing it and without developing the illness, while still passing it on to their vulnerable, developing baby. Tissue samples are grown in a lab to detect suspected listeriosis. Courses of antibiotics for pregnant women can help protect the baby, which is at risk of having the infection spread
to vital organs. The fetus can also pick up Listeria in utero and then not exhibit major symptoms until some time after birth; in a newborn or infant, signs include those of meningitis, such as a bulging soft spot on the head, irritability, lethargy, and lack of appetite.

  Many of the Colorado cantaloupe victims were in their eighties or beyond—just think of all the cantaloupe on the menus of nursing homes, where comfort food, nutrition, and easily chewed foods are a priority. Listeria could become an even more prominent preoccupation for food safety officials as the U.S. population continues to age.

  Clostridium Perfringens

  Clostridium perfringens could be called the “cafeteria disease.” It arises from a bacteria that exists widely in the natural and man-made environment as spores, which then take advantage of moderate temperatures to reproduce rapidly and rise to a contamination level, threatening illness to humans that ingest them. Food becomes more vulnerable to that kind of bacteria growth when it’s left out to cool too slowly, or servers fail to heat it up again to a level that kills off the new bacteria. Imagine slabs of roast beef sitting on poorly tended steam tables at a convention hall, or a buffet of neglected scrambled eggs cooling and congealing at a Las Vegas hotel. Clostridium perfringens causes an estimated one million cases of illness in the United States each year, carried and spread from the intestines of humans and wild or domestic animals. Once ingested by humans through food, the bacteria colonize and spread, causing intense stomachaches and diarrhea, along with cramps, according to the FDA’s “Big Bug Book.”

  Symptoms begin about eight to twenty-two hours after eating the contaminated food, so it’s a relatively short incubation that can make traceback a little easier. In relatively healthy people, symptoms are usually over within twenty-four hours, although minor complications for some patients can last up to two weeks. Any deaths associated with Clostridium are from the ever-present gastrointestinal complication of dehydration after losing fluids. A rarer form of illness caused by Clostridium perfringens arises from bacteria creating necrosis in the intestines, called necrotic enteritis.

  The illness can be diagnosed by its symptoms, though they, of course, overlap with many gastrointestinal problems. Fecal testing can confirm it, but many of the outbreaks go undetected because general practice doctors rarely test specifically for Clostridium perfingens. Tests can take one to three days to return results. Health officials who are alerted to potential cases can also go looking for food sources and get those tested for Clostridium; confirming the source can force institutions to throw away bad food and overhaul their serving methods.

  Treatment usually consists of waiting and sympathy, accompanied by rehydration measures if there is extensive loss of fluids, particularly in children. Antibiotics are not recommended. For home cooks, the lesson from Clostridium is that food sitting out between 68 degrees and 140 degrees Fahrenheit is vulnerable to many kinds of bacterial growth. Cool it down quickly or heat it up sharply before serving.

  Toxins and Parasites

  Though we will not attempt to be exhaustive in detailing every virus, bacteria, parasite, or toxin that can ride along on bad food or water, a few more are worth a mention. Most of them account for only infrequent outbreaks or affect a small number of the people targeted by foodborne pathogens.

  A “staph” infection commonly associated with hospital surgery or untreated wounds can also come in the form of food poisoning, and often does. Staphylococcus aureus bacteria are ever-present in our environment and often arrive on food from unknowing food service workers and handlers. The bacteria produce toxins that are not cooked out of foods by heat. It is estimated to cause hundreds of thousands of cases a year, but very few are officially reported since the illness, while sometimes violent, comes in as little as thirty minutes after contact and is often gone in a day.

  Giardia infection is considered a backpacker’s problem, because of its strong association with drinking stream water tainted with cattle manure or other animal-feces runoff. But it’s also a dog-owner’s problem, and a daycare problem, and an open-water swimmer’s problem. The parasite resides and grows in the intestines of many life forms, and it is one of the main reasons American backcountry users need to filter, boil, or chemically treat any local water they want to drink. Dogs can pick it up in many outdoor settings, getting the same diarrheal symptoms themselves and bringing it back home for transmission to their people. Giardiasis can range from “greasy stools that float,” according to the CDC, to stomach cramps and nausea, to gaseousness and dehydration. Doctors might need more than one stool sample over multiple days to complete a test. Prescription drugs can help speed up recovery significantly, though people do recover on their own.

  Toxoplasmosis is a parasite that infects millions of Americans but which rarely erupts into symptoms in those human carriers. It’s most often ingested in undercooked meat, in particular pork, lamb, and venison. Cat feces are another transmitter, threatening some cat owners who are not careful about handling and hygiene. Symptoms often feel like a long-term flu, with aches and pains and swollen glands for a month or more. Occasionally patients develop a more severe case, including an ocular form of the illness that should be treated by eye doctors.

  Streptococcus bacteria ingested through food can induce the same sore throat symptoms more commonly associated with an airborne or environmental contagion; other forms of foodborne strep can cause gastrointestinal problems that feel more like one of the better-known food poisons.

  Some naturally occurring substances become toxins when concentrated too much in food, or in humans who eat too much of one thing. Snappers and other fish that fatten on algae near reefs can produce ciguatera poisoning, which creates a telltale numbing of the lips and tongue as a warning sign. Many diners avoid shellfish in summer months because of the various poisons they can produce after growing in hot-weather algae blooms. Forms of botulism still exist, though poisonings or outbreaks are rare compared to the size of its lingering legend as a foodborne danger. There are honey intoxications from eating too much in a season when bees used too many rhododendrons; there are molds that grow on peanuts, and city water systems that occasionally harbor a Cryptosporidium scare. But stick to learning the dangers of what the FDA likes to call the Big Five—norovirus, Salmonella, Shigella, Hepatitis A, and E. coli O157:H7—and you’ll be well prepared to handle the great majority of food safety problems your family will likely ever face.

  10

  Eating Healthy and Eating Safe: No, They Aren’t the Same Thing

  Go locavore. Eat organic. Find farm-fresh eggs from chickens that roam free to scratch the dirt and peck for bugs. Share half a butchered cow in a joint order with your neighbor, choosing it from a bucolic ranch with rolling green hills and no hormones or antibiotics mixed into the feed. Order your never-frozen Thanksgiving turkey directly from the farmer instead of shopping with the masses tossing hard-as-a-rock birds around the bin at the supermarket in search of the perfect centerpiece. Stroll through the farmers’ market each week, sampling watermelon and homemade sausages and loaves of bread full of hearty seeds and grains. Go ahead—these are all wonderful ways to live. You’ll develop a greater appreciation for the people who raise our food and, at the same time, help bolster the local economy.

  But while you are doing all of this, don’t be naïve enough to assume you are less likely than traditional grocery store shoppers to pick up a dangerous food pathogen along the way.

  Eating healthy, or organically, or locally, has its benefits—fewer pesticides, more humane treatment of animals, less fossil fuel burned to transport the bananas from Chile or the hamburger from who knows where—but it has not been found to reduce the risk of foodborne illness.

  Still, there are ways to seek the best in healthy, local eating and—at the same time—do your best to avoid foodborne illness. The most important thing is knowing the risks and how to minimize them.

  Studies have found lower lev
els of chemicals in organically farmed food and hormone-free meats, but they have not determined these foods are less likely to make people sick from Salmonella or E. coli or Listeria. After all, organic foods are still grown or raised in and on dirt. Birds fly overhead, leaving bacteria-laced droppings behind. Wild animals trot through the farm fields. The closer to nature, the closer to bacteria, in all its good and bad forms, is usually how it goes. Again, that’s why frozen chicken nuggets and boxes of crackers aren’t the usual suspects behind the nation’s worst outbreaks.

  “Organic certification does not address food safety. Food safety is not part of the equation,” said Dr. Michael Doyle, director of the Center for Food Safety at the University of Georgia. “Just because the government has this certification program, it doesn’t mean it’s safer.”1

  In fact, some studies have found that organic food might be slightly more likely to contain bacteria than conventionally grown or raised food. This is at least in part linked to fertilizer. In place of nitrogen-based fertilizers, organic farmers often use manure, which is teeming with bacteria, E. coli in particular. To make it safe, farmers are supposed to cook it first, ideally to 165 degrees. Compost it, toss it in an outdoor oven, flip it often enough to make sure the heat penetrates all the way through and cooks out the bacteria. The process can take days or even weeks. “You have a very good possibility of not getting it all, raising the risk of spreading E. coli on the crop,” said David Lineback, senior fellow at the Joint Institute for Food Safety and Applied Nutrition at the University of Maryland. “A lot of people don’t take the time.”2

  That sounds risky, perhaps, until you consider that a few decades ago, farmers simply shoveled manure straight from the stalls to the crops, unaware of the harmful bacteria it contained. But back then, people who died of foodborne illness weren’t likely to figure out what was killing them, either.