As researchers look back at foodborne outbreaks, they are not only confirming that these complications appear in survivors but adding to the list of illnesses that may occur. A survey of 101,855 residents of Sweden who were made sick by food between 1997 and 2004 found, for instance, that they had higher-than-normal rates of aortic aneurysms, ulcerative colitis and reactive arthritis. A review of a major provincial health database in Australia revealed that people there who contracted any bacterial gastrointestinal infection were 57 percent more likely to develop either ulcerative colitis or Crohn’s disease, another chronic bowel condition, than people born in the same place and era who had not had such infections. And several years after a 2005 outbreak of Salmonella in Spain, 65 percent of 248 victims said they had developed joint or muscle pain or stiffness, compared with 24 percent of a control group who were not affected by the outbreak.
Few comprehensive analyses have been conducted in the U.S. Traditionally, food-related investigations have aimed at finding and interviewing victims during the outbreak, Smith says. Because acute illness lasts a couple of weeks at most, little attention has been paid to keeping track of victims afterward—something that might be very complicated because they may go to different doctors and even live in different states.
One of the U.S. studies, published in 2008, traced victims of foodborne illness in Minnesota and Oregon between 2002 and 2004. Researchers determined whom to contact based on records collected by a CDC surveillance project known as the Foodborne Diseases Active Surveillance Network (FoodNet), which collects reports of lab-confirmed infections caused by 10 different organisms. Out of 4,468 victims, 575 (13 percent) reported later symptoms that matched reactive arthritis, although most—unlike Dana—were never diagnosed by a specialist.
The link between foodborne illness and long-term health consequences could be a coincidence, although advocates say that the chances are remote. A better way to prove the connection would be to identify victims when they first become ill and track them for years thereafter, a research arrangement called a prospective study. There are a few such studies worldwide, and a recently concluded one—the only one to take place in North America—was stunning and persuasive.
In May 2000 the drinking water in Walkerton, Ont., became contaminated with E. coli O157 after heavy rains washed manure from farm fields into its aquifer. More than 2,300 people, about half the town’s population, developed fever and diarrhea soon afterward. In 2002 the Ontario government funded the Walkerton Health Study to assess any health effects that might persist among the victims. In 2010 the study published its findings: compared with residents who did not get very sick, those who endured several days of diarrhea during the outbreak had a 33 percent greater likelihood of developing high blood pressure, a 210 percent greater risk of heart attack or stroke, and a 340 percent greater risk of kidney problems in the eight years following the outbreak.
Those outcomes were not limited to people who developed the most serious consequences of E. coli O157 infection. Even Walkerton residents with milder symptoms experienced circulatory problems that would not have been linked to E. coli without the prospective monitoring. That discovery suggests how common the late-onset effects of E. coli infection might be, says William F. Clark, the study’s leader and a professor of nephrology at the University of Western Ontario. Clark recommends that survivors of such illnesses have their blood pressure checked every year and their kidney function checked every two or three years.
Given how few scientists have studied the issue, most of the problems have come to light thanks to patient advocacy groups. STOP’s original survey, in which Colette Dziadul participated, collected first-person accounts from patients. It was followed by a 2009 white paper from the nonprofit Center for Foodborne Illness Research and Prevention, which unearthed research on long-term sequelae that were buried in the medical literature.
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19 Comments
Add CommentAs an Extension Service Master Food Preserver I consider this article to be an important 'wake up call' to the public. A broader awareness of the potential for long term complications from food poisoning can't help but make our mission of food safety education more germane.
Reply | Report Abuse | Link to thisThis article deserves national dissemination.
An interesting and important article. The following quote has me puzzled, however:
Reply | Report Abuse | Link to this"The Centers for Disease Control and Prevention estimated in 2011 that the U.S. sees 48 million illnesses, 128,000 hospitalizations and 3,000 deaths every year from foodborne organisms. (The European Union had 48,964 cases and 46 deaths in 2009, the most recent year tallied.)"
The US population is 311MM and the EU is 502MM. What accounts for the vast difference in the illness and mortality rates? European Climate? Food safety? Medical care? Is there a decimal missing?
It also would be useful to know the base rates for the illnesses described -- hypertension, heart attack, etc. To what extent do foodborne illnesses increase the occurrence or severity of those ailments? What differences in base rates are there between the US and the EU?
The key question that comes out of this article is -- what causes the legacy effects seen from food poisoning? It appears likely that in fact the e coli or other agent survives within the body in smaller amounts long after the acute symptoms of infection have subsided, leading to longer-term effects. It would be great to see further medical research in this area -- are there ways to detect infectious agents in smaller quantities, and to eradicate them in the infected individual. I have had food poisoning at least a dozen times, including from leftovers in my refrigerator, restaurants, overseas travel, so it seems highly unlikely we will be able to eliminate the root causes of food poisoning (though certainly we should try our best) -- thus it is critically important that we improve the treatment of infection to reduce long-term health implications.
Reply | Report Abuse | Link to thisWhenever I have had food poisoning, the doctor's advice has been to give it a few days, it'll probably go away on its own. I suspect that is not great advice given the latest research, and the doctors themselves need to be educated around this.
Reply | Report Abuse | Link to thismust be a typo
Reply | Report Abuse | Link to thisI don't think there'll be any one answer, but if I had to pick one, it'd be food safety. Since the Bush administration gutted the FDA and introduced the "inspect your own products for safety," I imagine the pressure to maintain a profitable bottom line has had some deleterious effects on the food supply.
Reply | Report Abuse | Link to thisIt is thought that the organism is actually cleared from the body (so don't take antibiotics trying to get rid of something that is not there) but autoimmunity has been initiated. Parts of the bug look like parts of you, and your immune system continues to attack your own body after the bug is long gone.
Reply | Report Abuse | Link to thisThe prediction ,as I understand " is that poison will trigger a nuclear war and a quick reduction of 2 thirds of humans.
Reply | Report Abuse | Link to thisIn answer to J Dice: Quite a bit is now known about the legacy effects from food poisoning organisms. Shiga toxins produced by some E. coli not only kill some cells directly but also tip the balance toward coagulation and away from anti-coagulant effects. Clots can form in small capillaries, such as those in the brain and some parts of the kidney, and everything "behind" the clot can then die due to lack of oxygen and other nutrients. The areas affected may be small, but the overall effects can be both subtle and profound. In the case of Salmonella and Campylobacter, the known mechanisms are associated with manipulation of the host - the human patient's - immune system. Immune system cells that can react specifically with human tissues and organs are switched off, tightly controlled. Infections with some bacteria can reactivate these cells, leading to "inappropriate" damage from killer cells or from antibody-producing cells. Of course, though many of the mechanism by which bacteria that cause "food poisoning" are quite well known, there are still a lot of the steps, proteins, genes, etc. that are not known. Part of my research is searching the genome and proteome and testing possible candidates to find what causes disease, including the long-term sequelae.
Reply | Report Abuse | Link to thisThank you all for your comments, and especially CliffClark for explaining what is going on mechanically. I'm grateful you found the piece interesting enough to comment! - Maryn
Reply | Report Abuse | Link to thisTo answer the question from Anataseem, the numbers for the U.S. are estimates based on the total number of actual cases that are reported. The numbers from the EU are the actual number of laboratory confirmed cases. For every 1 case that is confirmed in a laboratory, there are generally 10 to 30 cases that are not reported because not everyone goes to the doctor and gets a stool specimen taken (necessary to confirm the disease) when they get sick. That's why the numbers seem so different.
Reply | Report Abuse | Link to thisI too find the numbers quite disturbing. 48 millions illnesses in the USA for a population of about 310 millions; this is nearly one in 6 person and this is EACH YEAR. If the numbers are correct, it means something must be terribly wrong.
Reply | Report Abuse | Link to thisCompared to the European Union were they had 48,964 cases on a population of over 500 millions or a case in over 10,000.
Which numbers are correct? Is it possible that ther are 1,000 tines more cases in the USA than the EU with a smaller population?
I read the article in the april issue, found the numbers literally incredible, and commented in the article with the podcast, but repeat it here, even though others have commented along the same lines
Reply | Report Abuse | Link to this"I found the article most interesting, but the figures on food poisoning in US, EU and Sweden very confusing, at best they do not refer to the same thing.
US, 48 million illnesses, 128000 hospitalizations and 3000 deaths per year for appx 300 million inhabitants
vs. EU, 48964 cases, 46 deaths in 2009 for 500 million inhabitants
and Sweden, 101855 made sick by food between 1997 and 2004, or per year appx 13000 for barely 10 million inhabitants?
I.E., more than 1000 times per capita greater risk of food poisoning and death in the US, compared to EU?
And the Swedes accounting for 1/4 of the food poisoning in the EU?"
The difference in occurence exceed the 10-30 times mentioned by Foodepi by 50-100 times!
This is a very interesting study. Statistical correlation between food poisoning symptoms and other critical health conditions. This correlation is however presented as a causation for which I do not see proof of. Is it really the food poisoning that is causing these later increases in heart failures, kidney problems?
Reply | Report Abuse | Link to thisBoth Title (with the term "legacy") and subtitle (with the phrase "lifelong consequences") guide us to think it without bringing any proof for it.
Wouldn't it be possible to have a simpler explanation for the correlation showed in the study, like age? I imagine that this simple factor was taken into account in this very analysis, however other factors, not accessible in this study might be the true cause for the correlation we see here.
I finally got around to reading the April issue, and question the legacy of food poisoning, the same as tompot at comment 14. Is it possible that the ones who didn't have food poisoning symptoms are the more 'robust' persons of the bell curve distribution of the population? In general, the more 'robust' individuals would have fewer problems of any type. As tompot says, correlation is not causation.
Reply | Report Abuse | Link to thisI'm glad awareness of this issue is growing; I recently attended a seminar at Arizona State University for sanitarians which included a lecture about Campylobacter -- how it's spread, its sequelae, & how to mitigate it. Unfortunately, in an increasingly mobile world (as mentioned in the article about why US citizens are less studied longterm because we move frequently) strong knowledge/certainty about longterm sequelae of foodborne illnesses will probably develop slowly. Hopefully the US is open to learning from the studies (esp. the Walkerton study) of other countries which suggest a strong correlation (& likely causality) between infections & longterm/delayed effects.
Reply | Report Abuse | Link to thisi am a female who has recovered from a very serious reactive arthritis "attack" ( 250CRP )at age 54, 2 weeks in hospital with intravenous antibiotics and 3 months of cortisone,i am HLA B21+ most reactive arthritis patients have this marker ca 8% of the population ,meaning having a immune deficiency and now after months of puzzlement i finally am able to say it was caused by the giardiasis parasite... massive flagyl medication has made me almost symptom free,but the parasite is taking advantage of the immune deficiency and another very serious food issue has come up , histamine intolerance,
Reply | Report Abuse | Link to thisthe article just skims the food issue, it would be great to see a few articles in the american scientific:
reactive arthritis, how to recognize the symptoms.
HBL B27+ and its effects on joints,eyes and heart.
histamine intolerance, foods containing histamines and foods that activate histamine release in the body. the symptoms and the vitamin c deficiency connection. is it a digestive juices problem?
survival in medieval europe ,conserved foods and food poisoning.
e262 and its effects on food and our bodies : are we being unwittingly conserved too?
most people ,if they feel sick after eating think this is normal....
and children are made to eat foods they hate ...
When I was a kid, often had food poisoning, or I think it was food poisoning. But the question is - how could I have food poisoning if all the others eat the same food were healthy? I found very good article about food poisoning, this is link http://medicalsymptomssearch.net/food-poisoning-symptoms-causes-diagnosis-and-treatment/
Reply | Report Abuse | Link to this(I hope I can place the link here... )
About joint pain. I had problems with my knees, and guess what all doctors said about it..? It hurts because I quickly grow! And now I am grow up and I have arthritis!
I agree with tompot. This article jumps from correlation to causation without documenting any proof. The Walkerton, Ont. data is a case in point: the data quoted compares those who get sick to those who did not get sick, all from the same town and supposedly the same exposure. I'd like to see the town's data as a whole compared to the province to see if the town overall had an increased rate of these illnesses to help tease out whether the infection is the cause, or whether the infection and the later illnesses are both being caused by some other underlying cause-in-common in these individuals such as a genetic predisposition, for example.
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