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See Inside Scientific American Volume 306, Issue 4

Food Poisoning's Hidden Legacy

Most people think of foodborne illness as an unpleasant few days of fever and diarrhea, but for some there may be lifelong consequences



Ted Morrison

Colette Dziadul struggled for years to understand her daughter’s joint problems. Dana, who is now 14 years old, complained from toddlerhood that her knees and ankles hurt. The aches kept her up at night, made her wake her parents to ask for painkillers and forced her to sit out school sports. Nevertheless, two pediatricians and an orthopedist diagnosed the problem as “growing pains” that would fade as she grew older.

Then, when Dana was 11, Dziadul participated in a survey about foodborne illness. The questionnaire came from an organization called Safe Tables Our Priority (now STOP Foodborne Illness), which was canvassing survivors of outbreaks for details of their recoveries. When she was three years old, Dana had spent two weeks in the hospital—one of 50 people sickened after eating cantaloupe that had been contaminated with Salmonella. Among the complications of infection that the survey listed were symptoms of a form of joint damage known as reactive arthritis.

Dziadul was dumbfounded. She found Dana a rheumatologist, who confirmed that the pain was caused by arthritis for which there was no other explanation. Then she went back into Dana’s medical records. On Dana’s 10th day in the hospital a nurse had recorded that the youngster was limping and complaining of joint pain. Could those long-forgotten symptoms have been the first sign of arthritis, starting as her body reacted to the Salmonella infection? “That there could be a connection between Salmonella and arthritis never crossed my mind,”
Dziadul says. “And it never crossed most of the doctors’ minds.”

It is a scary idea that food poisoning—which we think of as lasting just a few days—could instead have lifelong aftereffects. The incidence of such “sequelae,” in medical parlance, has been thought to be low, but not many researchers studied the problem until recently. New findings by several scientific teams suggest the phenomenon is more common than anyone thought.

A Common Problem?
Foodborne disease has an enormous public health impact even if you count only the initial, acute episodes of illness. 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 U.S. Department of Agriculture’s Economic Research Service calculates the cost of foodborne illnesses just from bacterial infection to be at least $6.7 billion, counting medical care, premature deaths and lost productivity. Re­searchers who attempt to track chronic effects say that the actual bill is much higher.

“People don’t understand the full consequences of foodborne disease,” says Kirk Smith of the Minnesota Department of Health, which lends its investigators around the U.S. “They think you get diarrhea for a few days and then you are better. They don’t understand that there is a whole range of chronic sequelae. And although any of them may not be common individually, when you put them together they add up to a lot.”

Long-term consequences are not limited to individuals who were hospitalized, as Dana was. They have also been recorded in people who experienced what seemed to be minor bouts of fever, vomiting or diarrhea. The consequences include reactive arthritis, urinary tract problems and damage to the eyes after Salmonella and Shigella infections; Guillain-Barré syndrome and ulcerative colitis (a chronic bowel inflammation) after Campylobacter infection; and kidney failure and diabetes after infection with Escherichia coli O157:H7. Those organisms are very common: federal investigators have identified them in meat, milk, poultry, eggs, seafood, fruit, vegetables and even processed foods.

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