Food poisoning's long shadow: complications can last years. (Cover Story).

So you wiped your hands on a towel instead of washing them after you prepped the chicken for the grill. Or you didn't use a thermometer to make sure your hamburger reached 160 [degrees] F in the center. Or you ordered your deli sandwich with sprouts.

No harm. Even if you're unlucky enough to get food poisoning, it probably means just a stomach-ache or an up-close-and-personal encounter with your commode. Or so you think.

"Food-borne disease can have a life-altering impact," says Morris Potter of the Food and Drug Administration's Center for Food Safety and Nutrition. "Some people are never the same again."

Food poisoning can lead to Guillain-Barre Syndrome, reactive arthritis, or hemolytic uremic syndrome--diseases that can leave their victims with chronic pain, paralysis, and kidney damage.

Guillain-Barre Syndrome

"It was devastating to lose control over my body so quickly and so completely," remembers George Jones of Piscataway, New Jersey. "I was having breakfast with my daughter five years ago when I felt a tingling in my fingertips and toes that progressed up my arms and legs. Within two days, I couldn't walk, and it just continued to get worse and worse until two weeks later I was completely paralyzed. I couldn't move my arms or legs or head. Just my eyelids.

"The terror of being utterly helpless was unimaginable. But gradually I got better, and after six weeks in the hospital and in rehabilitation I was able to go home. I was lucky. I made about a 98 percent recovery. Some people suffer lifelong problems from GBS."

GBS, or Guillain-Barre Syndrome, strikes an estimated 3,000 to 6,000 people a year in the U.S. It's a terrifying disease in which the body's immune system strips away the sheathing that protects the nerves that extend out from the brain and spinal cord. What begins as a tingling sensation in the arms and legs can progress--sometimes within days--to paralysis.

Five to ten percent of GBS victims die, and another 15 to 20 percent are left with nerve damage that, in some cases, leaves them unable to care for themselves. One in five victims temporarily need ventilators to keep them breathing while their bodies fight off the disease. There is no known cure.

While scientists don't know what causes Guillain-Barre Syndrome, they do know that more than half the cases occur soon after a bacterial or viral infection. That could be anything from a sore throat to food poisoning.

"Evidence is growing that the most important trigger of GBS is the bacterium Campylobacter jejuni, which causes the greatest number of food-borne illnesses in the U.S. each year," says Ban Mishu Allos of the Vanderbilt University School of Medicine in Nashville.

"At least 30 to 40 percent of GBS patients have been infected with Campylobacter during the two weeks before the start of their illness," she adds. That's based on studies in six different countries. (2)

Worse still, the people whose Guillain-Barre Syndrome is triggered by Campylobacter instead of a virus, another bacterium, or some other mechanism, are likely to suffer greater nerve damage. (2)

How do people get Campylobacter infections? "More than 70 percent of the cases are associated with eating chicken," says Allos.

In fact, that package of chicken you drop into your shopping cart is probably already contaminated. In the summer of 2000, Consumer Reports magazine tested four national brands of poultry. Seventy percent of the samples were contaminated with Campylobacter.

Fortunately, thorough cooking destroys Campylobacter. And even if you do get food poisoning, your odds of coming down with Guillain-Barre Syndrome are slim.

But once the bug strikes, there's no way to lower your risk of developing GBS. Within a few weeks, you'll either get it or you won't. "So consumers should do their best to avoid Campylobacter in the first place," says Allos. (See "Safe at the Plate.")

Reactive Arthritis

When the Pope visited Ontario, Canada, in 1984, 432 of the police officers who helped provide security fell ill from Salmonella food poisoning. Over the next three months, 27 of them developed reactive arthritis. Five years later, 18 still showed symptoms, and four had become too incapacitated to work as police officers.

In 1994, 800 people attending a company-sponsored Thanksgiving banquet in the Tacoma, Washington, area ate turkey and dressing that were contaminated with Salmonella enteritidis bacteria. Of the 400 who became sick, one in three had diarrhea for more than a week, and one in ten got it so bad that they ended up at the hospital. (1) But for many, diarrhea turned out to be the least of their problems.

"Within one month of getting sick, 29 percent of those who came down with food poisoning reported pain, swelling, or redness at their joints," says Mark Dworkin, now at the Illinois Department of Public Health in Chicago. As with Guillain-Barre Syndrome, those who had the worst bouts of food poisoning were the most likely to get reactive arthritis.

The investigators didn't follow the people for more than a month, so it's impossible to know how many continued to suffer. But in other studies, joint pain brought on by food poisoning lasted for years. (3) And other bugs--like Shigella, Yersinia, Campylobacter, and Clostridia--can also cause lasting joint pain. (4)

Hemolytic Uremic Syndrome 

The Jack in the Box food poisoning outbreak of 1993 is a distant memory for most of us. But that may not be true for the 700 people in Washington, California, Nevada, and Idaho who became ill after eating undercooked hamburgers made from ground beef that was contaminated with E. coli O157:H7 bacteria.

Four children died and dozens were hospitalized with kidney problems and bleeding. One young victim required a kidney transplant. Three others had their gallbladders removed.

Brianne Kiner, now a teenager, suffered the worst of those who survived. Six weeks in a coma left Brianne so disabled that she needed five years of rehabilitation before she could return to school. Her pancreas shut down, so she has to inject herself with insulin every day for her diabetes. Her large intestine was removed and her kidneys were so weakened that she will be unable to have children. And she has to take anticonvulsants to control her seizures and antacids because her stomach lining is damaged.

"My life has changed immensely due to what happened nine years ago," says Brianne. "If I had never become ill, I never would have had to deal with diabetes. If I had never become ill, I never would have had this sense of constant supervision. I'm always going to feel like I'm under a piece of glass because other people are afraid of what is going to happen to me because they don't know how my body is going to react."

E. coli O157:H7 is one nasty bug. According to the Centers for Disease Control and Prevention (CDC), five to ten percent of the young children who become sick from the bacterium develop hemolytic uremic syndrome (HUS). Bloody diarrhea is usually the first sign that the disease has started destroying red blood cells, damaging blood vessel walls, and attacking the kidneys.

Ninety percent of hemolytic uremic syndrome cases occur in children under the age of three. About one in 20 children who get it suffer a slow and agonizing death, as one organ after another stops functioning. For those who survive, one in three sustain permanent kidney damage and close to one in ten develop other lifelong complications like high blood pressure or recurring seizures.

"The only way to prevent hemolytic uremic syndrome from striking children is to prevent the E. coli infection in the first place," says Philip Tarr of the University of Washington in Seattle. "Once diarrhea occurs, it's quite likely futile to try to stop HUS from developing, because the bacteria's toxin is already damaging the blood vessels."

While you're most likely to come across E. coli O157:H7 in undercooked ground beef, you can also get it from lettuce, which can become contaminated with manure through fertilizer or tainted water, says the CDC. Other sources: steaks and roasts, unpasteurized fruit juice and cider (the FDA requires that they carry a warning label), and unpasteurized milk (it's legal, as long as it doesn't cross state lines).

(1) Clinical Infectious Diseases 33:1010, 2001.

(2) Infect. Dis. Clin. N. Amer. 12:173, 1998.

(3) Ann. Rheum. Dis. 56:516, 1997.

(4) Amer. Fam. Physician 60: 499, 1999.

RELATED ARTICEL:

"A lot of people think that food poisoning is nothing more than a case of the green-apple two-step," says Food and Drug Administration food-safety expert Morris Potter. He's talking about diarrhea.

Yet in a certain percentage of cases (researchers aren't sure how high), a bout of food poisoning can lead to arthritis, kidney damage, or temporary paralysis.

The kidney damage--which affects mostly young children--is the result of hemolytic uremic syndrome. The paralysis is a symptom of Guillain-Barre Syndrome. And the arthritis isn't the typical osteoarthritis that strikes so many older people or the less-common rheumatoid arthritis that can cripple victims as young as six months. It's called reactive arthritis--an inflammation in the joints that's triggered by an infection and that can last anywhere from several weeks to a lifetime.

It's hard to get a handle on the long-term complications of food poisoning. Symptoms may not appear until weeks after a person recovers from the initial diarrhea or other GI distress. A new study suggests that the problem may be more serious than anybody suspected. A month after a 1994 Salmonella food-poisoning outbreak in Washington state, some one out of five victims complained of arthritis pain. (1)

"We don't do a good job of predicting which people who develop an acute food-borne infection will go on to develop chronic complications," says Potter.

RELATED ARTICLE: "I sure would love my old life and body back".

Eight months prior to getting sick, I went on a diet of only vegetables, fruit, and chicken, tons of chicken. My children teased me about sprouting wings. In January of 1996, I celebrated my 36th birthday and felt like I was in the prime of my life.

On February 14, I noticed that my feet were both tingling, as if they were in a deep sleep and wouldn't wake up. Eight hours later, I collapsed and could not bear weight on my legs. By February 16, I was fully paralyzed to my waist. After a spinal tap, doctors confirmed that I had Guillain-Barre Syndrome. Every day I became much worse. I was moved to the Intensive Care Unit and put on life-support, for I could no longer breathe on my own and was totally paralyzed. All I could move were my eyes and the tip of one finger. I couldn't believe the amount of pain I was in, didn't know it was humanly possible. There were so many tubes and machines--nothing in my body was working anymore. I nearly died three times. I wasn't expected to live.

After 2 1/2 or so months I started getting a little better, but the pain was still extreme. I was finally weaned off the ventilator, feeding tube, etc. I started relearning how to move my arms and hands. It was very hard and humiliating to once again learn how to eat, drink, etc. No one expected that I'd ever write again, and walking someday seemed to not be possible. Over the months I got better. I now do everything I used to. It's just a lot harder.

I sure have a fear of poultry, no matter how properly it is handled or cooked. I sure would love my old life and body back.

--Mary Milne, 42 FAIRY GLEN, SASKATCHEWAN, CANADA

RELATED ARTICLE: Safe at the plate.

AT THE STORE

* Don't let juice from raw meat, poultry, or fish drip on to your hands or any fresh foods in your grocery cart (or in your kitchen).

* Shop for cold and frozen foods last and put them in the refrigerator or freezer as soon as possible.

* Avoid unpasteurized milk and juice, as well as foods that could contain raw or undercooked eggs (among them: homemade or some restaurants' mayonnaise, eggnog, Caesar salad dressing, ice cream, mousse, meringue, or Bearnaise or Hollandaise sauce). And if your cookie or cake recipes call for eggs, make sure you don't eat--or let kids eat--any of the raw dough.

IN THE KITCHEN

* Always wash your hands in hot, soapy water before and after handling raw meat, poultry, seafood, or eggs.

* Keep your refrigerator at 40 [degrees] F or less and your freezer at 0 [degrees] F.

* Don't store raw or defrosted fish, poultry, or ground beef for more than two days, and other raw meats for more than five days.

* Thaw frozen foods in the fridge or defrost them in the microwave, not at room temperature.

* Cook meats thoroughly. Use a meat thermometer in the thickest part of the meat, but don't insert it until the outside is seared (if not, the thermometer could carry bacteria from the surface of the meat to the interior). The U.S. Department of Agriculture says to cook your meat at least to these internal temperatures:

145 [degrees] F--beef, lamb, veal

160 [degrees] F--ground beef, lamb, veal; all pork cuts

165 [degrees] F--ground poultry

170 [degrees] F--chicken breast

180 [degrees] F--other chicken parts, whole chicken or turkey (measured in the thigh)

* Always heat your marinades before basting meat or poultry.

* To keep bacteria from growing, put your sponge or scouring pad in the dishwasher every time you run it.

* People at high risk for food-borne disease (children, the elderly, and people with compromised immune systems) shouldn't eat raw alfalfa or beans sprouts. If you are a healthy adult, only buy sprouts that are refrigerated, and rinse them thoroughly with water before you use them.