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Maybe it was something you ate.


The force was with me. Or, rather, inside me. And itwas trying to get out in a hurry. My intestines felt as if they were playing host to a Bears-Raiders game. I was sick.

It has happened to all of us. In a few hours we go fromwell to wretched--and retching. Most of the time we blame the flu, and we even make up strains to suit the occasion, such as "the 24-hour bug that's going around."

But influenza is getting a bad rap. Last year in theUnited States, perhaps as many as 81 million times, what made us sick was something we ate. Roughly 9,000 people died of food poisoning, or food-borne illness, as government health officials call it.

My affliction was salmonellosis, so named because itwas the result of my ingesting salmonella bacteria. The strain that got me was Salmonella enteritidis, from an antigenic group that includes the rate--at least in the United States--and deadly Salmonella typhi, the cause of typhoid fever. The primary symptoms of Salmonella enteritidis are a headache, followed by days of what doctors term "unrelenting diarrhea." The usual treatment is to tough it out. My week of toughing it out included a diet of soy milk, cornflakes, and rice selected from a list of foods my doctor recommended.

He also told me each of us probablygets salmonella poisoning a hundred times during his life. "Sometimes it makes us very sick and sometimes it doesn't," he said. "We usually pass it off as the flue, but flu is customarily respiratory--more coldlike and achy. If diarrhea is the primary symptom, it was probably something you ate."

While I was recovering, I punched a request into mycomputer: search the Nexis data base for news references to food poisoning during the past two years. It hummed and hummed. Finally, it produced a list of more than 1,000 news articles. From these and other sources, I learned that food poisonings in America are increasing markedly.

The U.S. Centers for Disease control (CDC) recognizessome 300 food-borne illnesses, from common salmonellosis to the rare tetrodatoxin puffer fish poisoning. It's impossible to determine exactly how often people are laid low by these pathogens (the 81 million cited above is the roughest of estimates) because most victims never know that hit them. Even the infections of sufferers who seek medical attention are usually undiagnosed, because doctors allow the infections to run their course and seldom order tests to pinpoint the bacteria involved. A victim of food poisoning is likely to receive a specific diagnosis only if he becomes very, very sick or gets sick at the same time and in the same way as a whole bunch of other people.

The articles provided me with startling instances offood-borne illnesses:

* In the spring of 1985, as many as 200,000 peoplein the Midwest got salmonellosis. Investigators believe the most likely source was a valve that allowed a small amount of raw milk to leak into pasteurized milk at a dairy outside Chicago.

* In the summer of 1985, Listeria monocytogenesbacteria in soft cheese killed at least 80 Californians.

* In August 1985, botulism in salt-preserved fishkilled two elderly New Yorkers.

* In April 1986, salmonella in gefilte fish made 56people in suburban Washington, D.C., severely ill.

* In May 1986, 20 people who had attended a buffetin New Jersey got salmonellosis from eating stuffed pasta shells and lasagna. This led to a recall of 120 frozen pasta products in 47 states.

* In July 1986, more than a hundred Chicago-areadiners got sick from salmonella that health officials belived came from low-acid tomatoes that had been sliced by a carrier who had traces of his own feces on his hands.

* In August 1986, typhoid fever made nine peopledesperately ill after they'd eaten shrimp salad prepared by a typhoid carrier at a Maryland restaurant.

* In November 1986, five people in a Connecticutnursing home died from salmonella traced to pureed food.

* In December 1986, Nabisco ordered a nationwiderecall of millions of Baby Ruth candy bars after traces of Salmonella meleagridis were discovered in some lots.

My friends, like my computer screen, were also full offood-poisoning anecdotes. It was my own affliction, salmonellosis, that came up most frequently. This wasn't a coincidence. "Of all the food-borne pathogens we have to contend with in this country, salmonella is the one that's gaining on us fastest," says Robert Tauxe, an enteric disease epidemiologist and salmonella specialist at the CDC.

The Food and Drug Administration believes thatin 1985, 4 million Americans had a member of the Salmonella family for dinner. Thirty-five thousand were hospitalized with salmonellosis, which killed more than 1,000 people and left 120,000 others with chronic crippling diseases, such as arthritis. Tauxe says, "Salmonellosis was very rarely reported in the 1940s. It picked up steam in the '60s. Today the numbers just keep going up." The reasons, he says, "are many and subtle. You could point to the way we raise our livestock and the way we process and handle our food." As recently as 1975, only 23,448 cases were reported to the CDC. By last year that number had more than doubled. Those cases were just the tip of that possible 4-million-case iceberg. "Whatever numbers you want to use," Tauxe says, "I can tell you that the salmonella problem is one of the great underreported diseases in the country today."

A salmonella infection isusually just an unpleasant bout of gastrointestinal distress. The exception is the strain that causes typhoid fever, which is in a class by itself. It becomes systemic, invading the bloodstream and infecting many organs, where it triggers severe and sometimes fatal inflammations. Only about 500 cases are reported in the United States annually, and two-thirds of those are contracted abroad. Typhoid fever used to kill about one-third of its victims, and even with today's antibiotics, it still does in about one in ten. Nontyphoid salmonella is usually a killer only when it invades the bloodstream and colonizes in the brain or other organs. The intestines try to keep this from happening: diarrhea, in fact, is an immune response to ingested pathogenic bacteria. It flushes out the salmonellae that permeate the protective mucous coating and attach themselves to the intestinal walls.

But flushign teh sytem of salmonellaemay not end the illness. Says Doug Archer, director of the division of microbiology at the FDA: "Between 2 and & percent of salmonellosis sufferers are going to find out weeks later that they have reactive arthritis, which may be contracted because a component of the bacterium somehow fools the immune systems of people who have a certain gene--HLA-B27. Ten percent of the U.S. population have this gene." That means if 4 million people had salmonellosis last year, 120,000 of them will develop chronic arthritis as a result.

A smaller number of salmonella victims--perhapsonly one in 10,000--experience septic arthritis, a painful condition in which the bacteria invade the joints. Still others may suffer postinfection Reiter's syndrome, characterized by inflammation of the urethra, eyes, and joints.

Although farmers and peoplewho process food are well aware of the dangers of salmonella, they're sometimes helpless to prevent its spread. Tauxe and Mitchell Cohen, a CDC colleague, have reported that a growing number of antibiotic-resistant salmonellae are being passed from animals to man via food, because the animals are fed antibiotics that eliminate sensitive strains and lead to the development of resistant ones. As if all this weren't enough, sloppy housekeeping and food handling is abetting the increase in salmonella infections--especially in the home.

"It's easy to blame restaurants,"says Georgia Stevens Neruda, a U.S. Department of Agriculture food-safety expert and a home economist. "But when it comes to food poisoning, we usually do ourselves in at home."

Despite its name, this thing that'swaiting to ambush us in our kitchens has nothing to do with salmon. It was named for an American veterinarian, Daniel Salmon, who isolated it in 1886. Salmonella is a general term applied to a group of about 2,000 closely related bacteria. Each salmonella serotype--a subgroup sharing antigens--has its own name. The sero-types that most often made people sick in 1985 were S. typhimurium, which accounted for 49.7 percent of reported cases, followed by S. enteritidis (10 percent), S. heidelberg (9 percent), S. newport (4.3 percent), and S. hadar and S. agona (2 percent each). In the 25 years the CDC has been keeping track of serotypes, it has isolated close to 500 kinds of salmonella in humans.

Some serotypes prefer differentspecies of animals as hosts, but they're all spread in essentially the same manner. Since salmonella bacteria are shed alive and well in the feces of most animals, and since they're so tough they can withstand very hot and freezing weather, rain, and drought, they're found wherever food animals live. The animals pick up the salmoneallae from the soil or even from contaminated processed feed. Once consumed, the bacteria live in teh animals' intestines, where, depending on their serotype and number, they may or may not make the host sick. Then, during slaughtering and processing, minute numbers of the salmonellae can lead to contamination of food products. That's why the bacteria are found on or in raw meats, poultry, eggs, milk, fish, and shellfish. They're also carried by pets, especially birds, fish, dogs, cats, and turtles. In fact, the CDC determined that 14 percent of all salmonellosis cases in 1971 had been caused by pet tu rtles, which is why little turtles aren't sold in five-and-ten-cent stores any more.

Some serotypes are geographicallyspecific--or were, until we started shipping them all over the global village. Because of this specificty, salmonella makes for "fascinating epidemiological studies," says Tauxe, who then cites a prime example of microbial detective work at its best:

In teh wnter of 1973-74, a strain ofsalmonella struck 80 people living in different areas of the country. The source was discovered to be foil-wrapped, chocolate Christmas balls. The chocolates were tracked to a Canadian processor, and the bacteria, S. eastbourne, were traced to the cocoa beans used in manufacturing the candy. The beans were believed to have come from Ghana, where S. eastbourne has been isolated, and the bacteria weren't in the beans, but on them. There's speculation that the beans had been contaminated by gull feces while sitting on a dock in Africa.
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Title Annotation:salmonella poisoning
Author:Moser, Penny Ward
Publication:Saturday Evening Post
Date:Apr 1, 1987
Previous Article:"I think your mommy's had a stroke." (Pat Nixon)
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