What Physicians Need to Know About Foodborne Illness: Suspect, Identify, Treat, and Report

HOST: FOOD IS LOVE AND LIFE, CELEBRATION AND NURTURING. IT’S OUR PASSION, OUR HOBBY, AND ONE OF THE WAYS OF SHOWING WE CARE. AND IN THE UNITED STATES, THE FOOD SUPPLY THAT WE DEPEND ON IS AMONG THE SAFEST IN THE WORLD. HOWEVER, WHEN CERTAIN DISEASE-CAUSING BACTERIA, VIRUSES, PARASITES, OR CHEMICALS CONTAMINATE FOOD, THEY CAN CAUSE FOODBORNE ILLNESS. WOMAN: THERE IS ONE POINT WHERE THE DOCTORS CAME IN AND SAID SHE HAD LOST SO MUCH KIDNEY FUNCTION THAT WE SHOULD JUST BE PREPARED FOR THE WORST. DIFFERENT WOMAN: EVENTUALLY, SOMEBODY CAME TO THE INTENSIVE CARE UNIT WHERE I WAS, AND THEY SAID, “WE DON’T THINK HE’S GOING TO MAKE IT.” DIFFERENT WOMAN: A COUPLE OF TIMES, THEY THOUGHT I WAS GOING TO DIE. I COULDN’T LIFT MY HEAD OFF THE PILLOW, I WAS SO SICK, AND I’M JUST LUCKY I LIVED THROUGH IT. WE HAD A PRIEST COME IN AND GIVE HIM LAST RITES, AND, YOU KNOW, PRAYED FOR THE BEST. WOMAN: I LOOKED RIGHT AT THE DOCTOR, AND I SAID, “THAT’S NOT AN OPTION. “YOU HAVE TO FIX THIS. WE’RE NOT GOING TO LOSE HER.” HOST: FOODBORNE ILLNESS IS A COMMON, COSTLY, SOMETIMES LIFE-THREATENING, YET LARGELY PREVENTABLE PUBLIC HEALTH PROBLEM. THOUGH MUCH HAS BEEN DONE TO IMPROVE THE SAFETY OF OUR FOOD, WHAT CAN BE DONE TO MINIMIZE THE RISKS AND SAVE THE LIVES OF THOSE MOST AT RISK? THE CDC, THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION, ESTIMATE THAT THERE ARE ABOUT 48 MILLION CASES OF FOODBORNE ILLNESS ANNUALLY, THE EQUIVALENT OF SICKENING ONE IN 6 AMERICANS EACH YEAR, AND EACH YEAR, THESE ILLNESSES RESULT IN AN ESTIMATED 128,000 HOSPITALIZATIONS AND 3,000 DEATHS. MANY OUTBREAKS AND INDIVIDUAL CASES OF FOODBORNE ILLNESS RESULT FROM EXPOSURE TO THE TWO MOST COMMON FOODBORNE AGENTS–VIRUSES SUCH AS NOROVIRUS OR HEPATITIS A, AND BACTERIA LIKE SALMONELLA, LISTERIA, OR E. COLI. SO LET’S LOOK AT HOW WE CAN BETTER HELP OUR PATIENTS BY PREVENTING, DIAGNOSING, TREATING, AND REPORTING INDIVIDUAL CASES AND OUTBREAKS OF FOODBORNE DISEASE, ESPECIALLY FOR PATIENTS WHO ARE AT GREATEST RISK OF SERIOUS COMPLICATIONS, HOSPITALIZATION, OR EVEN DEATH. ALTHOUGH EVERYONE IS SUSCEPTIBLE TO FOODBORNE ILLNESS, SOME PEOPLE ARE AT GREATER RISK, SUCH AS PREGNANT WOMEN, YOUNG CHILDREN, OLDER PEOPLE, AND THOSE WITH COMPROMISED IMMUNE SYSTEMS, THAT IS, IMMUNE SYSTEMS NOT YET FULLY DEVELOPED OR WEAKENED EITHER BY ILLNESS OR TREATMENTS FOR ILLNESSES. ANNE MARIE STEPHENSON: WE’RE ALL AT RISK PRETTY MUCH FOR FOODBORNE ILLNESSES, BUT THERE ARE CERTAIN GROUPS WITHIN THAT THAT ARE AT HIGHER RISK AND, WHEN AFFECTED, HAVE MORE SIGNIFICANT COMPLICATIONS. THAT IS DUE TO OUR IMMUNE SYSTEM. OUR IMMUNE SYSTEM CHANGES THROUGHOUT A LIFETIME, AND CERTAIN CO-MORBIDITIES AS WELL AS SOME MEDICATIONS CAN ALSO AFFECT THAT, AS WELL, AND SOME OF THOSE GROUPS WHEN WE THINK ABOUT THOSE ARE OLDER ADULTS, YOUNG ADULTS THAT ALSO HAVE CO-MORBIDITIES AND MEDICAL DISEASES, AS WELL AS PREGNANT WOMEN. PREGNANCY IS A PHYSIOLOGICAL CHANGE WHICH ALSO AFFECTS THE IMMUNE SYSTEM, SO THE MOTHER, HER IMMUNE SYSTEM IS NOT ONLY WORKING FOR HER, BUT THE BABY, AS WELL, AND SO PREGNANT WOMEN ARE A HIGHER RISK FOR CERTAIN INFECTIONS BECAUSE CERTAIN INFECTIONS SUCH AS LISTERIA CAN CROSS THE PLACENTA AND AFFECT THE FETUS. TRISSI: I WAS PREGNANT WITH TWINS, AND I HAD BEEN PUT ON BED REST BECAUSE MY IRON COUNTS WERE LOW, SO MY SISTER BROUGHT ME A MEAT PRODUCT WITH A LOT OF IRON TO HELP WITH THAT, AND I STARTED FEELING A LITTLE CRAMPY AND FEVERISH. THE MORNING OF SEPTEMBER 30th, I WOKE UP FEELING REALLY ACHY IN MY BACK AND JUST DIDN’T FEEL GREAT. LATER ON THAT DAY, I SUDDENLY WENT INTO LABOR, AND MY TWINS WERE BORN THAT DAY. THEY IMMEDIATELY TOOK THEM TO THE NICU. AT FIRST, I WASN’T ALARMED BECAUSE IT’S VERY COMMON WITH A TWIN PREGNANCY. I THINK IT WAS PROBABLY THE NEXT DAY THAT I REALLY UNDERSTOOD THAT THEY WERE VERY SERIOUSLY ILL. I WAS TOLD THAT MY SON’S APGAR WAS A ONE ON A SCALE OF ONE TO 10 AND THAT THEY COULD TELL HE WAS ALIVE, BUT THEY COULDN’T REGISTER A TEMPERATURE ON HIM AT ALL, AND HIS VITAL SIGNS WERE VERY WEAK, AND I WAS TOLD MY DAUGHTER’S APGAR WAS A 4, LITTLE BIT BETTER, BUT DEFINITELY NOT WHAT YOU WANT TO HEAR. PAUL: YOU KNOW, THIS WAS SUPPOSED TO BE THE HAPPIEST DAY OF MY LIFE, SO THAT WAS EXTREMELY JUST DISCONCERTING TO ME, TO SEE WHAT WAS HAPPENING, VERY SCARY. TRISSI: I STARTED FEELING VERY UNCOMFORTABLE, AND I STARTED BEING ASKED UNUSUAL QUESTIONS, SUCH AS, “ARE YOU A MARATHON RUNNER?” AND I SAID, “NO. I’VE BEEN ON BED REST. I CAN BARELY WALK UP A FLIGHT OF STEPS.” IT WAS BASICALLY BECAUSE HER TEMPERATURE, HER BODY TEMPERATURE, WAS GOING DOWN SO LOW AND ALSO HER PULSE WAS EXTREMELY LOW, AND THEY HAD TO PUT A BEAR HUGGER AROUND HER TO WARM HER UP, AND, YOU KNOW, IT WAS REALLY AT THAT POINT THAT I REALIZED EVERYBODY IN MY FAMILY WAS EXTREMELY SICK. HOST: IN 2011, DIANA WAS 64 YEARS OLD AND IN FAIRLY GOOD HEALTH, BUT HER AGE LEFT HER VULNERABLE TO FOODBORNE ILLNESS. DIANA: MY YOUNGEST DAUGHTER HAD BEEN ILL, AND SHE WAS IN THE HOSPITAL, SO I WAS IN A HURRY TO GET SOMETHING TO EAT BECAUSE IT WAS LATE IN THE EVENING, AND I RAN IN THE STORE AND PICKED UP SOME GROUND TURKEY, AND I COOKED ABOUT HALF OF IT AND THREW THE OTHER HALF IN THE FREEZER. I WOKE UP WITH A REALLY, REALLY UPSET STOMACH. THAT’S WHEN MY PROBLEM WITH THE DIARRHEA STARTED, AND BY THE NEXT DAY, IT WAS CONSTANT. I THOUGHT IT WAS JUST A CASE OF THE FLU, YOU KNOW, AND IT HAD JUST GOTTEN SEVERE. MY SON CAME BY BECAUSE HE SAID, “MOM, YOU JUST SOUND TERRIBLE,” AND HE TOOK ME TO URGENT CARE. THEY LOOKED AT ME, AND MY POTASSIUM WAS 0.5. YOU’RE SUPPOSED TO DIE AT 1.5, SO I HAD GONE WAY BEYOND WHERE I SHOULD HAVE GONE, SO THEY CALLED AN AMBULANCE AND IMMEDIATELY TRANSPORTED ME TO THE MAIN HOSPITAL. I LOOK BACK AT THE TIME BECAUSE I HAD MY GRANDSON. HE WAS LITTLE THEN, AND HE’S A PICKY EATER, IS THE ONLY REASON HE DIDN’T PROBABLY EAT SOME, SO JUST THINK HOW SERIOUS THAT WOULD’VE BEEN IF I WOULD HAVE FED IT TO HIM. STEPHENSON: SO WITH CHILDREN, THE THING IS, IS THAT THEIR IMMUNE SYSTEM IS NOT FULLY DEVELOPED. IT STILL TAKES TIME TO MATURE, AND FOR THAT REASON, THEY ARE MORE AT RISK, AND SO THERE ARE CERTAIN INFECTIONS, SUCH AS SALMONELLA AND E. COLI, THAT HAVE HIGHER RATES IN CHILDREN AS A RESULT. RYLEE: WELL, WHEN I WAS 9 YEARS OLD, I WENT ON VACATION WITH MY MOM AND MY DAD TO SAN FRANCISCO. IT WAS FOR MY NINTH BIRTHDAY. ONE DAY, I WAS WITH MY FATHER, AND WE WENT OUT TO GO GROCERY SHOPPING. I WAS THE ONE WHO ACTUALLY PICKED OUT THE SPINACH BAG, AND IT’S REALLY UNFORTUNATE THAT I GOT SICK FROM THAT SPINACH. KATHLEEN: RYLEE’S FIRST SYMPTOMS WERE JUST SOME STOMACH CRAMPING AND SOME DIARRHEA AND SEEMED LIKE JUST A NUISANCE AT THE TIME, BUT IN THAT SHORT DRIVE BETWEEN MONTERREY BAY AND SAN FRANCISCO, WE HAD TO STOP MULTIPLE TIMES, AND SHE CAME OUT OF THE BATHROOM ONE TIME AND SAID, “MOM, THERE’S BLOOD IN MY DIARRHEA.” AND I WENT, “WHAT? NO. OK. “NEXT TIME YOU GO, CALL ME. I’LL COME LOOK AT IT,” AND, SURE ENOUGH, I LOOKED, AND I WENT, “OH, GOD,” AND AS SOON AS WE GOT TO THE HOTEL, I CALLED HER PEDIATRICIAN AND TOLD THEM WHAT WAS GOING ON, AND THEY SAID, “GET HER TO AN EMERGENCY ROOM OR AN URGENT CARE,” AND SHE HAD ALREADY LOST SO MUCH BLOOD AND SO MUCH FLUIDS, THEY COULDN’T EVEN GET HER BLOOD PRESSURE, SO WHAT STARTED OFF AS A 4-DAY TRIP TO SAN FRANCISCO FOR HER NINTH BIRTHDAY ENDED UP BEING AN OVER-A-MONTH-LONG ORDEAL. HOST: OVER THE PAST SEVERAL YEARS, THERE HAVE BEEN SIGNIFICANT FOODBORNE DISEASE OUTBREAKS IN THE UNITED STATES. AMONG THE MOST PROMINENT WAS AN OUTBREAK OF LISTERIOSIS IN 2011 RESULTING FROM CONSUMPTION OF CONTAMINATED WHOLE CANTALOUPES. THE CANTALOUPES WERE GROWN ON A FARM IN COLORADO BUT CAUSED ILLNESSES IN 28 STATES IN TOTAL. THE CANTALOUPES WERE RECALLED, BUT 147 PEOPLE BECAME ILL, OF WHOM 143 WERE HOSPITALIZED AND 33 DIED. THEN THERE WAS THE SALMONELLOSIS OUTBREAK IN 2008 LINKED TO CONTAMINATED PEANUT BUTTER THAT CAUSED ILLNESSES IN 714 PEOPLE IN 46 STATES. MORE THAN 166 WERE HOSPITALIZED, AND THE INFECTIONS MAY HAVE CONTRIBUTED TO 9 DEATHS. AN OUTBREAK DUE TO SPINACH CONTAMINATED WITH SHIGA-TOXIN-PRODUCING E. COLI TOOK PLACE IN 2006 THAT RESULTED IN 238 ILLNESSES REPORTED FROM 26 STATES. 103 PEOPLE WERE HOSPITALIZED, AND 5 DIED, INCLUDING TWO ELDERLY PERSONS AND A TWO-YEAR-OLD CHILD. OUTBREAKS LIKE THESE AND OTHERS SPURRED THE FDA TO ISSUE REGULATIONS TO CARRY OUT THE FOOD SAFETY MODERNIZATION ACT OF 2011, THE MOST SWEEPING REFORM OF FOOD SAFETY LAWS IN MORE THAN 70 YEARS. THESE NEW RULES REQUIRE FOOD PRODUCERS TO IDENTIFY POTENTIAL PROBLEMS IN THEIR FOOD PROCESSING PLANTS AND DEVELOP CONTROLS TO PREVENT OR MINIMIZE THOSE PROBLEMS BEFORE THEY HAPPEN. THEY ALSO SET SCIENCE-BASED SAFETY STANDARDS FOR THE GROWING, HARVESTING, AND PACKING OF FRESH PRODUCE. OUTBREAKS ONLY REPRESENT PART OF THE STORY, THOUGH. EVEN IF THERE IS NO IDENTIFIED OUTBREAK OR RECALL, PATIENTS CAN PRESENT AT DOCTORS’ OFFICES AND HOSPITALS WITH FOODBORNE ILLNESS SYMPTOMS AT ANY TIME, AND IT’S UP TO THE HEALTH CARE PROVIDERS TO DIAGNOSE IT PROPERLY. STEPHENSON: WHEN EVALUATING A PATIENT FOR FOODBORNE ILLNESS, THE HEALTH CARE PROVIDER SHOULD CONSIDER 4 STEPS. THOSE ARE SUSPECT, IDENTIFY, TREAT, AND REPORT. LET’S START BY DISCUSSING THE FIRST TWO STEPS, WHICH ARE SUSPECT AND IDENTIFY. BY SUSPECT, I’M REFERRING TO THE SYMPTOMS THAT ARE PRESENT THAT THE PATIENT PRESENTS WITH, AND THIS ALSO WOULD INCLUDE THE HISTORY OF THE SYMPTOMS AND ALSO TO CONSIDER THE PATIENT’S MEDICAL HISTORY, AS WELL. MOST COMMONLY, FOODBORNE ILLNESSES CAN PRESENT WITH GASTROINTESTINAL SYMPTOMS, SUCH AS NAUSEA, VOMITING, ABDOMINAL PAIN, AND DIARRHEA, AND SO FOODBORNE ILLNESS SHOULD BE IN THE DIFFERENTIAL DIAGNOSIS FOR THE HEALTH CARE PROVIDER. THERE ARE CERTAIN TIMES WHERE THIS BECOMES A LITTLE BIT DIFFICULT, PARTICULARLY WITH PATIENTS THAT HAVE CO-MORBIDITIES SUCH AS MALIGNANCIES THAT ARE BEING TREATED WITH CHEMOTHERAPY. CHEMOTHERAPY SIDE EFFECTS COMMONLY ARE GASTROINTESTINAL SYMPTOMS, SO IT’S IMPORTANT TO ALSO KEEP THAT IN MIND WHEN YOU’RE EVALUATING THOSE PATIENTS, AS WELL. AS WE MENTION SUSPECT AND WE TALK ABOUT THE HISTORY OF THE PATIENT’S SYMPTOMS, A FOOD DIARY IS ALWAYS HELPFUL AS WELL AS TIMING AS TO WHEN THE SYMPTOMS STARTED BECAUSE THIS CAN HELP NARROW THE DIFFERENTIAL DIAGNOSIS IN TERMS OF WHICH INFECTION FOR THE PRACTITIONER THAT’S TREATING THE PATIENT. IN ORDER FOR A HEALTH CARE PROVIDER TO MAKE A DIAGNOSIS, THEY NEED TO CONSIDER THE SPECTRUM OF CLINICAL MANIFESTATIONS OF FOODBORNE ILLNESSES BECAUSE PATIENTS MAY PRESENT WITH ATYPICAL SYMPTOMS, SUCH AS CHANGE IN MENTATION, LETHARGY, PARESTHESIAS, AS WELL AS PARALYSIS, AND THIS CAN MAKE IT QUITE DIFFICULT TO REALLY GET THE DIAGNOSIS. HOST: IT WAS PARTICULARLY DIFFICULT IN TRISSI’S CASE TO SUSPECT OR IDENTIFY THE PATHOGEN THAT HAD INFECTED HER AND THE TWINS. ONE REASON IS BECAUSE NONE OF THEM WERE PRESENTING WITH TYPICAL FOOD BORNE ILLNESS SYMPTOMS. THERE WAS NO VOMITING OR DIARRHEA AND NO OTHER GASTROINTESTINAL SYMPTOMS. TRISSI: MY DOCTOR TELLING ME THAT I WAS ONE OF THE TOP 10 STRANGEST CASES THAT HE HAD SEEN IN HIS 20 YEARS OF PRACTICE. I THINK THE DOCTORS SUSPECTED AN INFECTION, BUT THEY HAD NO IDEA WHAT IT WAS, AND APPARENTLY, INOVA FAIRFAX HAD NOT SEEN A CASE OF LISTERIA IN ABOUT 10 YEARS. PAUL: WE’RE VERY FORTUNATE TO HAVE AN AMAZING NICU AT INOVA HERE IN FAIRFAX. THEY WERE PUTTING THE BABIES THROUGH ALL THE PROTOCOLS, ALL THE TESTS, AND, LUCKILY, ONE OF THE NURSES THERE HAD ACTUALLY SEEN A LISTERIA OUTBREAK PREVIOUSLY WHERE SHE HAD WORKED, AND THE WAY THAT THEY WERE PRESENTING, SHE SAID, “HEY, THIS LOOKS LIKE THAT’S WHAT IT MIGHT BE,” AND THEN THE COURSE OF ANTIBIOTICS THEN WERE ADMINISTERED TO COUNTERACT THE SITUATION. TRISSI: SHE WAS ONE OF THE FIRST NURSES TO TREAT CHLOE AND LUKE. I BELIEVE SHE SAVED OUR LIVES. PAUL: WE OWE HER EVERYTHING. HOST: IN CALIFORNIA, THE TEAM AT UCSF RECOGNIZED RYLEE’S FOODBORNE ILLNESS SYMPTOMS AND ACTED QUICKLY TO TEST STOOL SAMPLES. WITHIN 24 HOURS, THEY WERE ABLE TO CONFIRM THAT SHE WAS INFECTED WITH SHIGA-TOXIN-PRODUCING E. COLI. THAT TIMELY IDENTIFICATION SAVED HER YOUNG LIFE. KATHLEEN: THE FIRST NIGHT RYLEE WAS IN THE HOSPITAL, HER DAD WAS CRYING… RYLEE: I JUST KNEW THAT SOMETHING WAS WRONG. KATHLEEN: AND RYLEE LOOKED AT HIM AND SAID, “I’M DYING, HUH?” RYLEE: I WAS FEELING HORRIBLE, AND I COULD FEEL THE ENERGY COMING OUT OF MY BODY. AND I JUST KNEW THAT IT COULD HAVE BEEN THE END. KATHLEEN: AND HE WAS LIKE, “NO, BABY. “YOU’RE NOT DYING. EVERYTHING IS GOING TO BE OK,” AND SHE WAS LIKE, “NO. YOU’RE CRYING, AND IF YOU’RE CRYING, I KNOW I’M DYING.” HOST: PATIENTS GET FOODBORNE ILLNESS WHEN THEY CONSUME CONTAMINATED FOOD OR BEVERAGES, SO THE MOST COMMON SYMPTOMS WILL BE GASTROINTESTINAL IN NATURE–NAUSEA, VOMITING, ABDOMINAL PAIN, AND/OR DIARRHEA, SOMETIMES BLOODY. WITH SOME FOODBORNE INFECTIONS, PATIENTS EXPERIENCE FEVER, WHILE IN OTHERS, THERE MAY BE NEUROLOGICAL SIGNS AND SYMPTOMS, SUCH AS PARESTHESIA, MOTOR WEAKNESS, OR PARALYSIS. ALL OF THESE SYMPTOMS CAN RANGE FROM RELATIVELY MILD DISCOMFORT TO VERY SERIOUS LIFE-THREATENING ILLNESSES, AND DIFFERENT CAUSATIVE AGENTS WILL PRODUCE DIFFERENT SYMPTOMS, AND, UNFORTUNATELY, THERE ARE MANY AGENTS TO WATCH OUT FOR. GO TO CDC.GOV FOR A LIST OF CAUSATIVE AGENTS AND INFORMATION ON EACH. WHEN A FOODBORNE ILLNESS IS SUSPECTED, A THOROUGH HISTORY SHOULD BE TAKEN FROM THE PATIENT THAT ELICITS INFORMATION AS TO WHETHER ANY HIGH-RISK FOODS WERE CONSUMED PRIOR TO ONSET OF ILLNESS. EXAMPLES OF HIGH-RISK FOODS INCLUDE RAW OR UNDERCOOKED MEATS OR SEAFOOD, UNPASTEURIZED DAIRY PRODUCTS, AND RAW SPROUTS. BECAUSE PRODUCE ITEMS HAVE PLAYED AN INCREASINGLY PROMINENT ROLE IN FOODBORNE DISEASE OUTBREAKS IN RECENT DECADES, IT’S IMPORTANT TO ASK PATIENTS ABOUT PRODUCE CONSUMPTION. ADDITIONALLY, PATIENTS SHOULD BE ASKED ABOUT RECENT CONTACT WITH ANIMALS AND WHETHER THEY HAVE RECENTLY EATEN AT RESTAURANTS OR EVENTS WITH GROUPS OF PEOPLE SERVED COMMON FOODS. IF WATERBORNE INFECTIONS ARE SUSPECTED, PATIENTS SHOULD BE QUERIED ABOUT DRINKING UNTREATED WATER OR IF THEY’VE BEEN EXPOSED TO A BODY OF WATER. IF THE PATIENT HISTORY SUGGESTS FOODBORNE ILLNESS IS THE CAUSE, THE APPROPRIATE LAB TESTING MUST BE DONE TO CONFIRM. ONCE A DIAGNOSIS HAS BEEN MADE, APPROPRIATE TREATMENT IS INDICATED. STEPHENSON: THE THIRD STEP IS TREAT. PROPER TREATMENT REALLY DEPENDS ON A PROPER DIAGNOSIS, BUT THERE ARE RESOURCES AVAILABLE FOR HEALTH CARE PROVIDERS AT CDC.GOV. IT’S CALLED “DIAGNOSIS AND MANAGEMENT OF FOODBORNE ILLNESSES,” AND THERE, YOU WILL FIND A HELPFUL CHART THAT HAS TREATMENT FOR MOST FOODBORNE PATHOGENS. KATHLEEN: RYLEE WAS IN THE HOSPITAL FOR 34 DAYS. MOST OF THAT WAS IN THE ICU. WHAT THEY TOLD US WAS THAT THEY COULD JUST DO PALLIATIVE CARE. IT’S KEEPING HER COMFORTABLE AND KEEPING HER HYDRATED UNTIL THE E. COLI PASSED THROUGH HER BODY, AND AS A PARENT, I COULDN’T FEEL ANY MORE USELESS TO HER. SHE WAS IN SO MUCH PAIN. THERE WAS NOTHING I COULD DO FOR HER, AND IT WAS HEART-WRENCHING. HOST: DIANA, WHO WAS SUFFERING FROM SALMONELLA POISONING, STRUGGLED WITH CONSTANT DIARRHEA AND DEHYDRATION. DIANA: I WAS GOING CONTINUALLY BECAUSE IT WAS NONSTOP. IN AN HOUR’S TIME OR SO, THEY’D BE PUTTING ANOTHER BAG UP, I WAS LOSING SO MUCH FLUID SO RAPIDLY. THAT’S HOW I GOT SO DEHYDRATED, BECAUSE IT WAS GOING OUT FASTER THAN THEY COULD PUT IT IN. STEPHENSON: MOST EPISODES OF GASTROENTERITIS, WE REALLY ENCOURAGE AGGRESSIVE ORAL HYDRATION, BUT THERE ARE SOME CASES WHERE PATIENTS ARE UNABLE TO KEEP UP WITH THE AMOUNT OF VOLUME THAT THEY’RE LOSING BY WAY OF VOMITING OR EVEN DIARRHEA. IN THOSE CASES, THOSE PATIENTS MAY REQUIRE IV HYDRATION AND EVEN HOSPITALIZATION IN A MONITORED SETTING. DIANA: I HAVE A WONDERFUL DOCTOR, AND SHE CAME, AND FOR A COUPLE DAYS WHEN I WAS IN THERE, SHE WAS THERE PROBABLY 3 OR 4 TIMES A DAY, AND A COUPLE TIMES, I REMEMBER HER SITTING ON THE SIDE OF THE BED RIGHT WHILE I WAS THERE AND JUST SAYING, YOU KNOW, “THIS NEEDS TO BE DONE,” OR, “THAT NEEDS TO BE DONE.” I’LL NEVER BE ABLE TO PAY HER FOR THE WONDERFUL CARE THAT SHE GAVE ME BECAUSE I DON’T THINK I WOULD BE HERE TODAY IF IT WASN’T THAT HOSPITAL AND HER MADE SUCH A POINT OF MAKING SURE THAT I HAD EVERYTHING I NEEDED. HOST: BATTLING E. COLI CAN BE A BIT OF A WAITING GAME, BUT RYLEE’S DOCTORS KNEW THERE WAS STILL A LOT TO BE DONE. THEY WORKED AROUND THE CLOCK NOT ONLY TO MAKE HER AS COMFORTABLE AS POSSIBLE, BUT TO COMBAT WHAT E. COLI WAS DOING TO HER TINY BODY. KATHLEEN: FOR THE KIDNEY FAILURE, THEY DID DIALYSIS. FOR THE FLUID THAT BUILT UP IN HER LUNGS, THEY HAD TO DO DRAINAGE TUBES ON EACH SIDE. SHE HAD FLUID BUILT UP AROUND HER HEART. SO THEY HAD TO DO A DRAINAGE TUBE IN HER CHEST. BECAUSE THE E. COLI TOXIN ATTACKED HER PANCREAS, SHE HAD TO HAVE TREATMENT FOR DIABETES, AND RYLEE HAD LOST A LOT OF BLOOD, SO SHE HAD MULTIPLE BLOOD TRANSFUSIONS. HOST: AT INOVA FAIRFAX HOSPITAL, THE TREATMENT FOR TRISSI AND HER DAUGHTER CHLOE WAS A FAIRLY STRAIGHTFORWARD COURSE OF ANTIBIOTICS, BUT FOR THE OTHER TWIN, LUKE, IT WAS BECOMING COMPLICATED. TRISSI: WE WERE TOLD BY THE DOCTORS THAT LUKE HAD INGESTED SOME OF THE MECONIUM AND THAT MY UTERUS WAS SO INFECTED THAT HE DEVELOPED PNEUMONIA FROM INGESTING THAT, WHICH CAUSED FURTHER COMPLICATIONS. HE HAD TO BE INTUBATED. PAUL: I WOULD GO AND VISIT THE NICU EVERY DAY, SO AT ONE POINT, I SHOWED TRISSI SOME PICTURES, AND I TOLD HER, YOU KNOW, LUKE WAS DOING THIS REALLY COOL THING. HE WAS, YOU KNOW, WAVING TO ME AND WHATNOT, AND THEN WE SUBSEQUENTLY FOUND OUT, UNFORTUNATELY, THAT IT WAS ACTUALLY HIM HAVING A SEIZURE OR TWO. TRISSI: SO HE WAS GIVEN PHENOBARBITAL, WHICH IS A VERY STRONG DRUG. THEY HAD TO PERFORM SURGERY ON LUKE TO ENABLE HIM TO RECEIVE ALL THE MEDICATIONS THAT HE NEEDED DIRECTLY THROUGH HIS HEART. THEY CALL IT CENTRAL LINE SURGERY. IT’S NOT SOMETHING YOU’RE ASKED ABOUT OR INFORMED ABOUT. THEY NEED TO DO IT, AND THEY DID WHAT THEY HAD TO DO. HOST: THE WHOLE ORDEAL IN THE HOSPITAL LASTED FOR A FEW WEEKS. TRISSI WAS IN THE ICU FOR 3 NIGHTS AND IN THE REGULAR MATERNITY WARD FOR ANOTHER 5 NIGHTS. CHLOE WAS IN THE NICU FOR 10 DAYS AND LUKE FOR ALMOST 3 WEEKS. PAUL: THIS WAS SUPPOSED TO BE AN AMAZING TIME FOR HER, COMING INTO MOTHERHOOD, AND THAT WAS REALLY JUST RIPPED AWAY FROM HER, AND THEN HERE WE ARE, SEEING OUR KIDS STRUGGLING JUST TO SURVIVE. VERY, VERY HARD. HOST: WE’VE TALKED ABOUT 3 OF THE 4 STEPS–SUSPECT, IDENTIFY, AND TREAT–AND IT GOES WITHOUT SAYING THAT PROPER DIAGNOSIS AND EFFECTIVE TREATMENT IS IMPERATIVE, BUT THE RESPONSIBILITY DOESN’T END THERE. THE FOURTH AND FINAL STEP, REPORTING FOODBORNE DISEASES, IS VITAL. ONCE A PATHOGEN HAS BEEN IDENTIFIED, IT’S THE PHYSICIAN’S RESPONSIBILITY TO REPORT IT TO THE LOCAL PUBLIC HEALTH DEPARTMENT. EACH STATE PUBLIC HEALTH OFFICE THEN REPORTS IT TO THE CDC. DIANA: IT’S UNBELIEVABLE THE AFFECT OF SALMONELLA ON ONE’S BODY BECAUSE THERE’S JUST HARDLY ANYTHING THAT WILL STOP IT. BASICALLY, I HAD TO RUN A COURSE. WITHIN THE FIRST COUPLE OF DAYS, I’M PRETTY SURE THE HEALTH DEPARTMENT WAS NOTIFIED BECAUSE OF THE SEVERITY OF IT. THE HEALTH DEPARTMENT CALLED ME AFTER I’D GONE HOME AND FOUND OUT THAT IT WAS SALMONELLA POISONING. I HAD THE OTHER HALF OF IT IN THE FREEZER BECAUSE I ONLY ATE ONE OF THE BURGERS, AND SHE SEEMED TO BE QUITE PLEASED ABOUT THAT, AND SO SHE ASKED IF SHE COULD COME AND GET IT, AND SHE BROUGHT SPECIAL CONTAINERS AND THIS BOXLIKE THING THAT WAS ALL FROZEN IN A WAY THAT THEY COULD PUT THAT RIGHT– THAT FROZEN IN THERE. IT GAVE THEM A SOURCE TO ANALYZE AND FIND OUT WHAT WAS ACTUALLY IN THAT AND ACTUALLY WERE THEY DIAGNOSING IT CORRECTLY. HOST: PROMPT REPORTING OF FOODBORNE DISEASES IS CRITICAL BECAUSE IT ALLOWS FOR RECOGNITION OF OUTBREAKS, HELPS STEM FURTHER TRANSMISSION OF DISEASE, AND IDENTIFIES WHETHER ADDITIONAL REGULATORY CONTROLS ARE NEEDED TO PREVENT FUTURE OUTBREAKS. FINALLY, AFTER SEVERAL MONTHS OF TREATMENT, TRISSI AND THE TWINS WERE OUT OF THE WOODS. TRISSI: THE STRAIN OF LISTERIA THAT WE HAD, THE MORTALITY RATE IS ABOUT 30%, SO THE FACT THAT THE THREE OF US SURVIVED IS PRETTY LUCKY. PAUL: SOMETIMES I FORGET WHERE WE’VE BEEN. FOR EXAMPLE, I’LL SEE MY DAUGHTER DO SOMETHING AMAZING. THEN I THINK BACK, AND I’M LIKE, “MAN, SHE’S HERE,” YOU KNOW, AND I HAVE THE ABILITY TO BE WITH HER. THEN LUKE, MY GOSH, YOU KNOW, THIS GUY’S TALLER THAN ME NOW, AND HE’S HERE, AND HE WAS 4 POUNDS, 14 OUNCES, WHEN HE WAS BORN. RYLEE: I CAN’T REALLY IMAGINE ME NOT GETTING SICK BECAUSE GETTING SICK AND THEN DECIDING TO DO SOMETHING ABOUT THE ISSUE AND ADVOCATING FOR FOOD SAFETY, THAT’S WHAT I FEEL IS MY PURPOSE IN LIFE. ADVOCATING FOR CHANGE TO FOOD SAFETY POLICY ALLOWS ME TO FEEL LIKE I’M NOT A VICTIM, BUT RATHER A VOICE FOR CHANGE AND AWARENESS. HOST: KEEPING PATIENTS SAFE FROM FOODBORNE ILLNESS IS FUNDAMENTAL TO THE HEALTH CARE COMMUNITY BECAUSE FOOD IS AN EXPRESSION OF WHO WE ARE. IT’S HOW WE COME TOGETHER, FIND COMFORT AND REASSURANCE, AND HOW WE CELEBRATE WHAT WE CHERISH MOST OF ALL. FOR A FULL LIST OF NOTIFIABLE PATHOGENS AND MORE INFORMATION ABOUT FOODBORNE ILLNESS, VISIT CDC.GOV. TO REQUEST RESOURCES ABOUT FOODBORNE ILLNESS, VISIT FDA.GOV AND SEARCH “FOOD SAFETY AND NUTRITION RESOURCES FOR HEALTHCARE PROFESSIONALS.” PATIENT EDUCATION MATERIALS ARE ALSO AVAILABLE FROM THE EDUCATION RESOURCE LIBRARY AT FDA.GOV.

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