OT: Long-Term Ills Tied to Bad Food

[Guest guest]

http://www.washingtonpost.com/wp-dyn/content/article/2008/08/29/AR2008082902519.\

html

Long-Term Ills Tied to Bad Food

Symptoms May Arise Years After Poisoning

By Annys Shin

Washington Post Staff Writer

Tuesday, September 2, 2008; HE01

Over the past five years, Pierce has suffered repeated kidney failure,

spent three years on dialysis, had the plasma in her blood replaced twice, and

lost a fiance, friends and a job -- all because of something she ate.

Pierce, now 30, was infected with a toxic strain of bacteria, E. coli O157:H7,

that can be spread through undercooked meat or raw produce. Today, she has a

healthy kidney donated by her brother, a full-time job and a husband. But the

medicines she takes to keep her body from rejecting her replacement kidney carry

a high risk of causing birth defects, so she has ruled out pregnancy.

" I would have liked to have had children, " she said.

Pierce belongs to a small subset of people who develop long-term health problems

from food poisoning. Their ranks are growing. Over the past decade, as medical

experts have sought out the source of certain chronic illnesses, they have

increasingly found links to episodes of food poisoning, sometimes many years

beforehand, according to the Centers for Disease Control and Prevention

<http://www.washingtonpost.com/ac2/related/topic/Centers+for+Disease+Control+and\

+Prevention?tid=informline>

..

Campylobacter, a bacterium associated with raw chicken, is now recognized as a

leading cause of the sudden acute paralysis known as Guillain-Barré

syndrome.20Certain strains of salmonella, the bacterium involved in the recent

outbreak in Mexican raw jalapeño and serrano peppers, can cause arthritis. And

E. coli O157:H7, a strain of an otherwise harmless bacterium that lives in

animal intestines, can release toxins that cause hemolytic uremic syndrome, or

HUS, a kidney disorder that in 25 to 50 percent of cases leads to kidney

failure, high blood pressure and other problems as much as 10 years later.

This list is just the beginning of the many health problems some people are now

attributing to food-borne infections.

" What the classical medical literature says and what we've seen is not the

same, " said Donna Rosenbaum, executive director of Safe Tables Our Priority, or

STOP, a nonprofit that represents people who have suffered serious food-borne

illness.

The CDC estimates there are 76 million cases of food-borne disease in the United

States annually. The vast majority of people experience it only as an unpleasant

bout of diarrhea or abdominal pain, though an estimated 5,000 to 9,000 Americans

die each year from food poisoning. A handful of pathogens are responsible for

more than 90 percent of those fatalities: salmonella, listeria, toxoplasma,

noroviruses, campylobacter and E. coli. Those most susceptible to infection are

small children, the elderly and people with compromised immune systems.

Until recently, doctors were focused on the acute phase of food-borne

infections, but since the 1990s, there has been " a more gradual recognition that

some of the pathogens do have20long-term [effects], " said Marguerite Neill, an

infectious-disease specialist who teaches at Brown University

<http://www.washingtonpost.com/ac2/related/topic/Brown+University?tid=informline\

>

.. " We're already on the right track in terms of [saying] food-borne illness is

more than diarrhea and may end up with long-term [illnesses]. " Some doctors are

now wondering, for example, whether food-borne infections trigger irritable

bowel syndrome and colitis, said Pavia, an infectious-disease expert at

the University of Utah

<http://www.washingtonpost.com/ac2/related/topic/University+of+Utah?tid=informli\

ne>

..

However, long-term health effects of food-borne infections are hard to study,

for a variety of reasons. First, it is tough to prove a link between some of

these illnesses and later chronic conditions such as arthritis. Second, despite

annual outbreaks across the nation, the subject hasn't attracted much public

attention or funding, Neill said. Also, federal health-care privacy laws make it

difficult for researchers to approach anyone who is not in their direct care.

To get around the last of these problems, STOP is setting up a national registry

of victims of food-borne disease who would be willing to participate in

longitudinal studies. The registry could help researchers determine, for

instance, how frequently food-borne infection leads to chronic health problems

and what role factors such as genetics play in who develops them.

A Case Study

Researchers and clinicians face unique challenges when studying the long-term

effects of HUS. The first outbreak20associated with E. coli in the United States

was in the 1980s. Many of the earliest victims are only now entering their

childbearing years.

Also, the number of HUS cases is small. Only about 5 to 10 percent of the 73,000

people each year who get sick from E. coli develop HUS.

The impact of HUS, however, is great. In the acute phase, microscopic blood

clots may form in the kidney, leading to kidney failure, Neill said. Sometimes

the kidney can be rescued with temporary dialysis. Less commonly, these blood

clots form in organs such as the brain and cause stroke or seizure. There may be

permanent damage to the kidney.

According to a long-term study of 157 HUS victims co-written by Pavia in 1994,

more than half developed kidney problems seven or more years after the initial

illness.

These people face a lifetime of medical treatment. " Anyone with HUS will be

monitored for the rest of their lives. If the acute course was severe enough,

the risk of long-term kidney complications, including end-stage renal disease

and kidney transplant, is quite high. The future medical cost alone can then be

in the millions, " said Marler, a Seattle lawyer who sues retailers and

food companies on behalf of food poisoning victims.

That is the scenario Armstrong faces. Her two daughters got sick after

eating bagged baby spinach in 2006. Her older daughter, Isabella, who was 4 at

the time, survived with no apparent health problems. But her younger daughter,

, who was 2 at the time, developed H

US. She has only 10 percent kidney function and will likely need more than one

kidney transplant in her lifetime, including one before she is an adult. Also,

when she becomes an adult, may face the same dilemma that Pierce

did: deciding whether bearing a child is worth the risk.

There may be a way to prevent the worst HUS cases and their consequences.

Doctors in Washington state have found that it is important to hydrate a patient

if they even suspect an E. coli infection. Doing so helps reduce the extent of

injury to the kidneys. More research needs to be done to identify other

effective interventions, said Tarr, an HUS expert at Washington

University School of Medicine

<http://www.washingtonpost.com/ac2/related/topic/Washington+University+in+St.+Lo\

uis?tid=informline> 

in St. Louis.

" There is a lot we don't know yet, " Tarr said.

Comments:shina@....