Food poisoning can be long-term problem

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Food poisoning can be long-term problem

By LAURAN NEERGAARD

AP Medical Writer

AP Photo/Elaine

WASHINGTON (AP) -- It's a dirty little secret of food poisoning: E.

coli and certain other foodborne illnesses can sometimes trigger serious

health problems months or years after patients survived that initial

bout.

Scientists only now are unraveling a legacy that has largely gone

unnoticed.

What they've spotted so far is troubling. In interviews with The

Associated Press, they described high blood pressure, kidney damage, even

full kidney failure striking 10 to 20 years later in people who survived

severe E. coli infection as children, arthritis after a bout of

salmonella or shigella, and a mysterious paralysis that can attack people

who just had mild symptoms of campylobacter.

" Folks often assume once you're over the acute illness, that's it,

you're back to normal and that's the end of it, " said Dr.

Tauxe of the Centers for Disease Control and Prevention. The long-term

consequences are " an important but relatively poorly documented,

poorly studied area of foodborne illness. "

These late effects are believed to make up a very small fraction of the

nation's 76 million annual food poisonings, although no one knows just

how many people are at risk. A bigger question is what other illnesses

have yet to be scientifically linked to food poisoning.

And with a rash of food recalls - including more than 30 million pounds

of ground beef pulled off the market last year alone - these are

questions are taking on new urgency.

" We're drastically underestimating the burden on society that

foodborne illnesses represent, " contends Donna Rosenbaum of the

consumer advocacy group STOP, Safe Tables Our Priority.

Every week, her group hears from patients with health complaints that

they suspect or have been told are related to food poisoning years

earlier, like a woman who survived severe E. coli at 8 only to have her

colon removed in her 20s. Or people who develop diabetes after food

poisoning inflamed the pancreas. Or parents who wonder if a child's

learning problems stem from food poisoning-caused dialysis as a

toddler.

" There's nobody to refer them to for an answer, " says

Rosenbaum.

So STOP this month is beginning the first national registry of

food-poisoning survivors with long-term health problems - people willing

to share their medical histories with scientists in hopes of boosting

much-needed research.

Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as

part of the Jack-in-the-Box hamburger outbreak that 15 years ago this

month made a deadly E. coli strain notorious.

She's now a successful college student but ticks off a list of health

problems unusual for a 20-year-old: High blood pressure, recurring

hospitalizations for colon inflammation, a hiatal hernia, thyroid

removal, endometriosis.

" I can't eat fatty foods. I can't eat things that are fried, never

been able to eat ice cream or milkshakes, " says Chrobuck.

" Would I have this many medical problems if I hadn't had the E.

coli? Definitely not. But there's no way to tie it definitely

back. "

The CDC says foodborne illnesses cause 325,000 hospitalizations and 5,000

deaths a year. Among survivors, some long-term consequences are obvious

from the outset. Some required kidney transplants. They may have scarred

intestines that promise lasting digestive difficulty.

But when people appear to recover, it is difficult to prove that later

problems really are a food-poisoning legacy and not some unfortunate

coincidence. It may be that people prone to certain gastrointestinal

conditions, for instance, also are genetically more vulnerable to germs

that cause foodborne illness.

For now, some of the best evidence comes from the University of Utah,

which has long tracked children with E. coli. About 10 percent of E. coli

sufferers develop a life-threatening complication called hemolytic uremic

syndrome, or HUS, where their kidneys and other organs fail.

Ten to 20 years after they recover, between 30 percent and half of HUS

survivors will have some kidney-caused problem, says Dr. Pavia,

the university's pediatric infectious diseases chief. That includes high

blood pressure caused by scarred kidneys, slowly failing kidneys, even

end-stage kidney failure that requires dialysis.

" I don't want to leave the message that everyone who had symptoms

.... is in trouble, " stresses Pavia.

Miserable as E. coli is, it doesn't seem to trigger long-term problems

unless it started shutting down the kidneys the first time around, he

says. " People with uncomplicated diarrhea, by and large we don't

have evidence yet that they have complications. "

Other proven long-term consequences:

-About 1 in 1,000 sufferers of campylobacter, a diarrhea-causing

infection spread by raw poultry, develop far more serious Guillain-Barre

syndrome a month or so later. Their body attacks their nerves, causing

paralysis that usually requires intensive care and a ventilator to

breathe. About a third of the nation's Guillain-Barre cases have been

linked to previous campylobacter, even if the diarrhea was very mild, and

they typically suffer a more severe case than patients who never had food

poisoning.

While they eventually recover, " We don't know a great deal about

what happens to those people five years later. What does 'normal' look

like? " Tauxe says.

-A small number of people develop what's called reactive arthritis six

months or longer after a bout of salmonella. It causes joint pain, eye

inflammation, sometimes painful urination, and can lead to chronic

arthritis. Certain strains of shigella and yersinia bacteria, far more

common abroad than in the U.S., trigger this reactive arthritis, too,

Tauxe says.

What about other patient complaints?

A variety of other organ problems might be triggered by HUS, that severe

E. coli - because it causes blood clots all over the body that could

leave a trail of damage, says Utah's Pavia. Among his hottest questions:

HUS patients often suffer pancreatitis. Does that increase risk for

diabetes later in life?

But proving a connection will require tracking a lot of patients who can

provide very good medical records documenting their initial foodborne

illness, he cautions.

---

EDITOR's NOTE - n Neergaard covers health and medical issues for The

Associated Press in Washington.

Don Neeper

Senior Software Engineer

SofTechnics, a METTLER TOLEDO Company

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