Marler Blog - Providing commentary on food poisoning outbreaks & litigation

The demographics associated with this monumental outbreak, due in significant part to the propensity of Listeriosis to affect the elderly, have given us the opportunity to explore history. As you know, several of our clients were decorated for extraordinary actions in World War II. The story of Isaak Margolin, however—at least the story before the Listeriosis illness that almost claimed this warrior—emerges from a vastly different historical lens.

Isaak Margolin is living history. Born February 18, 1915, to a Jewish family in Lithuania, Isaak’s family emigrated to Kiev, Ukraine when he was three years old, soon after the Russian Revolution. As did many during this time, Isaak’s family wanted to escape the disintegrating social and cultural structure of his homeland, which had merged with the Soviet Republic after the Revolution. Kiev became Isaak’s home until the late 1970s.

The notion of “home” for a young man in Eastern Europe in the 20s, 30s, and 40s, was different than today. Isaak did what he could to survive in an increasingly turbulent, and ultimately violent society. In the 20s, he went to Moscow, Russia, where he participated in the construction of the city’s underground railway. Later, before World War II, he would travel to Russia’s far east, along the border with China, to build another rail line.

When he returned to Kiev, Ukraine’s formal name had been changed to “Ukrainian Socialist Soviet Republic,” and the country was on a war footing. Isaak ultimately fought for the famous Ukrainian General Sydir Artemovych Kovpak as part of the Soviet partisan forces. As the Nazi Wehrmacht advanced into Soviet territory, Isaak tried to convince his entire family—including his wife Faina and daughter Maya—to escape through the Ural Mountains to the security of the Far East. Some of the family would not leave, believing the Nazis to be incapable of the atrocities that were being reported. But Faina, Maya, and Faina’s mother escaped on the last train carrying refugees out of Kiev, and remained in a village in Eastern Russia throughout the war. They struggled to survive.

Isaak remained in Kiev to fight, and to defend the factory at which he had formerly worked as a mechanic, and other important installations. Nazi forces ultimately surrounded the city, and Isaak escaped into surrounding forests, where he continued to serve under General Kovpak and fought a guerilla war. He was ultimately injured, taken prisoner by the Nazis, and escaped a concentration camp to return to the army and continue the fight.

Though Kiev was liberated earlier, Isaak did not see his family again until after the war ended. After they were reunited, Isaak and his family remained in Kiev until 1979. Isaak and Faina had another child; a son named Yakov. Isaak eventually became disillusioned with the oppressive Soviet communist regime, and finally received political asylum and emigrated to Denver, Colorado around 1979.

In Denver, where Isaak has remained since immigrating, he has enjoyed an extended and growing family. He is pictured below with a great-grandson. In all, Isaak has four grandchildren and nine great grandchildren.

Before Isaak’s Listeriosis illness, he was completely independent, despite being 97 years old. He exercised at a local gym nearly every day. Things changed drastically, however, after he ate a cantaloupe that had been purchased from M&I International Market in Denver in August 2011.

The onset of Isaak’s symptoms began around August 28 with a low-grade fever and diarrhea. The bouts of diarrhea soon became dark and bloody, and increased to the point that by August 31, they were occurring 10 to 12 times daily. Isaak also felt very weak and depleted, having been unable to eat or drink much at all since the illness began.

On August 31, Isaak saw his primary physician, Irina Pines, MD, at Webb Family and Internal Medicine. He described to Dr. Pines a several-day history of fever and bloody diarrhea. Dr. Pines described Isaak as being dehydrated and thought that his illness was a viral syndrome due to food poisoning. She advised that he be seen at the Rose Medical Center emergency department the same day. Transport occurred by ambulance.

At the ER, Isaak saw David Moon, MD, describing a course similar to the one he related to Dr. Pines. Dr. Moon obtained blood, urine and stool samples for study, and began Isaak on intravenous fluids for rehydration, as well as Tylenol for fever and pain. CBC showed that Isaak had an elevated BUN and creatinine, and that he was deficient in potassium and sodium. He also had low platelets, and protein was present in the urine. A portable chest x-ray showed a slightly prominent cardiac silhouette, which was thought to be “likely technically related” to the illness process. Isaak received supplemental oxygen via nasal cannula during his stay in the ER, and was ultimately discharged home after a few hours, stating that he felt much better. Dr. Moon advised that he be seen in follow up with Dr. Pines.

Isaak stayed at home, mostly resting, for the next two days. The pace of his diarrhea had slackened some, but he continued to have difficulty staying hydrated, and continued to feel weak and generally ill. Having endured much worse before, however, he resolved to simply do what he could to make himself comfortable until the illness resolved of its own accord. Isaak did not yet know, of course, that he was suffering from a life-threatening bacterial infection that was actively killing dozens across the United States.

On September 2, the blood sample taken at the ER on August 31 showed gram-positive rods, and then Listeria monocytogenes. A physician at Rose Medical Center called Isaak’s family immediately and requested that he be brought back to the ER for inpatient care and treatment. Isaak arrived shortly thereafter with family members.

On arrival at Rose Medical Center, Isaak saw Laurn Sarnat, MD, who noted an intractable, low grade fever, mild dizziness, a multi-day history of dark-colored diarrhea, a sore throat, and left-sided chest discomfort. He was started on supplemental oxygen and intravenous fluids. Given the positive test for Listeria from the sample on August 31, Dr. Sarnat began ampicillin therapy intravenously. Dr. Sarnat also ordered an echocardiogram to rule out endocarditis, as well as an MRI of the brain. Tylenol was given for control of Isaak’s ongoing pain and fever. Dr. Sarnat’s diagnoses were acute Listeria bacteremia and febrile gastroenteritis.

The echocardiogram was done the next day, September 3, showing (1) mild concentric left ventricular hypertrophy, (2) mild left atrial enlargement, (3) mildly sclerotic aortic valve, (4) moderate mitral and tricuspid regurgitation, (5) severe pulmonary hypertension, and (6) grade 1 diastolic dysfunction. The brain MRI was done on September 2, and showed small vessel ischemic change but no acute disease. After the MRI, Dr. Hammer, who consulted from infectious disease, noted that he anticipated that the ampicillin therapy would continue for 3 weeks, “which is presumptive for meningoencephalitis.”

Over the next several days, Isaak continued to be hypokalemic, and developed hypophosphatemia, though this resolved sooner. After several days’ hospitalization, by September 5, though the hypokalemia continued, Isaak was not having any more diarrhea or fever. Nevertheless, ampicillin therapy continued, as it would for several more weeks.

Ultimately, Isaak’s family decided not to have the physicians at Rose Medical Center perform a lumbar puncture. Isaak’s physicians had told them that the results likely would not dictate any different course of treatment, since Isaak had already tested positive for Listeria. But in order to effectively address that infection, physicians indicated that Isaak would need to have a peripherally inserted central catheter (PICC line) installed to facilitate continuous ampicillin therapy. The procedure occurred, and fortunately was uneventful, on September 6. Afterward, ultrasound showed good placement in the left basilic vein, with the tip lodged securely in the superior vena cava.

Isaak was upset to learn that he could not be discharged home, which is where he badly wanted to go by the end of his hospitalization at Rose Medical Center. Instead, in order to ensure that his Listeria infection resolved with appropriate ampicillin therapy, he was transferred on September 8 to Shalom Park, a convalescent care center for elderly people.

During his stay at Shalom Park, Isaak progressed well, though it was a difficult time for him. He has always been very social and highly independent, despite his old age, and to be reliant on others for his care caused him to become depressed. Jake Berzon, Isaak’s grandson, states:

After spending more than a week at the hospital with Listeria, Isaak had to spend another three plus weeks in rehabilitation at a nursing home, surrounded by people, many of whom he had been acquainted with before, but all of whom are now completely disabled physically, mentally and most often both – a most depressing experience for anybody, but especially for an optimist like Isaak. Isaak persevered yet again, came through the full cycle of rehabilitation at the nursing home and returned to his home.

On September 26, the PICC line was finally removed. Again the procedure was uneventful. Isaak was asking to be discharged home on September 27, and so, after nurses spoke with Mike Todd, MD, who had overseen Isaak’s care at Shalom Park, he was discharged.

In the weeks that followed, Isaak did his best to regain the functionality and independence that he had enjoyed prior to his Listeriosis illness. He never has. Again, Jake Berzon:

He is still not fully recovered from the disease, his two children, who themselves are not in the best of health are also getting up there in age, are not able to help as much as they would like to, the four grandchildren try to help as much as they can, as well, but all live far away and all are raising little kids, under 5 years of age. To sum it all up, Isaak is a fighter and his children and grandchildren never had any doubt that he would live a full 120 years and see his great grandchildren as adults. After Listeria, unfortunately, we just cannot believe that any longer.