Marler Blog : Food Poisoning Lawyer & Attorney : Bill Marler : Marler Clark

My wife and 16-year-old daughter spent the week at the Democratic National Convention.  Me, I took our other 13-year-old and 9-year-old daughters to Hawaii for a few days in the surf and sun.  Yes, we did go to a laua - picture below the main course.

OK, I get asked all the time what I eat and do not eat - yes, I ate it.  My kids, however, kept asking why they killed and cooked Wilbur?  So, a little bit of an experiment in food illness surveillance?  It has been 48 hours since I ate Wilbur, let's see how it goes.  If the pig is contaminated with listeria, I have a long time to wait with the incubation period running up to a month. 

As the Canadian Public Health Agency says, 29 cases of listeriosis have been confirmed nationally, and another 31 suspected cases are being investigated.  Maple Leaf, the manufacturer of the contaminated product, has ordered the return of all products made at the plant from nursing homes, hospitals, restaurants and stores, in one of Canada's biggest food recalls.  For more information on Listeria, see www.about-listeria.com.

And for more worries North of the border, Salmonella kills one, leaves 87 ill in Quebec
Cheese Recall.  A salmonella outbreak in Quebec has left one person dead and 87 others sick, prompting the Ministry of Agriculture, Fisheries and Food to recall three cheeses manufactured by Fromages La Chaudiere Inc.  Blocks of hard cheese, as well as cheese curds labelled La Chaudiere, Polo and Tradition, manufactured between July 24 and Aug. 24, have been pulled off store shelves as they may be contaminated with salmonella.  The outbreak has centred in three regions of Quebec -- Chaudiere Appalaches, Estrie and Mauricie Centre du Quebec -- but the cheeses have a wide distribution throughout the province, Horacio Arruda, Quebec's director of public health, said in a news conference yesterday in Montreal.  Over the past week, a total of six cheeses have been pulled from store shelves across the province. In addition to the three cheeses recalled on Thursday, three other cheeses were recalled earlier this week because they may contain listeria.  For more information on salmonella, see www.about-salmonella.com.

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Three elderly men have died and at least one pregnant woman has miscarried since last June after drinking listeria-contaminated pasteurized milk from Whittier Farms in Shrewsbury, Massachusetts. At least two others have been sickened as well. According to the Massachusetts Department of Health, tests have found no problems with the pasteurization process at the Whittier Farms plant, so investigators have turned their attention to the cooling and bottling machinery. So, the question really becomes where in the process did the milk become contaminated? Assuming that it really was not a problem in under-pasteurization, where, after heating, was the listeria bacteria introduced?

The families of victims of this outbreak have recently contacted us. One of the questions asked is how listeria survived pasteurization or how it was contaminated after pasteurization. Historically, there have been bacteria outbreaks tied to pasteurized milk, but the outbreaks seem tied to under-pasteurization or post-pasteurization contamination.

Date - Location - Species - Cases

1966 - Florida - Shigella flexneri - 97

1975 - Louisiana - Salmonella Newport - 49

1976 - New York - Y. enterocolitica - 38

1978 - Arizona - S. Typhimurium - 23

1979 - UK - Campylobacter jejuni - 3,500

1982 - Tenn., Ark., Miss. - Y. enterocolitica - 172

1983 - Massachusetts - Listeria monocytogenes - 49

1984 - Kentucky - S. Typhimurium - 16

1985 - Illinois - S. Typhimurium - >150,000

1986 - Vermont - Campylobacter jejuni - 35

1992 - UK - Campylobacter jejuni - 23

1992 - UK - Campylobacter sp. - 110

1994 - Illinois - L. monocytogenes - 45

1995 - UK - Campylobacter sp. - 12

1995 - Vermont, New Hampshire - Y. enterocolitica - 10

1999 - UK - E. coli O157:H7 - 114

2000 - Pennsylvania, New Jersey - S. Typhimurium - 93

2004 - Denmark - E. coli O157:H7 - 25

2005 - Colorado - Campylobacter jejuni - 40

2006 - California - Campylobacter jejuni - 1,644

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

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I have been following this tragic tale since right after Christmas in a series of three posts (1, 2, 3). I was somewhat surprised when Linda Bock of the Worcester Telegram wrote in yesterdays paper that Whittier Farms “voluntarily” stopped production of milk after it had learned that two men over 70 had died, one 87 year old man was still hospitalized and one young woman lost her baby. One wonders how “voluntary” the recall really was? Listeria monocytogenes is a very nasty bug in milk - it clearly can be deadly.

Cornell University, speaking specifically about milk, reported that Listeria monocytogenes can be found in soil and water and has been isolated from a large number of environmental sources. Listeria monocytogenes is destroyed by pasteurization, but if food products are contaminated after pasteurization, Listeria monocytogenes, can grow at refrigerator temperatures.

According to the FDA, Listeria typically causes illness in pregnant adults, newborns, the elderly, and patients with compromised immune systems, but healthy adults and children may also become infected. Symptoms of Listeriosis include flu-like symptoms, fever, muscle aches, stiff neck, headache, septicemia, meningitis, miscarriage, stillbirth, premature delivery, abortion, or death. The CDC reports that in the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die. Unfortunatley, is doubtful that fetal deaths are counted in that number.

In June of 2006 researchers at the University of California at Berkeley published disturbing data on “Listeriosis's path to miscarriage traced to placental infection.” Their research showed that the bacteria may invade the placenta, where - protected from the body's immune system - they proliferate rapidly before pouring out to infect organs such as the liver and spleen. The illness they cause often results in miscarriage or infection of the fetus.

Listeria infections in the elderly are also common and can be deadly as well. Not surprisingly, inflammation and atrophy of the gastric mucosa escalates with age. Because stomach acids play an important role in limiting the number of bacteria that enter the small intestine, the low gastric acidity common in the elderly, especially those with gastric ulcer disease, increases the likelihood of infection when bacteria is ingested in food or drink. In addition, underlying (co-morbid) conditions contribute to the morbidity and mortality of infection in the elderly. These conditions make the elderly susceptible to certain complications of an infectious diarrheal illness like electrolyte imbalance, dehydration, and shock. And, finally, as people age the immune system is compromised. It leads to an inappropriate, inefficient, and sometimes detrimental immune response, and its effect on health often manifests most apparently during intense stress (e.g., surgery, sepsis, multiple organ failure, malnutrition, dehydration).

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According to Stephen Smith of the Boston Globe Staff in his article, “State test points to dairy as germ source:”

Coffee-flavored milk taken from a cooler at a central Massachusetts dairy carried germs identical to bacteria that killed two elderly men and made two other people sick….

Genetic fingerprinting conducted at the state laboratory has indicated that a milk sample collected at Whittier Farms dairy two weeks ago, a sample taken in November from a bottle in a victim's refrigerator, and blood drawn from the four patients all harbored exactly the same type of listeria.

Clearly, there was a failure in the pasteurization process or the contamination was introduced post-pasteurization.  Recent reports suggest the later.  Although outbreaks associated with mis-pasteurized milk have occurred, in nearly every instance it was a failure of the pasteurization process or post-pasteurization contamination that lead to illnesses. See by prior blog post, “More News on Massachusetts listeria Deaths Related to Whittier Farms Pasteurized Milk.”

So, before you go out and start buying raw milk because you are now worrying about mis-pasteurization, please take a hard look at the list of raw milk outbreaks put together by Barfblog and the below PowerPoint from the FDA:

Here is some interesting information on Raw Milk Production:  "Raw Milk Legal Status in Top 10 Milk Production States:"

1. California – 2903 million pounds in 2003 – Raw milk sales are legal in retail stores.

2. Wisconsin – 1852 million pounds in 2003 – In January, 2005, a raw milk bill was submitted to the Wisconsin legislature

3. New York – 1015 million pounds in 2003 – Raw milk sales are permitted on the farm.

4. Pennsylvania – 855 million pounds in 2003 – Raw milk sales are legal both on the farm and retail

5. Minnesota – 691 million pounds in 2003 – State Constitution stated in Article XIII, Section 7: Any person may sell or peddle the products of the farm or garden occupied and cultivated by him without obtaining a license therefor.

6. Idaho – 734 million pounds in 2003 – Raw milk sales are legal with a license

7. New Mexico – 565 million pounds in 2003 – Raw milk and raw milk products sales are legal both on the farm and in retail stores

8. Michigan – 511 million pounds in 2003 – Raw milk sales are illegal but the state condones cow sharing programs

9. Washington – 467 million pounds in 2003 – Grade A dairies may sell raw milk

10. Texas – 471 million pounds in 2003 – Raw milk sales are permitted

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According to the Milford Daily News, the Massachusetts Department of Public Health (DPH) issued a warning today warning consumers not to drink any milk products from Whittier Farms in Shrewsbury because of listeria bacteria contamination, which has contributed to the death of two people. Four cases of listeriosis infection have been identified by DPH, according to a statement released by the state department late this afternoon. The cases occurred in June, October and two in November. The four cases involved three elderly residents and a pregnant woman from Worcester County. Two of the people have died. They have not been identified. DNA fingerprinting conducted by the State Laboratory Institute showed that the bacteria causing these infections came from a common source. Samples collected showed product contamination.

According the its website:

Whittier Farms is located in the historic and picturesque town of Sutton, Massachusetts. The farm is presently owned and operated by the fourth and fifth generation of the Whittier Family. The farm consists of two locations, which oversee each other from the tops of two hills with rolling fields nestled between them, depicting a true New England countryside.

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

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FSIS announced today that the Maramont Corporation, a Brooklyn, N.Y, firm, is voluntarily recalling approximately 88 pounds of a beef patty product that may be contaminated with Listeria monocytogenes. The beef patty products were produced on December 18 and distributed on December 19 to schools in the Jersey City, N.J., area.  The following product is subject to recall:

2-oz packages of "BROILED BEEF PATTY (MICROWAVE)." The products were individually packaged and delivered from 17.25-pound cases. Each case label bears a lot code of "07352" and product number "2801." Each case label also bears the establishment number "EST. 5370" inside the USDA mark of inspection.

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1000 cases result in death. Certain groups of individuals are at greater risk for listeriosis, including pregnant women (and their unborn children) and immunocompromised persons. Among infants, listeriosis occurs when the infection is transmitted from the mother, either through the placenta or during the birthing process. These host factors, along with the amount of bacteria ingested and the virulence of the strain, determine the risk of disease. Human cases of listeriosis are, for the most part, sporadic and treatable. Nonetheless, Listeria remains an important threat to public health, especially among those most susceptible to this disease.

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Well, the stocking are hung and the presents are all wrapped, and I am surfing the net to see what there is to blog about (my version of the “Night Before Christmas”) when I found this quote:

“Nine billion food animals are produced and slaughtered in the United States annually, and all of those animals are defecating and shedding bacteria, including drug-resistant bacteria…. We are running out of antibiotics to treat human infections.” Lance Price

Antibiotic-resistant bugs have been in the news recently. Some, like Salmonella Newport, have caused illness in consumers of Safeway ground beef.  Newsday recently reported - "Poultry Workers may spread E. coli" – No, not E. coli O157:H7, but gentamicin-resistant E. coli.

Public health investigators at Johns Hopkins University estimate that workers in poultry factories in the United States are 32 times more likely to be colonized with E. coli that repels the antibiotic gentamicin than other people. The drug is used to treat both poultry and humans.

Recently, in a new study, “MRSA prevalent in Canadian pig farms and pig farmers,” published in Veterinary Microbiology found methicillin-resistant Staphylococcus aureus (MRSA) prevalent in Canadian pig farms and pig farmers, pointing to animal agriculture as a source of the deadly bacteria.

The US Government seems concerned enough to at least study the problem of antibiotic resistant bugs in our food supply.  It created the National Antimicrobial Resistance Monitoring System (NARMS) in 1996 as a collaborative effort between the United States Department of Agriculture,  Food and Drug Administration's Center for Veterinary Medicine and the Centers for Disease Control and Prevention.

The NARMS program monitors changes in antimicrobial drug susceptibilities of selected enteric bacterial organisms in humans, animals, and retail meats to a panel of antimicrobial drugs important in human and animal medicine.  Animal and human isolates currently monitored in NARMS include Salmonella, Campylobacter, E. coli, Listeria and Shigella.  Some selected articles on antibiotic resistance:

Antibiotic Resistance in Listeria, Antibiotic Resistance in Shigella, Antibiotic Resistance in Escherichia coli, Antibiotic Resistance in Campylobacter, Antibiotic resistance in Salmonella

Well, looks like it will be a far too busy and profitable New Year.

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When Taco Bell offered free tacos for every American during baseball’s World Series last month, all I could do was hold my head and mutter something like: "Hasta luego, Amigos!"

The very idea of doling out fast-food tacos to millions of baseball fans should ring like a casino jackpot jingle in the corridors of a personal injury law firm like mine - or all the "wannabees" that are beginning to light up the Internet with "google ads" and plagiarized blogs.  Recently tacos seem have a food-poisoning track record right up there with Chinese-manufactured pet food.  In the past few years alone, we’ve seen outbreaks of deadly E. coli O157:H7, Salmonella, Hepatitis A, Listeria, Shigella and Norovirus in at least 13 states, from Washington and California to New York and Texas – all traced to restaurant tacos.

Just this year there have been taco-related outbreaks in Alabama, Illinois and Oregon.  And those are just the outbreaks scientifically traced by public health officials.  We’ll never know how many more people have been sickened without identifying a source.  Tracing the source of disease outbreaks isn’t easy.  Health officials need to detect an outbreak early, thoroughly interview sick people and find the common denominator before memories fade and evidence disappears.

And even when tacos are suspect, the specific source of the poison varies from one outbreak to the next.  In the Alabama outbreak last summer, the culprit may have been lettuce laced with E. coli.  In Illinois, it was Salmonella in the cheese.  An outbreak at Taco Bell last year in East Coast states was blamed on tainted lettuce, or as my post below says - maybe not.  Others have been tracked back to green onions, cilantro or undercooked meat.  It seems that when restaurants layer tortillas, meat, cheese, tomatoes, onions, avocado and lettuce, there are multiple opportunities to contaminate, cross-contaminate and make people sick.

Take, for example, a major outbreak of Hepatitis A in Florida in December, 2000.  Officials at the Lake County Health Department learned that seven people were sick, and five were hospitalized with Hepatitis A, all in a two-week span.  State and local officials identified the toxin and questioned each of the patients, including family members and friends who were not so sick.  Eventually, officials identified 78 people sickened in five eastern states. In the Florida case, most of the sick people had eaten at a Taco Bell restaurant in Fruitland Park.  Further inquiry narrowed the possibilities down to six menu items and eight ingredients, and only two of those items had been eaten by a majority of the sick people. Eventually, they zeroed in on the green onions as the most likely cause.  But, given the fact that nearly every menu item in a Taco Bell has nearly the same ingredients, how do you really know what ingredient was contaminated?

My point: Tacos can be dangerous.  The ingredients – meat and lettuce and green onions – come from an array of sources, are handled by so many people and are all tossed into the same products, creating a very muddy trail of evidence.  A list of outbreaks below:

Date	Location	Vendor	Microorganism	Food type
Oct 98	WA	Finley School	E. coli O157:H7	Taco Meal
Aug 00	TN	San Antonio	Salmonella	Unknown
Oct 00	CA	Viva Mexico	Shigella	Salsa
Feb 02	IL	Laredo	Salmonella	Employee
Aug 03	TX	Cheese	LIsteria	Cheese
Aug 03	MO	Habaneros	E. coli O157:H7	Salsa
Nov 03	PA	Chi-Chi's	Hepatitis A	Onions
Sep 05	CA	La Golondrina	Hepatitis A	Lettuce?
Jun 06	OH	La Fiesta	Norovirus	Employee
Nov 06	Several	Taco Bell	E. coli O157:H7	Lettuce?
Nov 06	Several	Taco Johns	E. coli O157:H7	Lettuce
Jan 07	AU	Mex Express	Botulism	Cheese
Jan 07	OR	Sergio's Dos	Norovirus	Unknown
Mar 07	IL	El Paso	Salmonella	Cheese
Jul 07	AL	Little Rosie's	E. coli O157:H7	Lettuce

And there have been more - In October 2007, Tortilla Flat was the scene of a Norovirus outbreak and just a few days ago, Carniceria Y Taqueria served Salmonella-Tainted Tacos in North Carolina.  Buenos Noches.  Thanks to my friends at K-State (who bring you BARFBLOG) for providing a "bite" of the history of the "terrible tacos."

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Texas Firm Recalls Frozen Sausage Roll Products For Possible Listeria Contamination
Recall Release CLASS I RECALL
FSIS-RC-053-2007 HEALTH RISK: HIGH

Double B Foods, Inc., a Meridian, Texas, firm, is voluntarily recalling approximately 98,000 pounds of frozen sausage roll products that may be contaminated with Listeria monocytogenes, the U.S. Department of Agriculture's Food Safety and Inspection Service announced today. The frozen sausage roll products were produced on various dates between Oct. 25 and Nov. 6, and were distributed to retail establishments in Texas, and institutions, catalogue sales and distribution centers in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania and Texas.

The following product is subject to recall:

* 7.5-pound cases of "DOUBLE B FOODS, MORNING SAUSAGE ROLL, Chicken and Turkey Knockwurst Wrapped in the Dough and Baked." Each label bears the establishment number "P-7184" inside the USDA mark of inspection.
* 10-pound cases of "DOUBLE B FOODS, MORNING SAUSAGE ROLL, Smoked Knockwurst Wrapped in Dough and Baked." Each label bears the establishment number "EST. 7184" inside the USDA mark of inspection.
* 10-pound cases of "DOUBLE B FOODS, SAUSAGE-N-CHEDDAR IN A BLANKET, Smoked Knockwurst with Cheese Baked in Dough." Each label bears the establishment number "EST. 7184" inside the USDA mark of inspection.
* 10-pound cases of "DOUBLE B FOODS, REDUCED SODIUM MORNING SAUSAGE ROLL, Chicken and Turkey Knockwurst Wrapped in Dough and Baked." Each label bears the establishment number "P-7184" inside the USDA mark of inspection.
* 7.5-pound cases of "DOUBLE B FOODS, REDUCED SODIUM MORNING SAUSAGE ROLL, Chicken and Turkey Knockwurst Wrapped in Dough and Baked." Each label bears the establishment number "P-7184" inside the USDA mark of inspection.
* 10-pound cases of "DOUBLE B FOODS, MORNING SAUSAGE ROLL." Each label bears the establishment number "P-7184" inside the USDA mark of inspection.
* 8- and 16-ounce packages of "H-E-B SAUSAGE & CHEDDAR KOLACHE, Smoked Sausage with Cheese Baked in Dough." Each package bears a sell by date of "12/13/07" or "12/20/07," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8-pound bags of "H-E-B SAUSAGE & CHEDDAR KOLACHE, Smoked Knockwurst with Cheese Baked in Dough." Each bag bears a sell by date of "7/30/08," "8/01/08" or "8/06/08," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8-pound bags of "H-E-B FULLY COOKED SAUSAGE CHEDDAR & JALAPENO KOLACHES, Smoked Sausage with Cheese Baked in Dough." Each bag bears a sell by date of "7/26/08," "8/1/08" or "8/2/08," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8- and 16-ounce packages of "H-E-B FULLY COOKED SAUSAGE & CHEDDAR KOLACHES, Smoked Sausage with Cheese Baked in Dough." Each package bears a sell by date of "12/16/2007," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8-ounce packages of "H-E-B FULLY COOKED SAUSAGE CHEDDAR & JALAPENO KOLACHES, Smoked Sausage with Cheese Baked in Dough." Each bag bears a sell by date of "12/16/2007," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8-pound bags of "H-E-B SAUSAGE KOLACHE, SMOKED SAUSAGE BAKED IN DOUGH." Each bag bears a sell by date of "8/1/2007," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 10-pound cases of "MORNING SAUSAGE ROLL, Knockwurst Wrapped in Dough and Baked." Each label bears a case code of "2370211," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 10-pound cases of "SAUSAGE IN A BLANKET, Sausage Wrapped in Dough and Baked." Each label bears a case code of "1332642," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 8-ounce packages of "SMOKY'S FULLY BAKED SAUSAGE ROLLS, SAUSAGE & CHEESE." Each label bears the establishment number "EST. 7184" inside the USDA mark of inspection.
* 2.25-pound packages of "SOUTHERN HERITAGE, SAUSAGE-N-CHEDDAR MORNING ROLL, Smoked Sausage with Cheese Baked in Dough." Each label bears a case code of "5788-SH," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.
* 2.25-pound packages of "WHEELER SMOKED SAUSAGE KOLACHES." Each label bears a case code of "8788-W," as well as the establishment number "EST. 7184" inside the USDA mark of inspection.

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The Centers for Disease Control and Prevention (CDC) estimates that each year 76 million - or one out of every four - Americans are sickened as a result of consuming contaminated foods or beverages. Some become seriously ill; 325,000 require hospitalization and 5,000 die. Older adults, young children, and those who have weakened immune systems are particularly vulnerable.

More than 250 different foodborne diseases have been identified. Most of these diseases are infections caused by a variety of bacteria, viruses, and parasites.

Foods that are contaminated with poisonous chemicals or harmful substances can also cause illness. Symptoms of foodborne illness vary by disease but the most common are nausea, vomiting, abdominal cramps, and diarrhea.

I have some of the symptoms described. Do I have a foodborne illness?

Possibly. For example, scientists estimate that 35% of diarrheal illness is caused by a foodborne pathogen. Diarrhea that is caused by food poisoning usually lasts one week or less. Symptoms that appear suddenly are a sign of foodborne illness, although the last food consumed is not necessarily the cause of illness. Different microbes have different incubation periods. The incubation period refers to the time between ingestion and onset of symptoms.

Incubation Periods of Common Foodborne Pathogens

PATHOGEN INCUBATION PERIOD
Staphylococcus aureus1 to 8 hours, typically 2 to 4 hours.
Campylobacter 2 to 7 days, typically 3 to 5 days.
E. coli O157:H7 1 to 10 days, typically 2 to 5 days.
Salmonella 6 to 72 hours, typically 18-36 hours.
Shigella 12 hours to 7 days, typically 1-3 days.
Hepatitis A 15 to 50 days, typically 25-30 days.
Listeria 3 to 20 days, typically 14 days
Norovirus 24 to 72 hours, typically 36 hours.

How can I find out if I am sick because of something I ate or drank?

Foodborne infections are usually diagnosed by laboratory tests that identify the organism. Bacteria such as E. coli O157:H7, Salmonella, Shigella, and Campylobacter are found by microbiologic testing of the ill person's stool. Parasites can be identified by examining stool specimens under the microscope. Laboratory testing to detect viruses requires stool specimens or serum derived from blood samples. Many foodborne infections are not detected through routine laboratory procedures and health care providers must order appropriate testing before the cause can be identified.

Should I see a doctor if I think I have a foodborne illness?

A person with symptoms of a foodborne illness should seek prompt medical attention if there is blood in the stools, if they are experiencing prolonged vomiting or show signs of dehydration, if diarrhea last 3 days or more or if diarrhea lasts more than 3 days. Anyone at risk for serious consequences - the very young, the very old, or those with immune impairment - should consult a health care provider if symptoms do not improve after 24 hours.

What else should I do?

If you think you have a foodborne illness contact your local health department. They will ask you questions about your symptoms, when they started, and what you have eaten for several days prior to symptom onset. Because some of the organisms that cause illness can be spread by ways other than food, they will ask you about other potential sources such as contact with others with similar symptoms or exposure to animals. This distinction is important so that public health authorities can if necessary, take steps to stop others from becoming ill.

If you know others who have similar symptoms, urge them to contact the health department. Oftentimes, information compiled from a group of individuals provides clues to the source of illness that can be missed when only one person reports to the health department.

If you suspect that your illness is food related, keep any left over food for possible testing. If laboratory tests show the food was contaminated, you will have powerful evidence that the food is the likely cause of your illness. The health department will advise you about any laboratory tests that should be conducted and how long food should be kept. Similarly, keep retail or restaurant receipts showing that you purchased the suspected food. Receipts often contain valuable pieces of information about a food product that the consumer does not know or cannot recall.

Common myths of foodborne illness

As you attempt to determine if you have a foodborne illness and what the potential source could be, avoid these common misconceptions.

The last thing I ate is what made me sick.

Not necessarily. Refer to the table that shows how long it takes for certain microbes to grow inside your body and cause illness. Write down what you ate, where you ate, and when you ate in as much detail as possible. Health department investigators will ask you for this information and accurate recall is critical.

If other people ate what I ate and did not become ill, that particular meal could not be the source of my illness.

Not necessarily. It is well documented that microbes that cause foodborne illness are not always uniformly distributed in a food item. Also, people have different immune systems. One person may consume hamburger prepared from a package of ground beef and become seriously ill with E. coli O157:H7 or Salmonella while his dining companion consumes ground beef from the same package and remains healthy.

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"Listeria monocytogenes is a particularly nasty pathogen that can cause severe injury, including death. It appears that Bil Mar Foods and Sara Lee will ultimately be held responsible for this incident," said, William Marler, whose law firm Marler Clark has represented victims of food borne illnesses through out the United States.

Denis Stearns, a Marler Clark partner said, "It is becoming apparent that listeria is more common than we previously thought, and requires greater vigilance from both food manufacturers and consumers." Continues Stearns, "If it is confirmed that this outbreak is linked to cold cuts, then there is truly cause for alarm. This is food that is intended to be eaten without being cooked. There's nothing a consumer could have done to avoided this. It's like being sucker-punched."

In 1983 in Massachusetts, 49 people became ill after consuming contaminated pasteurized milk. 42 cases occurred in immuno-compromised adults. Fifteen deaths resulted. In 1985 in California, there were 86 cases of listeriosis due to consumption of Mexican-style soft cheese made from raw milk. Forty-two of the neonatal infants developed listeriosis. In Texas, 1988, a female cancer patient died as a result of listeriosis after consuming turkey frankfurters. The turkey frankfurters, which came from a processor in Texas, and were found at supermarket outlets and in the woman's refrigerator, tested positive for Listeria.

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