The link between Sandra (Sandy) Antle’s Listeria infection and contaminated cantaloupe is clear. In August 2011 Mrs. Antle consumed tainted cantaloupe purchased on several occasions at King Soopers located at 7575 South University Boulevard in Littleton, Colorado. King Soopers is part of the Kroger family of grocery stores. Prior to her death, Sandy was a long-time, loyal shopper.
Sandy died September 18, 2011 at 1:42 PM, with her husband of 55 years, Robert, her son, Greg, and her son-in-law, Russ, at her side. Although she was 75 years old, to all that knew the lively, vibrant Sandy, she simply died too young. To her family and friends, there was more love for her to spread. They are left with a deep void, impossible to fill.
To properly understand the impact Sandy’s loss has left with those who knew her, it is imperative to know who Sandy was in life. To start, she was the center of her family. As her now-grieving husband, Robert, describes her, “she had the personality everyone wishes they had. And it got better with age.” She loved gathering the extended Antle family for holidays, birthdays and vacations together. The holidays especially were “big happening” at the Antle household.
But Sandy was not a homebody. She would drag Robert to nearly every event of their kids’ and grandkid’s lives. As her son, Greg, recalls, “every day was busy in retirement.” In Robert’s words: “We lived a very active social life with our many friends. These were things we did as a couple. These activities usually were limited to about twice per week. Even with the chronic lymphocytic leukemia, which she lived with for 23 years, Sandy lived an active life.” Swim meets and soccer games were always on tap. Robert and Sandy even made the effort to attend grandson Tyler’s college soccer games with George Mason University.
They also enjoyed traveling extensively. In June 2011, they traveled to see Robert’s mother. Sandy had a bright smile and a laugh that could fill a room, a quality easy to capture on film. For Robert, looking at this photo, it is almost impossible to imagine that only three months later his wife would lie unresponsive in a hospital bed before passing away from Listeria contracted by eating cantaloupe.
Prior to her illness, at the time of her physical in June 2011, Sandy was doing well, with no major complications or any reasons for concern. Her treating physician, Thomas C. White, MD, notes as follows:
I saw her for a routine physical in June 2011. At that time, she was feeling fairly well. Her exam was unremarkable except for an enlarged spleen. Her labs showed mild elevations of lever enzymes. At that time we arranged some tests to follow-up on the osteoporosis and thyroid nodules, but no other intervention was planned.
Sandy began to feel ill while doing what she always did—spending time with her family. On both September 6th and 7th she was at Children’s Hospital with her grandson, Casey. Casey, a special needs child, was being prepared for major back surgery and Sandy was determined to get in as much time with him as possible. Robert, however, noticed she seemed unusually tired on the 7th. On the 8th, when her diarrhea began, they both thought little of it, although they were slightly concerned. Despite having lived with and managed her Chronic Lymphocytic Leukemia for over 23 years, and experiencing a C. diff infection in 2010, Sandy was otherwise a healthy person. So when her diarrheal symptoms continued into the evening on the 8th, and actually grew markedly worse by the next day, they were both very concerned. Robert called and talked to Thomas White, MD, on September 9th who recommend she be taken straight to the ER.
They arrived at the Swedish Medical Center ER in the morning hours. Sandy was assessed and her symptoms of two days of worsening diarrhea were noted. After reviewing her present health and medical history, the treating physician initially assessed her with a urinary tract infection and diarrhea thought to have been caused by a C. diff infection. Accordingly, antibiotics were ordered. The decision was made to admit her for observation and treatment. Both Sandy and Robert felt that, given her last experience with a C. diff infection, she would be out and home soon. That was, unfortunately, not to be the case.
After making sure that Sandy was comfortable that night, Robert kissed her goodbye and drove home to get some rest.
A blood specimen collected September 9 tested positive for Listeria Monocytogenes (LM). The Public Health Laboratory at the Colorado Department of Public Health and Environment (CDPHE) conducted Pulsed Field Gel Electrophoresis (PFGE) of the isolate cultured from her blood (CDPHE Specimen ID Number HUM-2011024899).
The next morning, September 10, while getting dressed, Robert recalled briefly hearing something on the news about an expanding Listeria outbreak being announced in the Denver Post. At the time nobody knew it was cantaloupe, which Sandy loved to eat when in season.
He drove back to Swedish Medical Center around 7:30 AM. From the moment he arrived, something was not right with his wife—although she was interacting with people and attempting to converse, she could not finish her sentences. It was as if a curtain had been closed on her mind. Robert was instantly alarmed and voiced his concern. He and Paul Mikulecky, MD, discussed Sandy’s symptoms and Robert’s concern that it might be Listeria based on that morning’s news report.
Within 24 hours of her arrival at the hospital, Sandy’s blood cultures were confirmed presumptively positive for Listeria, and an infectious disease consultation was ordered. One of the nurses provided Robert with a printout on general information concerning Listeria, and none of it was reassuring. It was decided to start her on vancomycin as well as meropenem, a potent antibiotic combination.
Sandy’s daughter, Sharon, came by to visit with her mom and see how she was doing. They had a nice conversation and Sharon remained hopeful that her mom’s recovery would be swift. However, just after Sharon left Sandy’s side to head to see her son, Casey, at Children’s Hospital, Sandy went into acute respiratory distress. Seemingly without warning, her breathing rate and blood pressure spiked. Her son, Greg, and husband, Robert, only recall being helpless as alarms went off and Sandy was rushed away to ICU.
When Sandy arrived in ICU, she was breathing about 40 times per minute, unable to take full breaths, and having a cough with frothy-appearing phlegm. The doctors quickly prepped her for immediate intubation and a subclavain catheter was inserted to help rescusciatate her.
A 12-lead EKG showed ST depression, indicating a restriction in blood supply to tissue. A subsequent chest x-ray indicated bilateral pulmonary infiltrate that had developed in only the past two hours, “very suspicious for pulmonary edema.”
Because Sandy was intubated and on a ventilator, Greg and Robert did their best to recall the course of events leading up to Sandy’s surprising downturn. They were shaken and upset as they recalled the panic in her eyes. The doctors performed a physical check, noting that she was responsive to painful stimuli and voice, but was very lethargic and quickly drifted off to sleep.
Ahmad Rashid, MD, checked on Sandy’s condition and noted:
She was initially admitted for treatment of a urinary tract infection and evaluation of C diff diarrhea. But this morning, her blood cultures 2/2 grew gram-positive coccobacilli, which were highly suspicious of Listeria bacteremia, especially given the fact that she recently has a history of cantaloupe ingestion.
A cardiac consultation was requested for Sandy’s newly developed pulmonary edema. The plan included treating her with diuresis, beta-blockers and ACE inhibitor therapy, and an invasive intra-aortic balloon pump. The cardiologist, Richard Mathe, MD, noted, “she had no other history of heart disease. Specially, there is no previous history of heart failure or valvular disease. In the past year, she has experienced no cardiovascular symptoms, according to the family.”
On Sunday the 11th, Sandy seemed to improve enough to remove her from breathing assist. The physicians told the family that the antibiotics seemed to be helping Sandy, but that hope was short lived. The Listeria had left Sandy’s blood and was now in her spinal fluid and brain. Although the family still held out hope, time was not on Sandy’s side. For the next 24 hours, everyone remained hopeful, but worried.
Thinking back, Sharon is still struck by how quickly her mother declined—“her body just went into shock.”
By the 13th a brain CT Scan showed increasing fluid buildup on her brain. Sandy remained deeply somnolent despite receiving no sedatives. In fact, she was very difficult to arouse and only had minimal withdrawl when noxious stimuli were placed near her nose. Thus, a right frontal ventriculostomy was recommended in an attempt to relieve pressure on her brain, along with a lumbar puncture. The risks, benefits, and alternatives were carefully explained to Robert and the rest of the family, who agreed to try the procedure. Robert recalls being told, “Sandy was not improving. The doctors kept coming to me with bad news.”
Sandy was prepped in the ICU, with the right frontal region of her head shaved for the procedure. An incision was made in the mid pupillary line anterior to the coronal suture, where a self-retaining retractor was placed and then a twist drill hole placed in the right frontal region. The procedure successfully relieved some pressure, with 15 cm of water drained. The report was negative for malignant cells, but positive for inflammation and blood contamination—she was clearly septic.
On the 14th Sandy’s condition continued to deteriorate. She was still intubated, but now needed no sedation. Her pupils were sluggish to minimally reactive. There was “no spontaneous movement.” An EEG and MRI were ordered, both were abnormal.
Sandy remained unresponsive on both the 15th and 16th. An EEG showed very abnormal results, with moderate-to-severe slowing, although no seizures were noted. She had no normal physical responses to stimuli. The woman known as Sandy to her friends and family was quickly slipping away before their eyes. They could only sit by her bedside, whispering words of love into her ear, praying for a miracle.
On the 17th the physician’s orders were simply “Listeria Meningitis.” Despite everyone’s best efforts, the treating physicians had to sit down with Robert, Sharon, and Greg, to discuss Sandy’s bleak prognosis. Robert recalls one of the final conversations with the doctors:
Finally, on the 18th of September they talked with me, basically giving me no hope that Sandy could live and be much more than in a vegative state. There was no indicator of brain activity on her last test. I sat down with my family explaining the information I had been given. We all agreed that Sandy would never want to live like that and advised the doctors to remove the life support.
Sandy’s life support was disconnected. She died quietly with Robert, Greg, and Russ right by her beside at 1:42 PM on September 18th.
The effect of Sandy’s passing has been devastating on her family. Her son, Greg, still remembers with great clarity those last days in the hospital: “the suffering she went through during the last eight days of her life was immense.”
For Sharon, she sees the devastation of Sandy’s loss on her father’s face every time they speak: “For my Dad, this was devastating. She was his best friend, his lover, his partner, and his wife for 55 years. It was devastating.”
Finally, for Sandy’s husband, Robert left alone after decades spent with the love of his life, he sums up Sandy best—“She is probably the finest person you’d have ever met. I really never believed I would grieve so much. I miss her more it seems every day. We were married for 55 years in August. I have great difficulty in looking forward, as I know I must.”