A Medical Case Study- When Leftover Food Causes Medical Dilemma

11 months ago

The Christmas celebration was an exquisite one, as we had friends and families come together to celebrate the festive season. For the Christmas celebration, we were expecting a lot of guest so there was so many cooking and people could possibly stuff themselves with food if they were not careful, so with such you would expect that there would be leftovers. The next day, people ate the leftovers, and still had some in he afternoon of the following day. While this didn't land us in the hospital bed, I will be discussing a case of a family that ate leftover pasta salad and landed at the hospital fighting for their lives.

It was the year 2003, after a family picnic at a park on a Saturday, the family saved up the Pasta Salad prepared on Friday for the event so they can have it on the Monday and this meal lead to 5 children falling ill. The salad didn't smell nice so three of the children couldn't each much but their younger siblings of age 7 and 9 eat it all.

After about 6 hours, the youngest sibling who was age 7 began to vomit, having difficulty breathing, and was rushed to the hospital. Soon all the children were in the hospital as they began to vomit and began to feel weak. The youngest children 7 and 9 suffered serious breathing difficulty, and were intubated immediately and placed under mechanical ventilator.

Soon the children were transported to the University Hospital in Leuven but on their way, the 7 year old child began to experience pulmonary hemorrhage were blood began to leak to the alveoli in the lungs causing the girl to bleed into the lower respiratory tract. The paramedics had to apply continuous resuscitation so she could remain alive. At the hospital, she experienced extreme muscle cramp, and went into a coma even when she was having internal bleeding. Her condition became worse and led to her death in about 20 minutes after arriving at the hospital.

The 9 year old child was quickly ventilated and monitored. This didn't mean that the other children weren't affected, actually they were affected but to different severity. The 9 year old child was treated for liver failure immediately as the hospital gave him Lactulose, Neomycin, and Acetylcysteine. Luckily he didn't die as he regained consciousness.

The older children were treated with fluid resuscitation but they all spent 8 days in the hospital where they were placed under serious observation before all surviving 4 were allowed to go home. After the picnic, they refrigerated the pasta so what could have gone wrong?

You see, I think there is something with pastas and Spaghetti leftovers because as I was reading about the previous medical case, I saw another which discussed the case of a Father and a son who ate leftover spaghetti with homemade pesto. Although they refrigerated the spaghetti, they brought it out severally during the process of keeping it refrigerated. The pasta spent hours outside the refrigerator before putting it back, then reheating when they wanted to eat.

Although the spaghetti had a awful smell but they ate it with the son having more than his father. After about 30 minutes, they both began to vomit, suffer abdominal pain and diarrhea but since the father was a medical doctor was able to use Charcoal and anti-emetics to help with the vomiting. While the father had diarrhea, the son didn't have but then he had uncontrolled vomiting which prevented him from keeping the charcoal down.

The father began to use several treatment along with acetaminophen but there was no changes and it continued for about 2 days when the son became fatigue and listless. On arrival at the hospital, the doctors confirmed that he was jaundiced, and suffer from tachycardia (increased heart rate). He was diagnosed with fulminant hepatic failure (necrosis of hepatocytes), Acute Renal failure (Kidney failure), and Rhabdomyolysis (Muscle leaking into the blood).

His pupils responded to light, but he was unable to respond to commands and walk. His blood was taken for examination but toxins were not found in his blood also there were no bacteria that could lead to liver failure. It was also concluded that viruses such as Epstein Barr Virus, Hepes, or Hepatitis were not responsible for the liver failure. The son was immediately scheduled for a liver transplant and supportive treatment. Soon, he suffered a brain edema were there was fluid in his brain putting pressure on his brain and died.

It is no doubt that both families ate leftovers and suffered liver problems so what could have been the cause. The liver is responsible for detoxifying substance in the blood and this could be from what we eat, so this might be the reason why it is attacked first. Actually, autopsy from the 7 year old girl's found Bacillus cereus in her gut and spleen, and she had necrotic liver. They tested the food she ate and found Bacillus cereus which shut down her liver and led to her death.

Autopsy of the boy also found Bacillus cereus in the gut of the boy, as well as the necrosis of the liver. The Bacteria led to the impairment of his liver mitochondria, which then started killing his liver cells.

Bacillus cereus is a food borne pathogenic bacteria that produces toxins Emetic toxin (leading to Emetic Syndrome), and Diarrhoeal toxin (causing diarrhoeal syndrome). The emetic toxin causes vomiting, nausea and occasional diarrhea. The bacteria is predominantly found in the soil and can be found in food items but are associated with starchy food. It has heat resistant spores thereby allowing it to survive cooking process. They grow in pH levels greater than 4.8, and in temperatures between 8 and 55 degree Celsius. This bacteria get into foods via improper handling and storage but when the food is cooked at 121 degree Celsius, the spores are destroyed.

Both of these tragic incidents highlight a critical but often overlooked aspect of food safety: the danger of improperly stored leftovers. In both cases, the culprit was Bacillus cereus, a bacteria known for causing foodborne illnesses, particularly in starchy foods. This bacteria can produce toxins that are harmful, even lethal, particularly when food is not stored or reheated correctly.

These stories serve as a stark reminder of the importance of proper food handling and the risks associated with consuming leftovers that may have been stored improperly. It underscores the need for awareness and caution, especially during festive seasons when the abundance of food can lead to complacency in food safety practices. Remember, when in doubt, it's always safer to discard questionable leftovers than to risk severe health consequences.

^{https://www.nejm.org/doi/full/10.1056/nejm199704173361604

https://journals.asm.org/doi/10.1128/jcm.43.8.4277-4279.2005?permanently=true#T1

https://emedicine.medscape.com/article/929028-overview

https://academic.oup.com/femspd/article/24/1/115/562235?login=false

https://my.clevelandclinic.org/health/body/22279-vagus-nerve

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893663/

https://academic.oup.com/femsle/article/157/2/223/620090?login=false

https://www.nifa.usda.gov/sites/default/files/resource/Preventing-Foodborne-Illness-Bacillus-cereus.pdf}