Chronic health effects of microbial foodborne disease.

The acute effects of foodborne disease are sometimes not the end of the illness. Several significant foodborne pathogens are capable of triggering chronic disease, and even permanent tissue or organ destruction, probably via immune mechanisms. Arthritis, septic and reactive, inflammatory bowel disease, haemolytic uraemic syndrome, Guillain-Barré syndrome, and possible several autoimmune disorders can be triggered by foodborne pathogens or their toxins. Research is needed to more fully understand the mechanisms by which the immune system is inappropriately activated by these common foodborne disease-causing agents.

Foodborne disease outbreaks in nursing homes, 1975 through 1987.

OBJECTIVE: --To describe the epidemiology of foodborne disease outbreaks in nursing homes and to identify where preventive efforts might be focused. DATA SOURCES: --Reports by state and local health departments of foodborne disease outbreaks occurring from January 1, 1975, through December 31, 1987. STUDY SELECTION: --Foodborne disease outbreaks reported to the Centers for Disease Control, Atlanta, Ga, on standard investigation forms. DATA EXTRACTION: --Each foodborne disease outbreak report was examined by an epidemiologist or statistician. Outbreaks were considered to have a known pathogen if confirmed by laboratory tests, and a known vehicle when an epidemiologic investigation implicated a specific food item. DATA SYNTHESIS: --From 1975 through 1987, 26 states reported 115 outbreaks of foodborne disease in nursing homes, causing illness in 4944 persons and death in 51. These outbreaks represented 2% of all reported foodborne disease outbreaks and 19% of outbreak-associated deaths in this period. Of 52 outbreaks with a known cause, Salmonella was the most frequently reported pathogen, accounting for 52% of outbreaks and 81% of deaths. Salmonella enteritidis outbreaks accounted for 56% of the Salmonella-associated deaths since 1981. The implicated food vehicles in S enteritidis outbreaks were made with eggs or prepared with equipment contaminated with eggs. Staphylococcal foodborne disease was the next most commonly identified cause, accounting for 23% of outbreaks. CONCLUSIONS: --Since the elderly are at high risk for serious morbidity from foodborne disease, nursing homes should practice careful food handling, preparation, and storage procedures; provide education for food handlers; and have active infection control programs to rapidly detect and control outbreaks of foodborne disease.

Food counseling for persons infected with HIV: strategy for defensive living.

More than a million people in the United States are now infected with human immunodeficiency virus (HIV), and by 1991, the United States will record 270,000 cases of acquired immunodeficiency syndrome (AIDS). At present, there is no way to estimate the number of AIDS patients who will be living in 1991. Intestinal diseases exert considerable morbidity and mortality on AIDS patients and persons with AIDS-related complex. The elevated frequency of certain intestinal infectious diseases in homosexual male AIDS patients has been attributed to sexual practices, but food seems a probable vector for some proportion of the infections in all AIDS-affected groups. Intestinal infectious diseases and resulting systemic infections can be life-threatening to AIDS patients. The infections may serve as cofactors that hasten HIV disease progression to AIDS, but absolute proof of this hypothesis is lacking. The longer the HIV-infected person maintains good general health and avoids potentially lethal infectious diseases, the better are the chances that effective treatments will be developed and made available. Foodborne diseases are generally avoidable, and increased education of AIDS patients and their physicians as to their nature is the key to their prevention.

Contemporary issues: diseases with a food vector.

Foodborne disease has become a contemporary issue. Several large, well-publicized outbreaks of foodborne disease have heightened public awareness that harmful microorganisms may be present in food and that chronic as well as acute disease may be caused by foodborne microbes. The field of food microbiology has likewise experienced a resurgence of interest. New tools, such as recombinant deoxyribonucleic acid technology and monoclonal antibody production, used to elucidate microbial virulence factors have facilitated identification of disease-causing microbes once thought to be harmless and demonstrated the complexity of individual virulence mechanisms previously considered to be well understood. Foodborne pathogens are also causing disease via some surprising food vectors, such as chopped, bottled garlic and sauteed onions. In addition to acute gastrointestinal disturbances, certain microorganisms may, through complex interactions with the human immune response, cause chronic diseases that affect several major organ systems. These microbes are serving as models in studies of molecular mimicry and genetic interrelatedness of procaryotes and eucaryotes. Other recently recognized attributes of foodborne microorganisms, such as the heat shock phenomenon and the possible nonculturability of some bacteria, may affect their ability to cause disease in humans. Because foodborne disease is a major cause of morbidity and mortality, the study of these diseases and their causative microorganisms presents a unique challenge to many professionals in the subdisciplines of microbiology, epidemiology, and clinical medicine.

Listeria methods development research at the Eastern Regional Research Center, U.S. Department of Agriculture.

Listeria methods research at the U.S. Department of Agriculture, Eastern Regional Research Center, has concentrated on 2 areas during the past year. The first was development of techniques for assessing isolation methods for their ability to detect sublethally stressed cells. It appears that a number of widely used media do not accurately detect Listeria that have been injured by thermal processing or acidification. The second was development of improved plating media. One, modified Vogel-Johnson agar, shows promise; it is highly selective and quantitative, and eliminates the need to select colonies on the basis of a blue color when illuminated with reflected light.

Estimates of incidence and costs of intestinal infectious diseases in the United States.

The incidence of acute episodes of intestinal infectious diseases in the United States was estimated through analysis of community-based studies and national interview surveys. Their differing results were reconciled by adjusting the study population age distributions in the community-based studies, by excluding those cases that also showed respiratory symptoms, and by accounting for structural differences in the surveys. The reconciliation process provided an estimate of 99 million acute cases of either vomiting or diarrhea, or both, each year in this country, half of which involved more than a full day of restricted activity. The analysis was limited to cases of acute gastrointestinal diseases with vomiting or diarrhea but without respiratory symptoms. Physicians were consulted for 8.2 million illnesses; 250,000 of these required hospitalization. In 1985, hospitalizations incurred $560 million in medical costs and $200 million in lost productivity. Nonhospitalized cases (7.9 million) for which physicians were consulted incurred $690 million in medical costs and $2.06 billion in lost productivity. More than 90 million cases for which no physician was consulted cost an estimated $19.5 billion in lost productivity. The estimates excluded such costs as death, pain and suffering, lost leisure time, financial losses to food establishments, and legal expenses. According to these estimates, medical costs and lost productivity from acute intestinal infectious diseases amount to a minimum of about $23 billion a year in the United States.

Enteric infections and other cofactors in AIDS.

It is generally accepted that human T-cell lymphotropic virus type III (HTL VIII) is the causative agent of acquired immunodeficiency syndrome (AIDS), but, asyet, there are no clear reasons for the different clinical manifestations of AIDS among individuals. In this article Douglas Archer and Walter Glinsmann discuss the history of AIDS and propose a link between HTLV-III infection and gastrointestinal disease processes with attendant malabsorption. They further propose that maximizing the nutritional status and minimizing the incidence of gastrointestinal infection of individuals infected with HTLV-III may prevent development of the full-blown AIDS.