A Taste of Food Poisoning

While it was prudent to rule out appendicitis, you might think food poisoning would have been high on the list of next suspects. But my requests for a culture were ignored.

The second doctor on duty finally agreed to take a stool sample, but said she doubted the problem was linked to anything Anna had eaten. She said that Anna probably had a gastrointestinal virus -- like the other five kids in the ER that night. I don't know how many (if any) of them were tested for a food-borne infection.

Patricia Griffin, chief of the food-borne disease branch of the CDC, said that an emergency room physician recently told her that she doesn't take stool cultures anymore since the results generally don't come back for a couple of days -- after the patient has been discharged. Plus, she said, a positive result wouldn't affect treatment: Although the type and severity of food-borne disease determines the specific therapy, many infections are not treated with antibiotics or anti-diarrhea medications. That's because antibiotics can complicate the condition and possibly lead to drug resistance, and anti-diarrheals keep the disease-causing bacteria in the system rather than help get it out. Since in many cases, there's no treatment other than keeping hydrated, doctors may figure it's fruitless to take a culture. "In their minds, they're not going to do anything different," Griffin said.

But there are good public health arguments for testing for food-borne disease.

"It's hard to talk about it in our society, which is so focused on health care for the individual person," said Griffin. "But from the societal point of view, that's the way we find outbreaks. It's the main way we find things wrong with our food system."

Although state procedures vary somewhat, the basic protocol for responding to a suspected food-borne illness is this: If a stool sample tests positive for food-borne bacteria, the results are supposed to be reported to the state, which then alerts the CDC. The hospital or private lab is urged to send a sample of the bacteria to the state, which does further testing to determine the serotype -- the specific strain of the bacteria identified. Knowing the serotype may help identify the food that caused the problem, since certain serotypes are more common to specific foods. Monitoring serotypes also helps the CDC keep tabs on which strains are increasing in prevalence and which are decreasing.

The state labs may also take a genetic fingerprint of the bacteria and enter it into a CDC database, to see if there are any matches. Since food processors distribute their food nationwide, people in Maine and California could get sick from the same firm's hamburgers. DNA matches could help spot outbreaks and stop them from spreading.

Follow-Through

In my daughter's case, the state never received her bacteria sample from the hospital, so her salmonella was never serotyped, and a genetic fingerprint was never sent to the CDC. I know this from Holly Conners, a nurse with the epidemiology and surveillance branch of the Montgomery County Health Department and the bright light of this whole ordeal. Conners ran interference for me to get this information, as I learned that protocol and privacy acts make it difficult to get it yourself -- even when it's your own kid.

All we know from the lab report is that Anna had salmonella Group D, which consists of nearly 200 strains, but that it was not the kind that can lead to typhoid fever.

Figuring out what made an individual person get sick often is impossible. "Sometimes you can, sometimes you can't," said Donna Rosenbaum, a food safety consultant and the first executive director of Safe Tables Our Priority (STOP), an advocacy group for victims of food-borne disease. "Occasionally you get lucky."

Sometimes, too much time has elapsed to find evidence, such as a suspect food item or a food service worker who failed to wash hands or follow sanitary procedures. When a lot of people at a wedding reception or restaurant get sick, the chances are greater that a link will be uncovered. But what are the chances that one cooking error or contaminated turkey sandwich will ever be tracked down?

Trying to piece the puzzle together yourself can become practically a full-time job. All while your child is screaming her head off on the toilet.