Teenager Loses Fingers and Feet After Eating Leftovers
In Singapore, we occasionally read about food poisoning cases landing victims in hospitals or even worse. But in one unusual case in the US, eating contaminated food caused a 19-year-old to lose both of his feet and all of his fingers.
Anyone who has suffered from food poisoning before would already know that it is no joke. Your stomach feels like it’s being wrung and turned inside out as you clock your personal best timing racing between your bed and the toilet bowl. It’s like the movie The Purge playing to an audience of one – you.
But in the case reported in The New England Journal Of Medicine (NEJM) in March 2021, the teenager had it a lot worse. He was admitted to hospital with vomiting, abdominal pain, fever, general weakness, chills and shortness of breath 20 hours after eating leftover chicken and noodles brought back by his roommate from a restaurant. The said roommate also felt sick and vomited after eating the food but did not suffer the same fate (more on his situation later).
Sounds like your regular case of food poisoning, right? What wasn’t regular was that the first teen also had neck stiffness and blurry vision, while his skin had a “mottled appearance”.
That wasn’t the last of his ordeal. According to the report, the teenager’s breathing became faster while in hospital but the oxygen level in his blood was low. His blood pressure dropped to half of what it was when he arrived at the emergency room. Doctors also noticed reddish-brown spots starting to appear all over his body like bruises.
Antibiotics were administered but they didn’t manage to turn things around and the patient had to be transported to another hospital with more resources. Over the next few days, his condition stabilised – except for the issue of the bruise-like patches all over his body.
As it turned out, the “bruises” were signs of blood clots caused by internal bleeding – and these clots were cutting off oxygen to his hands and feet. The patient had to have them amputated as the tissue in those extremities started to necrose and turn gangrenous.
WHAT IS GOING ON?
How did eating leftovers cause the teenager to lose his fingers and feet? While it may appear to be an extreme case of food poisoning, experts such as Dr Brenda Mae Alferez Salada, a senior resident physician with National University Hospital’s Division of Infectious Diseases, noted that it wasn’t.
First, the neck stiffness and haemorrhagic rash are signs pointing to meningococcal disease caused by the bacterium, Neisseria meningitidis, said Dr Salada. This is the same organism behind the inflammation of the brain’s and spinal cord’s lining seen in newborns and babies known as meningococcal meningitis.
Secondly, Neisseria meningitidis is not foodborne, said Dr Salada. Instead, it is transmitted “through direct contact with airborne droplets” from an infected person or carrier. You can also be infected “through contact with objects that are freshly soiled by an infected person’s or carrier’s nasal secretions”, said Dr Salada.
According to the US Centers For Disease Control And Prevention, one in 10 healthy people carry the bacteria in the back of their nose and throat without being ill.
“The bacteria colonising the upper respiratory tract may penetrate the mucosal cells to enter the blood stream, resulting in severe sepsis like the patient in the NEJM article,” said Dr Salada.
She continued: “The disease progresses rapidly after an incubation period of three to four days. Over the following hours or days, patients might complain of severe headache, vomiting, neck and back pain with rigidity, followed by altered consciousness and coma. Half of the patients develop shock or severe infection with low blood pressure.”
And there are repercussions after overcoming the infection. About 10 per cent to 20 per cent of survivors have long-term complications such as neurologic disability, deafness or loss of digits or limbs, said Dr Salada.
The NEJM case study did not explain how the bacteria got onto the food that the teenager ate. It did note that his roommate had eaten the same leftovers the night before he did and had vomited as a result. But that was it.
So why was his roommate spared the horrible fate? The answer lies in the two teenagers’ vaccination status. The patient, who had it worse, only received one dose of the meningococcal vaccine just before he entered middle school and did not get his booster shot by age 16. His roommate, however, had his vaccination covered
COULD YOU GET INFECTED, TOO?
Locally, meningococcal disease presents as single cases or small clusters, said Dr Salada. “So far, only nine cases were reported in 2018.” According to her, the disease occurs worldwide but has the highest incidence in sub-Saharan Africa, where “large epidemics occur semi-annually, particularly from November to June”.
It’s not just the location; congregating in large numbers while overseas can increase your risk of meningococcal disease as well. Staying in college dormitories in countries such as the US and UK, for instance, can be a risk factor, said Dr Salada. In fact, the meningococcal vaccine is required for those travelling to Saudi Arabia to perform the haj or annual pilgrimage.
The meningococcal vaccine (given in just one dose and protects against the four strains, A, C, W and Y) isn’t included in Singapore’s National Childhood Immunisation Programme as it is not endemic locally. So, if you’re travelling to somewhere risky, it is recommended that you get your jab two weeks before departure. A booster shot is required every three years.
COULD IT INFECT YOU THROUGH FOOD, TOO?
“Food poisoning” is a loosely used term for gastroenteritis, said Dr Reuben Wong, a gastroenterologist at Gleneagles Hospital. This “very common condition” is caused by the “contamination of food by viruses or bacteria, resulting in symptoms such as vomiting, diarrhoea, abdominal cramps and fever”.
The common food-poisoning culprits, at least in Singapore, are “enteric pathogens such as E coli and salmonella”, said Dr Wong. As for health issues created by Neisseria meningitidis locally, they are “markedly less common” in comparison, he said.
Still, it pays to be careful when handling and consuming leftovers. “Ensure that leftovers are uncontaminated before you save them for consumption later,” said Dr Wong.
“For example, a half-eaten sandwich or half-drunk bowl of soup, where there has been contact with someone’s mouth and saliva, is contaminated with oral microflora and should not be kept.” If the portion is too big and you foresee leftovers, scoop or separate out portions for keeping using a serving spoon first before digging in.
Also, note that foods that contain dairy components such as milk, cheese, cream and nutrient-rich broths are more prone to bacterial growth and proliferation, warned Dr Wong.
“As a rule of thumb, uncontaminated leftovers should be refrigerated and consumed within 24 hours. And certainly avoid keeping leftovers of leftovers,” he said.