Speaker 1: My name is Beth, and I got caught up in
Speaker 1: a salmonella outbreak. I was volunteering on a tall ship,
Speaker 1: and usually in exchange volunteering, you get, you know, your
Speaker 1: meals for the weekend and the place to sleep and
Speaker 1: hang out with a crew at the festival and all
Speaker 1: of that. So we'd been working at festival for a
Speaker 1: couple of days and spent all Saturday out in the
Speaker 1: sun all day, grabbed dinner real quick, hung out with
Speaker 1: my friends, popped a couple of bars in Cleveland, you know,
Speaker 1: evening out in the town. And the next morning, got up,
Speaker 1: did the same thing over again. Ate breakfast. I was
Speaker 1: at working in the head rig, out in the sun
Speaker 1: all morning, and again it's another hot day, but you know,
Speaker 1: nothing out of the ordinary.
Speaker 2: When we took a break.
Speaker 1: For lunch, I noticed that I was really feeling just
Speaker 1: hot and tired and dehydrated, you know. I sat down
Speaker 1: in the shade, I grabbed a water bottle, drank a
Speaker 1: bunch of water, and I just assumed I'd been out
Speaker 1: in the sun too long. The festival ended that day.
Speaker 1: I was supposed to get a ride back to my
Speaker 1: car so I could go home. The woman that was
Speaker 1: supposed to give me a ride to my car, wasn't
Speaker 1: there because you'd actually taken a couple of my crewmates
Speaker 1: to urgent care. Found out later that they were kind
Speaker 1: of feeling the same thing. They were dehydrated, they were
Speaker 1: some of them had upset stomachs. I eventually got a
Speaker 1: ride back to my car and headed home. It's about
Speaker 1: a forty five minute drive from downtown Cleveland to where
Speaker 1: I was living at the time, and as I'm driving,
Speaker 1: all of a sudden it hits me just like stomach cramps,
Speaker 1: stomach pain. I really felt like I had to fart
Speaker 1: and it I almost made it that last couple miles. Well,
Speaker 1: some parts can't be trusted. So I got home. I
Speaker 1: had actually pooped my pants a little bit, and so
Speaker 1: I just took off my clothes, through them in the
Speaker 1: washing machine, start a loae to wash, took a shower,
Speaker 1: put on pajamas, and went to bed. Woke up a
Speaker 1: couple times in the middle of the night again with
Speaker 1: just an urgent need to go to the bathroom, just
Speaker 1: watery diarrhea every time. Whatever was inside of my intestines
Speaker 1: was just on the fast track out and that so
Speaker 1: I spent Sunday night. That's how I spent Monday, and
Speaker 1: as I recall, that's how I spent Tuesday too. I
Speaker 1: mean I tried to eat gland food like cheerios or
Speaker 1: instant meshed potatoes, but every time I put something in
Speaker 1: my mouth, it was just on the fast track. Clear through.
Speaker 1: I started getting messages from some of my friends who
Speaker 1: were on the ship still, and it wasn't just me.
Speaker 1: It was at first it was eight or ten of
Speaker 1: us and twenty of us, and then all of a sudden,
Speaker 1: almost forty of us were sick and not getting better.
Speaker 1: Probably Tuesday, I stopped trying to eat. I'm like, I'll
Speaker 1: just let my entire digestive system empty out, reset itself,
Speaker 1: and we'll try food again in a day or two.
Speaker 1: That didn't fix the illness, but it did let me
Speaker 1: control my bowels well enough that I could actually go
Speaker 1: to urgent Care. So I did that. They collected a
Speaker 1: sample and sent it to the lab, and I went
Speaker 1: back home and lived on gatory. The next couple of days,
Speaker 1: Urgent Care called me back and they're like, oh, you
Speaker 1: have salmonilla. It should resolve itself, and you know, if not,
Speaker 1: follow with your primary care doctor. And that's really all
Speaker 1: they said about it. But you know, a week into this,
Speaker 1: I still can't eat solid food. So finally, eight and
Speaker 1: a half days later, I finally got into see my
Speaker 1: primary care position and she walked into the exam room.
Speaker 1: First thing she says is you look terrible. And the
Speaker 1: next question she asked me was did you finish your antibiotics?
Speaker 1: And I said, what an aibiotics? So it turns out
Speaker 1: that the lab results from Urgent Care had actually said
Speaker 1: you should, you know, treat this patient with this antibiotic.
Speaker 1: Urgent Care never prescribed that, So my doctor started me
Speaker 1: on the antibiotics. Four days later, all of a sudden,
Speaker 1: I can eat food again, like it's a minor miracle.
Speaker 1: But in that time and that it's about ten or
Speaker 1: eleven days between when I got sick and when I
Speaker 1: started feeling better, I dropped about sixteen pounds. You know,
Speaker 1: that took me from being a healthy weight to being underweight.
Speaker 1: And at the same time, this is happening to all
Speaker 1: of my crewmates too, so we knew that something had
Speaker 1: gone on in the ship. That weekend when the health
Speaker 1: department actually started doing surveys and talking to all the
Speaker 1: people who were and were not sick. We figured out
Speaker 1: that the people that were sick were not vegetarians, and
Speaker 1: they'd eaten dinner on board the ship on Saturday night.
Speaker 1: Saturday dinner was Mexican castrole, So there was a version
Speaker 1: with chicken in it, and there's a version that didn't
Speaker 1: have chicken in it. An interview with one of the
Speaker 1: guys that helped in the galley, he says he thinks
Speaker 1: that chicken had been cooked about six days earlier, and
Speaker 1: it was put into a wood stove after dinner one night,
Speaker 1: as the stove cooled off, so the cook goes to
Speaker 1: start the fire the next morning for breakfast and finds
Speaker 1: room temperature chicken, and the he throws in the refrigerator
Speaker 1: and that Saturday night ended up in that cast role.
Speaker 1: They also, you know, took a look around the equipment
Speaker 1: and took a lot of you know, measurements of you know,
Speaker 1: how hot the windstove got, how cold the refrigerator was,
Speaker 1: how cold the freezer was, things like that. And one
Speaker 1: of the things they discovered is there actually was not
Speaker 1: a food thermometer on board. One of the things about
Speaker 1: these ships is they have a blackwater tank and so
Speaker 1: whenever you flush a toilet on the ship, it actually
Speaker 1: doesn't flush like a toilet. You actually pumped the wastewater
Speaker 1: into the blackwater tank. That tank gets emptied basically with
Speaker 1: a septic haller truck, so those you know, big tank
Speaker 1: trucks that have the vacuum pumps. So as soon as
Speaker 1: the ship got back to Eerie, they scheduled that truck
Speaker 1: to come in and empty the blackwater tank because so
Speaker 1: many people have been using the heads that the blackwater
Speaker 1: tank was full. So first thing on Monday morning, his
Speaker 1: first stop of the day was the ship. He pulls
Speaker 1: in hooks up to all the connections so he can
Speaker 1: suck the poop out. When he emptied the truck the
Speaker 1: day before, he hadn't flipped the pump from pumping the
Speaker 1: blackwater out of his truck to sucking it into his truck.
Speaker 1: So what he actually did was he pushed a bunch
Speaker 1: of air into the blackwater tank, which pushed salmonilla contaminated
Speaker 1: pool water up through the vent and all over the
Speaker 1: plays where most of the crew sleeps, and they sanitized
Speaker 1: what they could but start for a lot of people
Speaker 1: got caught that way too, so we actually had a
Speaker 1: little secondary outbreak because the back truck was set to blow,
Speaker 1: not suck. At the end of it all, I believe
Speaker 1: there were thirty seven of us in the outbreak. It
Speaker 1: was enough, It was a large enough percentage of the
Speaker 1: crew that the ship actually had to miss some of
Speaker 1: our contracted sales and events. But it managed to take
Speaker 1: a bunch of young, healthy people and pretty much ruin
Speaker 1: an entire summer for us. Even though you started feeling
Speaker 1: better because you didn't have uncontrolled diarrhea anymore, for some
Speaker 1: of us, it was months before you could just eat
Speaker 1: whatever you wanted without thinking about it. And then a
Speaker 1: lot of us still to this day a decade later,
Speaker 1: don't eat chicken, and several of us have sworn off
Speaker 1: gatorade too. That it's just both of those things are
Speaker 1: things that remind us of that awful week that we
Speaker 1: all spent not being able to do anything more than
Speaker 1: five feet away from a toilet, and that was enough
Speaker 1: to lead to some regulatory changes in that community. And
Speaker 1: that's my story.
Speaker 2: Oh my, oh my gosh. I mean the number of
Speaker 2: times that I went, what right are you? Are you
Speaker 2: kidding me?
Speaker 3: Like I'm sorry?
Speaker 2: What that is one of the most outrageous stories, like
Speaker 2: the old chicken. I mean, I can't. I cannot.
Speaker 4: I don't know that I'm ever going to be able
Speaker 4: to eat chicken again.
Speaker 2: Just I don't know that I'm going to be able
Speaker 2: to eat like so many things again. Well, thank you
Speaker 2: Beth so much for sharing your story, Like, oh my gosh,
Speaker 2: what an unbelievable, horrible experience.
Speaker 3: Yeah.
Speaker 2: Hi, I'm Aaron Welsh.
Speaker 3: And I'm Erin on an Updike and this.
Speaker 2: Is this podcast will kill you.
Speaker 3: Welcome. We're talking about poop today.
Speaker 1: We are.
Speaker 2: I love these days, I truly do.
Speaker 4: We talk about poop in my house like a lot lately,
Speaker 4: and so this is just like another day.
Speaker 2: I mean, I feel like it's an important thing to
Speaker 2: talk about and it people get real squeamish about it.
Speaker 2: But literally every person produces fecal waste.
Speaker 3: Yeah, everybody poops.
Speaker 2: Everyone poops.
Speaker 3: It's important. We have books about it, you know. Yeah.
Speaker 2: I guess we're not going to get that much into it.
Speaker 4: Yeah, we're not going to like Bristol stool scale it
Speaker 4: over here.
Speaker 2: Okay, adding that to my things to Google later list.
Speaker 4: We can post a picture of it anyways.
Speaker 2: Anyways, Yeah, this is gonna be an interesting episode. So
Speaker 2: this is it's not our first salmonella episode.
Speaker 3: No, it isn't. It isn't. Yeah, but the.
Speaker 2: Last time we did salmonella, we did typhoid, which is different,
Speaker 2: very different, And there's a lot of complexity in salmonella
Speaker 2: and a lot of diversity in salmonella, and it's gonna
Speaker 2: be interesting.
Speaker 3: Yeah, it definitely is.
Speaker 2: And another thing that's going to be very interesting is
Speaker 2: that in this episode we also get to learn how
Speaker 2: you determine things like the difference between the salmonella that
Speaker 2: gives you typhoid versus a slightly maybe less scary salmonella.
Speaker 4: Sarah var Yeah, we are so excited to be joined
Speaker 4: later on in this episode by Sarah Zoucha, who is
Speaker 4: a medical laboratory scientist that's going to give us a
Speaker 4: behind the scenes look at this fascinating and so important career.
Speaker 4: Like what is medical laboratory science?
Speaker 3: We've never talked about it on this.
Speaker 4: Podcast, so we'll talk about it today and we'll talk
Speaker 4: about how you choose which tests to run on various
Speaker 4: samples and what are some of the stranger samples that
Speaker 4: have shown up in the lab. But we'll get to
Speaker 4: all of those questions and more later on in the episode.
Speaker 2: Oh, I'm so excited. It's going to be so much fun.
Speaker 3: Yeah, it will be.
Speaker 2: But first, should we Is it time for quarantinees?
Speaker 3: Quarantinees? I think so? When are we drinking today?
Speaker 2: Erin, we're drinking the chicken or the egg?
Speaker 3: Lah question mark?
Speaker 2: Get it?
Speaker 3: Because they could both give you salmonella.
Speaker 2: Yeah, along with many other things. Yeah, yeah, what is
Speaker 2: in the chicken and the egg?
Speaker 4: It's a very tasty concoction without any chicken or eggs
Speaker 4: in it.
Speaker 5: Yeah.
Speaker 2: Yeah, we decided against an egg white foam for this.
Speaker 4: One, considered and discarded. But it has gin and blueberry syrup,
Speaker 4: lemon juice, some club soda, a little fizz for you.
Speaker 4: It's fantastic.
Speaker 2: And if you want to have a foam, there are
Speaker 2: many different foaming alternatives. One of them is like the
Speaker 2: water from chickpeas aqua faba. You can turn it into
Speaker 2: a like a foam, a non egg white foam topper
Speaker 2: for your cocktail.
Speaker 4: And I don't think that you can get zamonella from
Speaker 4: canned beans. Maybe just botulism.
Speaker 2: Yeah, don't quote us on any of that. I'm any
Speaker 2: of this. Moving on, moving on.
Speaker 4: We'll post the full recipe for that quarantine and our
Speaker 4: non alcoholic PLACEBA read it on our website, This podcast
Speaker 4: will kill you dot com and all of our social
Speaker 4: media channels we.
Speaker 2: Will well and on our website. I have a post
Speaker 2: it note. Check it out. You can find these sources
Speaker 2: for all of our episodes. You can find transcripts. You
Speaker 2: can find links to our bookshop dot org affiliate account,
Speaker 2: or our good reading list.
Speaker 4: I'm loving your dramatic pauses here, Aaron.
Speaker 2: You can find music by Bloodmobile. You can find links
Speaker 2: to our merch our Patreon.
Speaker 3: Can't read your own handwriting?
Speaker 2: I can't. I cannot read my own handwriting and alcohol
Speaker 2: free episodes. That'll do it?
Speaker 4: Fantastic, well done. Well shall we get into this, Aaron.
Speaker 2: Let's do it.
Speaker 3: I'm excited about it, me too. We'll take a quick
Speaker 3: break first.
Speaker 4: Like you said, Aaron, we've already it becomes somewhat familiar
Speaker 4: with the genus salmonella during our typhoid fever episode. Today,
Speaker 4: we're going to focus on all of the other serovars
Speaker 4: of salmonella and enterica, so you may or may not
Speaker 4: listeners And Aaron remember from our typhoid episode that typhoid
Speaker 4: fever is caused by a very very specific bacterium. It's
Speaker 4: Salmonella enterica subspecies enterica serovar typhee.
Speaker 2: Okay, Oh, I forgot about the subspecies part of it, yep, exactly.
Speaker 4: And I also mentioned during that episode that there's another
Speaker 4: serovar paratyphee, and there's a couple different versions of that,
Speaker 4: and together those sera VARs cause what are known as
Speaker 4: enteric fevers.
Speaker 3: Or the typhoid fevers.
Speaker 4: Okay, so let's refamiliarize ourselves with salmonella and talk about
Speaker 4: all of the rest of them, shall we.
Speaker 2: I'm excited, let's do it.
Speaker 3: Let's so.
Speaker 4: Salmonella enterica is a negative, facultatively intracellular anaerobe, which means
Speaker 4: it can live and grow both inside and outside oursells,
Speaker 4: and both with or without the presence of oxygen. So
Speaker 4: it's quite versatile, I guess. And it is present worldwide.
Speaker 4: It's absolutely everywhere. And today we're focusing on all of
Speaker 4: the non enteric fever causing seravars. These are often called
Speaker 4: nts non typhoid salmonella.
Speaker 2: Oh.
Speaker 4: So, there are over twenty five hundred, two thousand and
Speaker 4: five hundred serivars of Salmonella enterica that are in six
Speaker 4: different subspecies.
Speaker 2: Okay, so quick question, And I don't know if we
Speaker 2: covered this on typhoid, what makes a seravar a seravar?
Speaker 3: I knew that you were going to ask that, and
Speaker 3: I still don't really know.
Speaker 2: Did I ask that on sealin R have typhoid?
Speaker 4: I can't remember. I still don't fully understand because it
Speaker 4: gets into the like very confusing genetics of bacterial species
Speaker 4: and like how you define a species and how you
Speaker 4: define a subspecies. I don't know the answer, but we
Speaker 4: can at least narrow it down a little further because
Speaker 4: of those six different subspecies of Salmonella enterica, we're focusing
Speaker 4: on Salmonella enterica subspecies enterica. So all of the serovars
Speaker 4: that cause disease in humans and other animals are in
Speaker 4: this very specific subspecies. And there are over fifteen hundred
Speaker 4: different seravars just in this subspecies alone.
Speaker 2: That's yeah, wow.
Speaker 3: Yeah.
Speaker 4: Basically, all of these different sero of VARs have differences
Speaker 4: between them obviously that lead for them to have differential
Speaker 4: host specificity.
Speaker 3: So some of these.
Speaker 4: Ser VARs infect and cause illness in a really wide
Speaker 4: range of host species, and others have a relatively narrow
Speaker 4: host range, like for example, Typhie right, which really only
Speaker 4: causes disease in humans. But luckily for what we're talking
Speaker 4: about today, most of the non typhoid subspecies, the pathogenic ones,
Speaker 4: cause pretty similar disease. They cause enterocolitis or diarrhea, so
Speaker 4: that's why they often get lumped together as the non
Speaker 4: typhoid Salmonella group. They definitely have a range in their
Speaker 4: severity and like I said, their host specificity, so some
Speaker 4: might really only cause disease in birds or in reptiles
Speaker 4: and only rarely in humans, where others are much more
Speaker 4: common in humans, etc. And they can range in their severity,
Speaker 4: and they can also differ in their susceptibility to antibiotics
Speaker 4: for a number of different reasons. We'll get into a
Speaker 4: little more later, but an important thing to keep in
Speaker 4: mind is that when characteristics that make a particular sera
Speaker 4: var more invasive or more likely to cause an invasive
Speaker 4: disease a more serious disease, combined with characteristics that confer
Speaker 4: antibiotic resistance, those two things combined can make for a
Speaker 4: pretty dangerous seraph ar. Yeah yeah, Okay, So let's get
Speaker 4: into how we get this, shall we? I think everybody
Speaker 4: knows at this point. Yeah, just like typhoid, other strains
Speaker 4: of salmonella in erica, I might refer to them as
Speaker 4: just nts or salmonella.
Speaker 2: I mean, I say salmonella throughout cool I think the
Speaker 2: whole time.
Speaker 4: Yeah, these are transmitted primarily fecal oral in some capacity.
Speaker 3: Poop is where these bacteria.
Speaker 4: Come from, and poop has to somehow make it into
Speaker 4: your mouth. Salmonella is really a gut pathogen. It's found
Speaker 4: as a commensal organism in the guts of a lot
Speaker 4: of different animals. So salmonella can make its way into
Speaker 4: the soil or the water wherever there is fecal contamination.
Speaker 4: But even if they're naturally in the gut of an animal,
Speaker 4: that doesn't mean that they should be in anywhere that
Speaker 4: they would come into contact with the food supply, right, Like, Okay,
Speaker 4: they're in the gut, they shouldn't be in the breast,
Speaker 4: they shouldn't be in the meat, they shouldn't be in
Speaker 4: the feathers, they shouldn't be anywhere else except for in
Speaker 4: the gut, right.
Speaker 3: Yeah.
Speaker 4: And also like salmonilla typhe that we talked about the
Speaker 4: other serivars of salmonilla do tend to require a relatively
Speaker 4: large infectious dose, upwards of fifty thousand bacteria in order
Speaker 4: to establish an infection. That's a lot. It is a lot,
Speaker 4: but these bacteria can grow to be in really high numbers,
Speaker 4: as we'll talk about in just a second. So when
Speaker 4: you get exposed to a pathogenic serivar of salmonilla, you
Speaker 4: eat it right on your chicken.
Speaker 3: Casserole or whatever.
Speaker 4: It travels through your stomach, through your intestines, and generally
Speaker 4: establishes an infection in the terminal ilium, which is like
Speaker 4: the last bit of your small intestine, or in your
Speaker 4: colon the large intestine. Those are the two areas that
Speaker 4: salmonella likes. Asterisk, I'm talking about human infection. I know
Speaker 4: nothing about the guts of other animals.
Speaker 2: Why does it like those areas?
Speaker 4: I think that that's just where it makes a great
Speaker 4: home in the epithelium. Okay, the epithelium is different throughout
Speaker 4: your whole rest of your gut, and your small intestine
Speaker 4: prior to that has a lot of like villi and
Speaker 4: all these little things that I don't know exactly why,
Speaker 4: But that's not where salmonella likes to make its home.
Speaker 1: Okay.
Speaker 4: Now, once it's there, they sort of grab on to
Speaker 4: that epithelium and they have a number of different virulence
Speaker 4: factors that what they do is induce a huge amount
Speaker 4: of inflammation, especially neutrophills, which are often one of our
Speaker 4: first responders, one of our first white blood cells to
Speaker 4: like rush into the scene, and they induce a ton
Speaker 4: of this. So you have tons and tons of neutrophils
Speaker 4: and other like inflammatory cells cytokines rushing to the area.
Speaker 4: And this all starts to happen. Within one to three
Speaker 4: hours of an infection. You see massive amounts of inflammation
Speaker 4: coming in. To try and fight off these bacteria, we
Speaker 4: start making a whole bunch of proteins, We start secreting
Speaker 4: things to try and fend off these bacteria, and then
Speaker 4: within a few more hours is when the diarrhea starts.
Speaker 3: Okay, So symptoms.
Speaker 4: Start within like six to twelve hours after exposure, but
Speaker 4: after the development of this intense amount of inflammation. Right, So,
Speaker 4: typically the symptoms are a pretty acute onset of really
Speaker 4: painful crampy crampy abdominal pain, and watery diarrhea. Sometimes this
Speaker 4: diarrhea can be bloody, especially more common in kids who
Speaker 4: tend to have even more severe inflammation. And then it's
Speaker 4: also not uncommon to have a lot of nausea and
Speaker 4: vomiting because your whole colon and that last part of
Speaker 4: your small intestine are just full of inflammation. It makes
Speaker 4: your whole guts really angry.
Speaker 2: To your body is just like, get everything out of
Speaker 2: me now, exactly.
Speaker 4: And the good news is that without any treatment whatsoever,
Speaker 4: Salmonella entercholitis salmonella related diarrhea tends to be a self
Speaker 4: limited infection that does clear up over the course of
Speaker 4: about a week, which is a really long time to
Speaker 4: be having massive diarrhea and nausea and vomiting.
Speaker 2: Right and not being able to keep anything down.
Speaker 4: Yeah, So as long as you can keep something down,
Speaker 4: as long as you can stay hydrated and avoid electrolyte
Speaker 4: imbalances from this diarrhea, then you're going to be okay.
Speaker 4: And in general, antibiotics are actually not recommend it, Like
Speaker 4: the CDC, the World Health Organization, it's generally agreed upon
Speaker 4: that for this type of self limited diarrhea, you generally
Speaker 4: don't give antibiotics, and the only times that you do
Speaker 4: are if there are specific risk factors that make you
Speaker 4: think that this is likely to become an invasive infection
Speaker 4: or you have very high risk of it just being
Speaker 4: a really severe diarrhea, like in our first hand account,
Speaker 4: if you're not keeping anything down, then of course something
Speaker 4: is wrong, or if you're very very young or very elderly,
Speaker 4: or immunal compromised, especially with something like HIV. And one
Speaker 4: of the reasons that it's generally recommended not to use
Speaker 4: antibiotics in the setting of diarrheal disease is that antibiotic
Speaker 4: administration in some cases can actually prolong the illness, and
Speaker 4: it can prolong the shedding of the infectious bacteria in
Speaker 4: this stool, which I find absolutely fascinating. But now the question,
Speaker 4: of course is how often does this become a more
Speaker 4: severe infection? And by more severe, what I mean is
Speaker 4: that while in general, these Salmonella enterocolitis infections are just
Speaker 4: limited to this diarrhea, if these bacteria enter through the
Speaker 4: wall of your colon or your small intestine and make
Speaker 4: it into your bloodstream, they can cause a systemic infection, right,
Speaker 4: and that can be really severe, just like typhoid.
Speaker 2: What does that systemic infection look like.
Speaker 4: Great question, Aaron. It looks a lot like typhoid or
Speaker 4: enteric fever. It can be a really really high fever.
Speaker 3: You can see.
Speaker 4: Enlargement of the liver and the spleen as the bacteria
Speaker 4: travel there and begin to replicate within our white blood cells.
Speaker 4: It can even invade the lungs in some cases, it
Speaker 4: can cause respiratory symptoms. If these bacteria travel to the
Speaker 4: heart and infect the heart or our large arteries like
Speaker 4: our aorda, it can cause endocarditis that's inflammation of the
Speaker 4: art or end arteritis that's inflammation of our arteries.
Speaker 3: This can very quickly.
Speaker 4: Become a systemic bacteremia, so people can then go into shock.
Speaker 4: They can get very sick, very quickly. And what's interesting
Speaker 4: is that often people who end up with invasive salmonella
Speaker 4: that's not typhoid, tend to not really have as much
Speaker 4: of the diarrheal.
Speaker 2: Type symptoms at the beginning throughout their infection. Interesting, yeah,
Speaker 2: because the body is not just like shedding the as
Speaker 2: much or what.
Speaker 4: Yeah, I don't fully know, and I really tried to
Speaker 4: get a handle on, first of all, how often does
Speaker 4: this happen? And from what I can tell, it's actually
Speaker 4: way more common than I realized because the papers that
Speaker 4: I found that cited an actual number said that it
Speaker 4: could be up to five percent.
Speaker 3: Of the time.
Speaker 4: Wow, which seems really really high, right, And the mortality
Speaker 4: rate in these invasive infections can be as high as
Speaker 4: twenty to twenty five percent.
Speaker 2: So this is interesting because I think it calls into
Speaker 2: question two things in my mind. Number one is that
Speaker 2: the five percent, like, how accurate are the estimates that
Speaker 2: we have of you know, salmonella cases? Number one?
Speaker 3: Yeah.
Speaker 2: Number two, I think that this makes me ask the
Speaker 2: question about like I understand that it's sometimes not recommended
Speaker 2: to give antibiotics for salmonella, but sometimes it is like,
Speaker 2: how do you know? Like that that line seems like
Speaker 2: suddenly you cross it and this could be really bad,
Speaker 2: really fast.
Speaker 3: Yeah, And so what I don't know.
Speaker 4: The answer to what I didn't quite see in the
Speaker 4: discussion of the invasive non typhoidal salmonella infections is whether
Speaker 4: people tend to have like a Salmonella enterocolitis salmonella related
Speaker 4: diarrhea and then progress to invasive disease, or if these
Speaker 4: are kind of like two different disease processes caused by
Speaker 4: the same infection or caused by the same bacterium rather okay,
Speaker 4: and it kind of seems like it's two separate disease processes.
Speaker 2: Huh, that's very interesting.
Speaker 4: Yeah, But that's not to say that people can't become
Speaker 4: severely ill from quote unquote just diarrhea.
Speaker 3: Right.
Speaker 4: You can end up with electrolyte imbalances, you can end
Speaker 4: up with weight loss, you can end up very, very
Speaker 4: sick even from just diarrhea. So it's not like nobody
Speaker 4: should get antibiotics. It's just a matter of like risk
Speaker 4: stratifying who's more likely to either have a really hard
Speaker 4: time with it and not be able to tolerate food
Speaker 4: and just have a really hard time with the infection,
Speaker 4: and who is likely to go on to potentially have
Speaker 4: a risk for invasive disease, And.
Speaker 2: So beyond people who are immune compromised, are there other
Speaker 2: risk factors for invasive disease?
Speaker 4: Being very young, so under five, being very old so
Speaker 4: over seventy or seventy five, And interestingly, so okay, let
Speaker 4: me back up for a second. Remember how I said
Speaker 4: that salmonella causes a lot of inflammation in your gut. Yeah,
Speaker 4: so this is something that's totally different that these non
Speaker 4: typhoidal salmonellas do that typhoid doesn't do. So typhoid doesn't
Speaker 4: cause a lot of inflammation in your gut, all of
Speaker 4: the other serivars that cause infection in humans do. And
Speaker 4: so one of the things that we have seen is
Speaker 4: that there are inherited deficiencies in certain inflammatory systems. Specifically,
Speaker 4: if anyone cares, it's like certain inner luken systems IL
Speaker 4: twelve and ILE twenty three. That people with deficiencies in
Speaker 4: these systems are at much higher risk of invasive non
Speaker 4: typhoidal salmonella infection, and they're more resistant to typhoid infections.
Speaker 2: That is fascinating.
Speaker 1: Uh huh. Yeah.
Speaker 4: The other thing is that salmonella that we're talking about today,
Speaker 4: these ser vrs seem to be specifically adapted to survive
Speaker 4: in a highly inflamed environment. So it's thought that this
Speaker 4: actually lends it a competitive advantage to establishing an infection
Speaker 4: in our guts. Right, they get into our guts, they
Speaker 4: stimulate a massive amount of inflammation that makes it harder
Speaker 4: for a lot of our normal gut flora to thrive.
Speaker 3: Then ensues massive.
Speaker 4: Diarrhea, wiping out all of their competitors, and then they
Speaker 4: can kind of flourish and take over.
Speaker 2: I really enjoy thinking about, like the ecology of microbial
Speaker 2: interactions inside I know someone, It's so interesting.
Speaker 3: Yeah, and I.
Speaker 4: Wonder too, how much could somebody's individual microbiome put them
Speaker 4: at risk or at less risk for not only having
Speaker 4: an infection, but having a severe infection or an invasive infection.
Speaker 2: Yeah, it's it's really interesting to think about. But also
Speaker 2: what about the people who get infected and then don't
Speaker 2: have any inflame animation and the salmonol just hangs out
Speaker 2: in there? Is that what's going on with carriers?
Speaker 4: So non typhotal salmonella, the kind that causes disease, we
Speaker 4: don't tend to see carriers the way in humans, at
Speaker 4: least the way that we see with typhoid. So people
Speaker 4: tend to shed for like a month after infection, like
Speaker 4: there's still salmonella there that they're pooping out, and in
Speaker 4: kids it can be as long as seven or eight weeks,
Speaker 4: which is still a fairly long time to be pooping
Speaker 4: out salmonella. But we don't see like we do in typhoid,
Speaker 4: this carrier state of like a year or two years,
Speaker 4: or ten years, or your whole life, which I think
Speaker 4: is really interesting, and it kind of points to like
Speaker 4: this really is a pathogen.
Speaker 3: In humans and not a commensal.
Speaker 4: Yeah, huh, yeah, that that's the biology erin Wow.
Speaker 3: I mean that's kind of short.
Speaker 2: How much do we know about? I mean, and this
Speaker 2: is probably like way too much of a rabbit hole question,
Speaker 2: but how much we know about different serovars and the
Speaker 2: frequency of them, or the intensity of disease that they cause,
Speaker 2: or which ones to keep an eye out for, which
Speaker 2: ones they are associated with, which food products, all those things.
Speaker 3: It's a very good question.
Speaker 4: So I read a paper that was really diving into
Speaker 4: that kind of like this specific epimiology of all of
Speaker 4: the different seravars. It's hard because there's like fifteen hundred,
Speaker 4: which is so many.
Speaker 2: Yeah, I feel like we could spend the entire episode
Speaker 2: just like listing the names of them, and then we'd
Speaker 2: be like, okay, a two hour episode.
Speaker 3: Yeah.
Speaker 4: So there are a few that kind of stick out
Speaker 4: as being the most common worldwide and causing and therefore
Speaker 4: I guess causing the most infection, not necessarily the most
Speaker 4: severe infection, but just the most common ones. Those are enturiditis.
Speaker 4: I'm hoping I'm pronouncing that close to right Typhomirium, of
Speaker 4: which there are like Typhomyrium A and B, Like, there's
Speaker 4: multiple kind of typhomeriums.
Speaker 3: Of course, Newport.
Speaker 4: Javiana or Javiana and Infantis. Those are kind of some
Speaker 4: of the top five.
Speaker 2: There's also a Kentucky one that I saw.
Speaker 3: There is a Kentucky one. Yeah place name you know,
Speaker 3: love it.
Speaker 4: There are there are so many serovars, and in general
Speaker 4: they do have different pathogenicity. So all of the different
Speaker 4: seravars that cause disease in humans and other animals have
Speaker 4: some similar like virulence factors that tend to be clustered
Speaker 4: on what are often called these like pathogenicity islands, which
Speaker 4: I think is a hilarious term, but it basically is
Speaker 4: just in their genome. They have these little clusters of
Speaker 4: genes that encode a number of different things like flagella
Speaker 4: and capsules and like type three transport systems that like
Speaker 4: blah blah blah help them to infect us. But there
Speaker 4: are also a number of different plasmids that they have
Speaker 4: that encode not all the other virulence factors that might
Speaker 4: make them more likely to say, be able to infect
Speaker 4: a bird or your bearded dragon or your frog and
Speaker 4: other ones that might make it easier to infect humans.
Speaker 4: But also a lot of these plasmids are what end
Speaker 4: up conferring antibiotic resistance, which of course is a huge
Speaker 4: problem when it comes to salmonella. And I'll talk a
Speaker 4: lot more about it at the end of this episode,
Speaker 4: but that's kind of the like what happens next, because
Speaker 4: even though we don't use antibiotics to treat all human infections,
Speaker 4: you have to have antibiotics that work to be able
Speaker 4: to treat this of your infections.
Speaker 2: Yeah, yep, but how Yeah.
Speaker 4: So Aaron, can you tell me a little bit about
Speaker 4: this bug?
Speaker 2: I can. Let's take a quick break and then we'll
Speaker 2: get started on that. You know, like we've talked about
Speaker 2: we've covered salmonola before in the context of typhoid, and
Speaker 2: even though that was I feel like that was a
Speaker 2: pretty big episode and we covered a lot of ground
Speaker 2: in that there really isn't that much overlap between that
Speaker 2: history and the history of general salmonella food poisoning, or
Speaker 2: at least like in terms of what I decided to
Speaker 2: talk about today. And I have to say that I'm
Speaker 2: really excited about it because it is I think such
Speaker 2: a fascinating look into how food preparation and can some
Speaker 2: has changed over the past one hundred years or so,
Speaker 2: and how food poisoning kind of grew as a concept
Speaker 2: during that time. But the thing that I'm most thrilled
Speaker 2: to talk about is how salmonella was involved in the
Speaker 2: first act of bioterrorism in the US.
Speaker 3: Stop it what?
Speaker 2: Yeah? I am Oh, I'm so glad. I'm so glad
Speaker 2: you don't know anything about this, because I know.
Speaker 3: Fun thing about anything, Aaron, I love it.
Speaker 2: Okay, So let's get let's get started. So in terms
Speaker 2: of evolutionary history stuff, the salmonella group that has been
Speaker 2: linked to food poisoning, like we talked about, is incredibly diverse,
Speaker 2: and the number of serovars and all of that is
Speaker 2: just it's it's I'm not going to go into the
Speaker 2: details about the origins of this or that seravar because
Speaker 2: it's there's just too much ground to cover. But I
Speaker 2: will say that understanding the evolutionary origins of certain serovars
Speaker 2: that are associated with food poisoning and which types of
Speaker 2: food poisoning, that's incredibly important in preventing outbreaks because that
Speaker 2: knowledge can influence control strategies for instance, if one seravar
Speaker 2: is only present in the guts of diseased animals, animals
Speaker 2: that are actively showing that they are diseased, you might
Speaker 2: use a different strategy than if a seravar was a
Speaker 2: natural commensal of the guts of like all cows or
Speaker 2: all pigs or something like that. And it can also
Speaker 2: help with identifying the source of contamination. So if you're
Speaker 2: dealing with the diseased animal only seravar and you find
Speaker 2: it in a bunch of meat, that could point towards
Speaker 2: fecal contamination in the meat processing aspect of it, which
Speaker 2: is like really bad, And I mean really in a
Speaker 2: sense finding someone else in any part of like an
Speaker 2: animal product is bad. But I also think that like
Speaker 2: it might be dependent upon the seravar when you're like, oh,
Speaker 2: that is really alarming. How did it get all over here?
Speaker 2: Whereas there might be ones that you more commonly see.
Speaker 4: Yeah, and especially because there are ones that infect different animals.
Speaker 4: So if you have one that's more common in chickens
Speaker 4: and it's all over your beef, right, how.
Speaker 3: Did you get there?
Speaker 2: What happened here? Yeah? Yeah, Okay, So salmonella food poisoning
Speaker 2: seems kind of ubiquitous nowadays, and probably most people either
Speaker 2: know someone who has had it or has had it themselves.
Speaker 2: But has it always been this ubiquitous food poisoning presence, right,
Speaker 2: I mean probably. It seems kind of tricky to get
Speaker 2: estimates of the timing of when salmonella started infecting people
Speaker 2: based on like molecular clock info, but people have probably
Speaker 2: been getting sick with salmonella and other food born pathogens forever.
Speaker 2: And I think that this probably ramped up somewhat with
Speaker 2: the agricultural revolution. But even though the widespread practice of
Speaker 2: keeping livestock would have increased exposure to salmonella, the big
Speaker 2: outbreaks that we see today were still ways away. Unlike
Speaker 2: in the typhoid episode where I talked about the plague
Speaker 2: of Athens and the four hundreds BCE and the impact
Speaker 2: of typhoid on the residents of Jamestown in like the
Speaker 2: sixteen hundreds. For more general salmonella food poisoning, I'm going
Speaker 2: to jump ahead to the mid to late eighteen hundreds,
Speaker 2: so around the time germ theory was more or less
Speaker 2: established as a thing. By this point in history, people had,
Speaker 2: of course, you know, long recognized for hundreds of years
Speaker 2: that foods could make you sick with fever or diarrhea
Speaker 2: or vomiting, but before germ theory, it seemed to generally
Speaker 2: be ascribed to chemical changes in the food as it decomposed,
Speaker 2: or like some element of rotting food. Specifically, it was
Speaker 2: around the early eighteen eighties that people began to realize
Speaker 2: that food could look perfectly fine and unspoiled and smell fine,
Speaker 2: but could contain microbes that would make you sick if
Speaker 2: you ate it, and one or rather many, I guess
Speaker 2: of those microbes happened to be salmonella. In eighteen eighty five,
Speaker 2: researchers Daniel Salmon or Salmon I don't know, because I'm
Speaker 2: realizing that we say salmonella, but not sam you know. Anyway,
Speaker 2: Daniel Salmon and Theobald Smith were the first to identify
Speaker 2: salmonella causing salmonellosis in pigs that were sick with hog cholera,
Speaker 2: and they thought that this microbe that they had found
Speaker 2: was responsible for hog cholera, which it wasn't, but they
Speaker 2: named it hog Colera bacillus. In nineteen hundred, it and
Speaker 2: several other microbes were reclassified and renamed salmonella in order
Speaker 2: of salmon. But even though this taxonomy was a complete mess,
Speaker 2: the important thing was that there was now a name
Speaker 2: for these cases of food poisoning, and it also kind
Speaker 2: of provided the ability to trace its source via microbiological techniques.
Speaker 2: Pretty soon after the first identification of salmonella in those
Speaker 2: pigs in the eighteen eighties, people began finding the bacteria
Speaker 2: in many different foods, especially pork, chicken, beef, and milk,
Speaker 2: and also in people who fell ill after eating those foods.
Speaker 2: Right like making the link between food and illness, and
Speaker 2: this period marks a huge turning point in the history
Speaker 2: of food safety, not just because salmonella had been identified,
Speaker 2: but also because it represents a shift in the way
Speaker 2: that people viewed foods that made you sick. So previously
Speaker 2: it had been specific foods themselves. Oh, this one is spoiled,
Speaker 2: this one has undergone a chemical change. But the recognition
Speaker 2: of salmonella and other microbes as directly causing those illnesses
Speaker 2: meant that any food could be contaminated without appearing to be,
Speaker 2: and more optimistically, that those sources of contamination could mostly
Speaker 2: be eliminated through the way you handled the food. You know,
Speaker 2: you could kill the bacteria through methods of cooking or preparation,
Speaker 2: especially heat. Food poisoning as a general term, like the
Speaker 2: term itself, came into use around this time, which I
Speaker 2: think is so interesting because it kind of represents this
Speaker 2: shift in thinking about microbes spoiling food rather than food
Speaker 2: just being spoiled on its own.
Speaker 6: Yeah.
Speaker 3: I never thought about that.
Speaker 2: Yeah, And I think this whole period also called for
Speaker 2: an infrastructure change in regulation of food safety, especially through testing, notification,
Speaker 2: and better food handling practices. But that was still a
Speaker 2: long way away, and there was a lot left to
Speaker 2: be desired, because as the global population continued to grow,
Speaker 2: people continued to leave the rural countrysides for cities. The
Speaker 2: way that people interacted with food increasingly changed. Food was
Speaker 2: traveling larger distances, refrigeration wasn't really necessarily a thing yet,
Speaker 2: and hand hygiene was far from universally practiced. As these
Speaker 2: things were going on, the rate of food poisoning just
Speaker 2: continued to increase, Right Like, our knowledge of this group
Speaker 2: of bacteria way outpaced our ability to do anything about it.
Speaker 2: But it wasn't really until the first few decades of
Speaker 2: the twentieth century that people began to realize the true
Speaker 2: extent of just how prevalent these pathogens were, and that's
Speaker 2: simply because people weren't monitoring food borne illnesses. The primary
Speaker 2: salmonella related focus throughout the late eighteen hundreds and early
Speaker 2: nineteen hundreds was typhoid, and so a lot of the
Speaker 2: efforts were centered more on improving water quality and identifying
Speaker 2: human care of the disease, as we well remember from
Speaker 2: our typhoid episode, But salmonellosis kind of was just like
Speaker 2: waiting for its moment to shine. In the first few
Speaker 2: decades of the twentieth century, salmonella seemed to be on
Speaker 2: the rise, and this was shown to be the case
Speaker 2: by the nineteen thirties or the nineteen forties, which is
Speaker 2: around the time that several countries had adopted food borne
Speaker 2: illness reporting systems. What these early reporting systems were finding
Speaker 2: was more and more salmonella. But was there an actual
Speaker 2: increase always an important question to ask, and it seems
Speaker 2: to be somewhat debated because screening tools weren't the greatest,
Speaker 2: although they did improve the nineteen thirties and the nineteen forties,
Speaker 2: when phage typing began to be used to distinguish among
Speaker 2: salmonella seravars, and so it's possible that one big part
Speaker 2: of the apparent increase in cases was due to improvements
Speaker 2: in screening or our increased ability to trace outbreaks, or
Speaker 2: even that more mild illnesses like food born illnesses were
Speaker 2: finally coming into view as more deadly diseases were being
Speaker 2: treated or vaccinated against. But I also feel like it's
Speaker 2: hard to chalk all of the increase up to just
Speaker 2: those things, because, like I mentioned earlier, the way people
Speaker 2: were handling food and eating food was changing, especially during
Speaker 2: World War Two and the years immediately after. So during
Speaker 2: World War two we saw a huge rise in communal
Speaker 2: feeding spots. Large numbers of people were being fed in
Speaker 2: canteens and cafeterias, and so there was a greater potential
Speaker 2: for larger outbreaks rather than sporadic cases. And this communal
Speaker 2: feeding and rationing also led to people reheating food more often,
Speaker 2: which when done improperly, can of course lead to food poisoning.
Speaker 2: So there were more opportunities for a larger number of
Speaker 2: people to get sick if the salmonella was there. But
Speaker 2: was salmonella itself growing in its presence or prevalence, and
Speaker 2: that also seems likely so let's consider things from the
Speaker 2: food production side, especially in the scaling up and the
Speaker 2: industrialization of many food products.
Speaker 3: That's the key.
Speaker 2: It is the key. So whereas previously people would mostly
Speaker 2: consume food that had been grown or produced in their
Speaker 2: near vicinity, like even just within a town or city,
Speaker 2: the growth of cities and a demand for more food
Speaker 2: and a greater variety of food meant that every step
Speaker 2: along the way in food production, the operation had to expand,
Speaker 2: it had to grow larger, and it had to become
Speaker 2: more like specialized in a way. Right in the years
Speaker 2: after World War Two, especially when wartime rationing restrictions were lifted,
Speaker 2: meat consumption increased in a big way, and to keep
Speaker 2: up with that, arming expanded and intensified. Small chicken ranches
Speaker 2: or dairy farms grew into or were largely replaced by
Speaker 2: huge industrial operations, and with bigger populations of livestock, salmonella
Speaker 2: could spread more easily and infect more animals, and it
Speaker 2: would become much more difficult to control or identify. Not
Speaker 2: to mention that around the same time post World War
Speaker 2: two is when widespread antibiotic use started to come into play,
Speaker 2: and antibiotic resistance was not far behind, and that also
Speaker 2: grew and grew and grew and grew, and to be honest,
Speaker 2: it's one of the most terrifying parts of this whole
Speaker 2: story that like, that's all I'm going to mention about it.
Speaker 4: Yeah, but listen to our antibiotic resistance episode from season
Speaker 4: three for more three.
Speaker 3: Yeah, yeah, season three.
Speaker 2: But another place where contamination came increasingly likely to occur
Speaker 2: again thinking about sort of this chain of food production
Speaker 2: is in slaughterhouses. Yeah, So slaughtering shifted from being mostly
Speaker 2: at or near the farms where these animals were raised
Speaker 2: to happening farther away because like, oh, you needed to
Speaker 2: have more equipment to process more animals, You need to
Speaker 2: have more specific equipment, Like it was difficult to have
Speaker 2: to be a jack of all trades as a farmer
Speaker 2: and do and make a living the way you used
Speaker 2: to like it, just it became less and less feasible,
Speaker 2: and so slaughtering began to be done mostly at these
Speaker 2: large slaughterhouses that processed many different types of meats in
Speaker 2: many different ways. So you can see how literally every
Speaker 2: step along the way of food production or preparation or
Speaker 2: consumption increased the potential for salmonella to spread, and in
Speaker 2: some cases these chain just in practices led to some
Speaker 2: increase in virulence or difficulty in treating, like we talked
Speaker 2: about with antibiotic resistance. And also it's important to point out,
Speaker 2: as I'm sure you will later on, that salmonella was
Speaker 2: not and is not limited to just the pork or
Speaker 2: poultry or beef industries. It's everywhere. It's everywhere, and an
Speaker 2: increase in salmonella in one area frequently leads to an
Speaker 2: increase in salmonella in all areas. The mid twentieth century
Speaker 2: did see several new regulations put into place, and testing
Speaker 2: had also become more refined, but the cat was out
Speaker 2: of the bag. Sporadic cases or outbreaks of salmonellosis had
Speaker 2: just become kind of like almost a regular thing. Wasn't
Speaker 2: that unexpected? So in September of nineteen eighty four, when
Speaker 2: residents of a small community in or began experiencing painful
Speaker 2: stomach cramps, diarrhea, nausea, fever, fatigue after eating at several
Speaker 2: restaurants in the area, local public health officials suspected salmonella
Speaker 2: was to blame naturally, and it was samples from several
Speaker 2: people who had sought care at hospitals in the area
Speaker 2: confirmed the presence of Salmonella typhomerium, which is, like you said,
Speaker 2: one of the most common causes of salmonilosis associated with
Speaker 2: the consumption of like contaminated animal products. So by the
Speaker 2: end of that first week of cases, thirteen of twenty
Speaker 2: eight employees at Shakey's Pizza, one of the restaurants suspected
Speaker 2: to be a source, had come down with food poisoning,
Speaker 2: and dozens of customers had called the restaurant complaining that
Speaker 2: they had gotten sick after eating there, and that wasn't
Speaker 2: the only restaurant affected. By the time the outbreak was
Speaker 2: over at the end of September, nearly one thousand people
Speaker 2: had reported symptoms of food poisoning and seven hundred and
Speaker 2: fifty one cases of salmonella had been confirmed. That's a lot,
Speaker 2: it's a lot. It was and I think remains the
Speaker 2: largest outbreak in Oregon's history. But fortunately this samanela did
Speaker 2: seem to resolve for a lot of people pretty like
Speaker 2: easily or pretty well, or was treatable with antibiotics. But
Speaker 2: people had missed work, they had these large medical bills,
Speaker 2: and their bodies had obviously been put through the ringer
Speaker 2: with this illness, and they were left with questions, what happened?
Speaker 2: Where did this come from?
Speaker 1: Why?
Speaker 5: Me?
Speaker 2: The big guns were called in to help the local
Speaker 2: public health department trace the source of the outbreak, and
Speaker 2: ES officers from the CDC arrived later that month and
Speaker 2: they went around interviewing hundreds of patients and their families
Speaker 2: about what they had eaten, where and when. And also
Speaker 2: they went to every restaurant in the area, testing food
Speaker 2: surfaces and employees for trace of salmonilla. They evaluated thermometers
Speaker 2: and ovens for any inconsistencies or faults. They tested cows, milk,
Speaker 2: septic tank, city water, pond, water, produce, literally everything they
Speaker 2: could think of for salmonilla, expecting to find a common
Speaker 2: source linking all of these cases. The fact that the
Speaker 2: outbreak seemed tied to many different restaurants pointed towards a
Speaker 2: particular food item that was served at all of them,
Speaker 2: but they couldn't pinpoint it. They couldn't find it. There
Speaker 2: was no single factor linking all of these cases. Which
Speaker 2: isn't to say that they didn't find salmonella, because they
Speaker 2: did find it in a few places, like in the
Speaker 2: coffee creamer at one restaurant, and in the blue cheese
Speaker 2: dressing in another, but those items weren't eaten by everyone
Speaker 2: who had gotten sick, and the blue She's dressing was
Speaker 2: contaminated during its preparation, not like before it got to
Speaker 2: the restaurant, which pointed towards a human source, but no
Speaker 2: one person worked at all of the restaurants. As the
Speaker 2: investigation went on, cases dwindled and leads dried up, and
Speaker 2: the CDC was left with the unsatisfying conclusion that the
Speaker 2: outbreak was I don't know, likely caused by employees at
Speaker 2: these different restaurants, and you know a lot of them
Speaker 2: lived together or roommates, and so maybe that's what happened.
Speaker 2: And you know, that's kind of how it goes sometimes
Speaker 2: with food poisoning outbreaks. There's no neat answer. But the
Speaker 2: people of Wasco County, Oregon would get their neat answer.
Speaker 2: They just had to wait about a year for it.
Speaker 3: Oh my god, I'm loving this.
Speaker 2: And when they got it, it was not the answer
Speaker 2: that they were expecting, although at least a few people
Speaker 2: had had their suspicions all along. The reason that the
Speaker 2: food poisoning investigation had such a hard time linking all
Speaker 2: the cases to one food or one person was because
Speaker 2: it was actually many foods poisoned by many people, people
Speaker 2: belonging to the Rajni SI some say movement, some say cult.
Speaker 2: So there was one common source for the salmonella cases
Speaker 2: all along, but the CDC investigators did not expect it
Speaker 2: to be intentional poisoning by a cult. Okay, so what why?
Speaker 1: What?
Speaker 2: What's happening?
Speaker 3: What? I'm sorry, this is a cult podcast now.
Speaker 1: I know.
Speaker 2: I know. Let's get into it, okay, And this is why.
Speaker 2: So this is why I asked you whether you had
Speaker 2: seen Wild Wild Country, that documentary series. Oh no, heaven,
Speaker 2: it's so interesting. And everyone who's listening and hasn't seen
Speaker 2: it yet go check it out. And everyone who has
Speaker 2: already seen it, and I suspect a great number of
Speaker 2: you out there have already seen it, watch it again
Speaker 2: or you know, like this is just a refresher, So
Speaker 2: I don't know, I hope you enjoy it.
Speaker 3: I'm excited.
Speaker 2: Okay, So to get into the what and the why
Speaker 2: and the how of this massive salmonella poisoning, which this
Speaker 2: is the like I said, the first bioterrorism attack in
Speaker 2: the US. We have to go back to around nineteen
Speaker 2: eighty one. That year, a group of people from this
Speaker 2: religious movement, including its founder, Bagwan Shri Rajdish, moved to
Speaker 2: Wasco County, Oregon, which is about ninety or so miles
Speaker 2: east of Portland, to a sixty four thousand acre ranch
Speaker 2: they had purchased. The group had left Puna, India for
Speaker 2: Oregon after a lot of political pressure and reports suggesting
Speaker 2: that the cult was basically a money making scheme which
Speaker 2: exploited not only it's wealthy members but also did other
Speaker 2: illegal things to make money. I don't know if it's
Speaker 2: been confirmed or not, but they wanted out and they
Speaker 2: wanted to establish.
Speaker 3: A utopia elsewhere.
Speaker 2: Ma Anan Sheila, the personal secretary and right hand woman
Speaker 2: of the cult's leader, Rajniche, was charged with finding a
Speaker 2: place where they could build this utopia where the followers,
Speaker 2: known as Sanyasen's or Rajni She's could freely practice Rajnish's teachings,
Speaker 2: which involved a lot of love, beauty, guiltless sex, and capitalism.
Speaker 2: There was a store where you could like become more
Speaker 2: enlightened by spending money. It's cool, kind of genius and
Speaker 2: so this is how she decided on this ranch, right,
Speaker 2: the sixty four thousand acres, plenty of space to grow,
Speaker 2: beautiful land, all of that stuff. Their arrival was not
Speaker 2: really met with open arms by the people living in
Speaker 2: Wassco County, especially those living in the small town of Antelope.
Speaker 2: And when I say small, I mean like population a
Speaker 2: few dozen small that was located really near the ranch.
Speaker 2: And tensions between the townspeople of Antelope and the ranch
Speaker 2: continued to mount as the Rajniches built up their community
Speaker 2: to essentially be a mini city, complete with dozens of
Speaker 2: modular buildings and mobile homes and a frames, a two
Speaker 2: point two acre meeting hall, a one hundred and sixty
Speaker 2: room hotel, a two block long shopping mall, a casino
Speaker 2: and a disco, a medical lab, a dam, and a
Speaker 2: lake water sewage and transportation systems, an airstrip for the
Speaker 2: five private jet planes and helicopter owned by the cult
Speaker 2: New Roads. I mean, you get the picture. It was
Speaker 2: they built a whole city, a whole city. It was
Speaker 2: a massive undertakings. It's yeah. And this happened within a
Speaker 2: very short time frame, like when just a matter of
Speaker 2: a couple of years which was terrifying for the people
Speaker 2: of Antelope, who started to look for ways to kick
Speaker 2: these people out of the town or ideally out of
Speaker 2: the country. And when the legal way of doing things
Speaker 2: didn't look like it was going to work to get
Speaker 2: them gone, some open threats began to be made with
Speaker 2: a lot of gun carrying around town. It was Yeah,
Speaker 2: and the Reshine She's they met fire with fire. They
Speaker 2: were began to stockpile weapons make threats to the town people,
Speaker 2: and they also used the legal roots available to them.
Speaker 2: They ran for town council. Oh okay, and they won handedly. Yeah,
Speaker 2: because the Ragine She's greatly outnumbered the other residents of Antelope.
Speaker 2: This meant that the cult now controlled everything in the town,
Speaker 2: like everything, the roads, the water, the police force. They
Speaker 2: renamed the town Rajni she And this of course further
Speaker 2: escalated things because then residents of Wasco County and Antelope
Speaker 2: ramped up their fight to get rid of the cult.
Speaker 2: On both sides, there was violence, there was threats of violence.
Speaker 2: It's a story of like constantly mounting tensions where cause
Speaker 2: and effect is really difficult or almost impossible to disentangle. Yeah,
Speaker 2: and a big reason for this constantly mounting tension was
Speaker 2: at least in terms of the cult ma Anan Sheila.
Speaker 2: So Sheila, who was spokesperson for the cult and effectively
Speaker 2: its leader during Ragni's four year vow of public silence,
Speaker 2: she was determined to win, to just gain more power,
Speaker 2: and that's what she viewed as her life's mission, this
Speaker 2: movement and making sure that this movement had whatever it
Speaker 2: needed to grow and expand, and any threat to the
Speaker 2: movement was a threat to her directly. So she announced
Speaker 2: that she wasn't going to stop at taking over Antelope.
Speaker 2: She had set her sites. Next on Wasco County, the
Speaker 2: entire county, after that, Oregon, and then the world. The
Speaker 2: only problem was that the cult members, who numbered like
Speaker 2: two to three thousand estimates vary, they didn't have the
Speaker 2: numbers to outvote. The other Wasco County residents, which is
Speaker 2: around twenty thousand at this time. Okay, but luckily Sheila
Speaker 2: had a strategy. She coordinated the buzzing in of thousands
Speaker 2: of people who were experiencing homelessness into the ranch to
Speaker 2: then get them to register to vote so that in
Speaker 2: the next Wasco County election in the fall of nineteen
Speaker 2: eighty four, they would have stronger representation, but that didn't
Speaker 2: work out as planned, again with legal battles. At this point, though,
Speaker 2: Sheila's position was getting to be a bit tenuous within
Speaker 2: the cult and she felt increasingly threatened and desperate to
Speaker 2: not lose her status as like the de facto cult leader.
Speaker 2: She had to win this. Registering thousands of recently arrived
Speaker 2: people to try to win an election didn't seem to
Speaker 2: be working out, but that's okay. Shila had another.
Speaker 3: Plan, oh no.
Speaker 2: In the spring of nineteen eighty four, Sheila and one
Speaker 2: of her top lieutenants, ma anand Pooja, who was a
Speaker 2: nurse in charge of the Rajnish Medical Corporation, they had
Speaker 2: a brainstorming session about ways they could, you know, ensure
Speaker 2: the that they won the election. One of the ideas
Speaker 2: floated was poisoning people to make them too sick to vote,
Speaker 2: but make them sick with what that was the question?
Speaker 2: Sila and Poja began reading books like I Kid You Not,
Speaker 2: How to Kill Volumes one through four stop and The
Speaker 2: Handbook of Poisons, which, like, I'm sure that like based
Speaker 2: on what we do for this podcast, our Google search
Speaker 2: history is also quite bizarre. Yeah, but still, but still.
Speaker 2: And they also visited a local urologist to ask which
Speaker 2: poisons and bacteria would be difficult to trace but deadly,
Speaker 2: And they were like, oh, well, we're worried about people
Speaker 2: poisoning the cults, so we want to know what we
Speaker 2: should keep an eye out for. And he was like salmonella, Like, well,
Speaker 2: kind of easy to trace, but okay. It seems like
Speaker 2: they were more concerned about like the logistics of it,
Speaker 2: and like, how do we best do this. Sheila had
Speaker 2: tried to coordinate the assassinations of political enemies of the cult,
Speaker 2: and she had also poisoned people who had wronged her
Speaker 2: within a cult. Naturally, Pooja was apparently known by some
Speaker 2: in a cult as Nurse Mengly because of her obsession
Speaker 2: with using poisons and pathogens as a weapon, with one
Speaker 2: report of her trying to weaponize HIV. So, you know,
Speaker 2: it's I'm sorry, what I know, it's horrifying, And there's
Speaker 2: so much more to the story that's like this is
Speaker 2: just scratching the surface. It's kind of unbelievable. So at
Speaker 2: the ranch there grew to be increasing conflict between the
Speaker 2: Rashni She's and these people that had been busted in,
Speaker 2: and so Pooja's and Sheila's solution was to tranquilize the
Speaker 2: people the new arrivals, either with sneak injections or by
Speaker 2: putting it in the beer that they were given every day,
Speaker 2: but for their sicken the public to prevent voting scheme.
Speaker 2: They also toyed with the idea of hepatitis viruses, typhoid
Speaker 2: and putting beavers for giardia, or just dead rats and
Speaker 2: mice into the public water system, just dropping it in
Speaker 2: there to make everyone sick. But salmonella seemed the most promising,
Speaker 2: not to mention accessible because where do you get salmonella?
Speaker 1: Right?
Speaker 2: You order it?
Speaker 3: You can order it.
Speaker 2: I don't know if regulations have changed, but because back
Speaker 2: then they had a medical corporation and a lab, all
Speaker 2: they had to do was order samples from companies. Yeah, salmonella,
Speaker 2: typhomiriam wasn't the only one they ordered. They also got
Speaker 2: positive agents for typhoid, gonorrhea, tularimia, ooh, shigella, and others.
Speaker 1: Yeah.
Speaker 4: I mean, you're supposed to have a medical lab that
Speaker 4: is biosafety licensed of a certain level to deal with
Speaker 4: certain pathogens, and those are supposed to be inspected. However,
Speaker 4: often to maintain their status, they're supposed to be checks
Speaker 4: and balances in place here.
Speaker 2: Well, but I think the thing is they had been
Speaker 2: inspected by the public health officials. Their operation, their medical
Speaker 2: lab operation was big, like they had jit equipment and everything.
Speaker 2: So it which makes it all the more scary, I think,
Speaker 2: I know. But to make sure that salmonella typhemurriam was
Speaker 2: the one they had to test it out. Of course,
Speaker 2: the perfect opportunity presented itself with a planned visit in
Speaker 2: late August nineteen eighty four by Judge William Holtse wasco
Speaker 2: County executive and Raymond Matthew Wasco County commissioner. They got
Speaker 2: a flat tire during their inspection of the ranch, and
Speaker 2: while changing the tire, they were offered some cups of
Speaker 2: water which they drank.
Speaker 3: Oh my goodness.
Speaker 2: Within about eight hours they were both violently ill and
Speaker 2: Holse nearly died. Like he went to the hospital and
Speaker 2: was like it was touch and go wow. And the
Speaker 2: cause salmonella salmonaa. So now we arrive at the big moment.
Speaker 2: The poisoning of Holse and Matthew showed that those samples
Speaker 2: could make people sick, but what it on a big
Speaker 2: scale For that, a bunch of members from the cult
Speaker 2: dressed up in disguise. They put on wigs, and they
Speaker 2: changed out their bright red clothes and robes for more
Speaker 2: neutral toned outfits, and they went around to restaurants and
Speaker 2: grocery stores in the dolls, mostly sprinkling salmonella on salad bars,
Speaker 2: in coffee creamers, in dressings, over produced departments and so on,
Speaker 2: like everywhere. They just literally seeded everything with salmonella.
Speaker 4: Okay, how did it come to light Aaron?
Speaker 2: Okay, So at the time, like I said, the CDC
Speaker 2: concluded that, well, we don't really know exactly what happened.
Speaker 2: What we suspect it was this person. There were people
Speaker 2: who did suspect that it was the cult, it was
Speaker 2: the Rajniches that were behind it, But there was no
Speaker 2: apparent evidence at the time linking the rush Niche She's
Speaker 2: to the outbreak the poisoning, which that was just sort
Speaker 2: of like a dry run, I guess, because this was
Speaker 2: in September and the actual voting happened later on, and
Speaker 2: so when it came time to the actual election, there was,
Speaker 2: as far as I'm aware of, no like salmonella poisoning,
Speaker 2: and the Rajnich candidates in this election lost by a landslide.
Speaker 2: There was a record ninety three percent voter turnout. Wow,
Speaker 2: that's really high. Sheila's position, I think, with this loss,
Speaker 2: continued to slip and her paranoia grew. And on September thirteenth,
Speaker 2: nineteen eighty five, which is about a year after that
Speaker 2: Salmonela attack began, Sheila and a few others fled to Europe.
Speaker 2: A few days later, raj Niche broke his four year
Speaker 2: vow of public silence. He came out on stage and
Speaker 2: was like, I denounced Sheila and her allies. They betrayed
Speaker 2: my faith. They had done they were responsible for all
Speaker 2: these criminal things. They're horrible people. They're no longer in
Speaker 2: the light, et cetera. You know, she attempted murder of
Speaker 2: followers who challenged her authority. She mismanaged my money and
Speaker 2: left this commune fifty five million dollars in debt, and
Speaker 2: so I have to sell my ninety rolls royces. She
Speaker 2: tried to poison my doctor and dentist. She did incredibly
Speaker 2: intensive wiretapping, experimented with different lethal poisons on mice to
Speaker 2: try to find ones that were untraceable and had coordinated
Speaker 2: this salmonella attack. And so in the midst of all
Speaker 2: of this denouncing of Sheila, Rajnische was like, I demand
Speaker 2: a government investigation. This is on you now, you need
Speaker 2: to investigate what's going what happened. And the investigation found
Speaker 2: glass vials containing salmonella bactrol discs that had been ordered
Speaker 2: from VWR Scientific and sure enough that salmonella was the
Speaker 2: same as the one that had made those hundreds of
Speaker 2: people sick in the Dallas and Rajishi, of course denied
Speaker 2: knowing any of it. He was like, I knew nothing.
Speaker 2: So was Shila just escapegoat for all of this? I mean,
Speaker 2: she clearly was responsible for like a lot, and she
Speaker 2: clearly was completely without morals. But yeah, so how does
Speaker 2: the story end. The story ends with a few of
Speaker 2: these key players getting some jail time about four years
Speaker 2: and had to pay some fines. So Sheila, if you
Speaker 2: are curious, now runs a couple of care homes in
Speaker 2: Switzerland for seniors and people with degenerative disorders.
Speaker 4: Your face, I no, oh, no, m hm, fascinating, Aaron, Aaron.
Speaker 2: Nah, I know, h it's so interesting because I was
Speaker 2: trying to figure out, like, what is the legacy of
Speaker 2: this bioterrorism attack. This was the first time when we
Speaker 2: were doing this episode that I had read about it,
Speaker 2: and I was like, what on earth, There's so much
Speaker 2: more to this story than I had any idea. This
Speaker 2: seems like it would have been huge news, and of
Speaker 2: course it was in Oregon, but from what I read,
Speaker 2: it doesn't seem like it got a ton of national attention.
Speaker 2: And I think that part of the reason for that
Speaker 2: is because public health officials were like, oh my gosh,
Speaker 2: this was so easy for them to do. We don't
Speaker 2: want people to know that this is possible. We don't
Speaker 2: want any copycats. This is disturbing. And so, as far
Speaker 2: as I could tell, it didn't really immediately result in
Speaker 2: any changes to regulations about who could order germs or
Speaker 2: for what purpose. I imagine I hope that that has
Speaker 2: changed somewhat by this point. Interesting in any case, the
Speaker 2: nineteen eighty four Wasco County salmonella attack was not the
Speaker 2: last time that salmonella made headlines. There have been many
Speaker 2: unintentional outbreaks since, including a huge one in Chicago from
Speaker 2: contamination at a milk processing plant, and it led to
Speaker 2: sixteen thousand confirmed cases.
Speaker 3: Ooh, sixteen thousand confirmed.
Speaker 2: That's what it said in the new In a news
Speaker 2: report I read, yeah, oh my god, that's going to
Speaker 2: be a lot more than that actual cases. Uh huh
Speaker 2: oh boy.
Speaker 1: Yeah.
Speaker 2: And reports in the late eighties revealed the incredible extent
Speaker 2: to which salmonella is present on eggs, which was also
Speaker 2: I think the first time that food hygiene as it
Speaker 2: related to salmonella gained more widespread awareness. But I'm really curious, Aaron,
Speaker 2: what has happened in the years since. Oh, I know,
Speaker 2: intibiotic resistance is an issue, and reporting and tracing outbreaks
Speaker 2: is so problematic. Can you bring me up to speed?
Speaker 2: How many people get sick? What's the biggest problems all
Speaker 2: that stuff?
Speaker 4: I can't wait to Let's take a break first, So
Speaker 4: I thought for this one, I'd start like as broad
Speaker 4: as possible and then dig down to more narrow All right, Okay,
Speaker 4: that's my sure. So globally, if we just look at
Speaker 4: food borne illness in general, the World Health Organization estimates
Speaker 4: over six hundred million infections and four hundred twenty thousand
Speaker 4: deaths associated with food born illness specifically, If we look
Speaker 4: just at the diarrheal food born infections. Those cause an
Speaker 4: estimated two hundred and thirty thousand deaths worldwide, so over half.
Speaker 4: And salmonella is one of these principal agents that cause
Speaker 4: death among those food born diarrheal illnesses. So it's estimated
Speaker 4: if we now just look more specifically at salmonella, that
Speaker 4: salmonella enteritis itself in twenty seventeen is estimated to have
Speaker 4: caused over ninety five million infections worldwide, and there's a
Speaker 4: really wide margin of error on that estimate, of course,
Speaker 4: and over fifty thousand deaths. Again wide margin of error.
Speaker 4: If we now get even more specific and turn to
Speaker 4: invasive disease, so invasive salmonella, not typhoid salmonilla, it's estimated
Speaker 4: that there were in twenty seventeen over five hundred and
Speaker 4: thirty five thousand cases of invasive non typhoidal salmonella, with
Speaker 4: the highest incidents in Sub Saharan Africa, and they estimated
Speaker 4: over thirty four cases per one hundred thousand happened in
Speaker 4: children under age five, so a huge burden in children,
Speaker 4: and they are of course some of the highest risk
Speaker 4: for severe illness and invasive disease and this paper also
Speaker 4: estimated over seventy seven thousand deaths in twenty seventeen just
Speaker 4: from invasive salmonilla. So that's separate from the salmonella enteritis.
Speaker 3: Oh wow, I know.
Speaker 4: Yeah, the all age case fatality rate for invasive salmonella
Speaker 4: was fourteen and a half percent on average, fourteen percent
Speaker 4: death toll from invasive salmonella.
Speaker 3: That is, I had no.
Speaker 4: Idea how severe an invasive salmonella infection.
Speaker 2: And so when you get an invasive salmonella infection, is
Speaker 2: it just that antibiotics don't always get there in time,
Speaker 2: or is it antibiotic resistant infections? Like what's contributing to
Speaker 2: that high death toll?
Speaker 4: Yeah, it's a good question. I think it's a lot
Speaker 4: of things. I think it's probably a combination.
Speaker 3: Of all of that.
Speaker 4: It's also that so the case fatality rate is even
Speaker 4: higher if you look at just the elderly, or look
Speaker 4: at just those under age five, or just those living
Speaker 4: with HIV, So that's even just the average. But I
Speaker 4: think it's a lot of things. I think it's how
Speaker 4: overwhelming the infection can be, maybe by the time you
Speaker 4: identify it.
Speaker 3: I think it's that a.
Speaker 4: Lot of these are happening in areas that have a
Speaker 4: lack of access to good medical care, or to rapid
Speaker 4: medical care with identification and quick treatment and that sort
Speaker 4: of thing. So I think it's a lot of factors
Speaker 4: that play into it. In the US alone, the CDC
Speaker 4: estimates that there are over one point three five million
Speaker 4: cases of salmonellosis every year, over twenty six thousand hospitalizations
Speaker 4: and four hundred twenty deaths in the US. And now
Speaker 4: here's where it gets even scarier. And this data I
Speaker 4: really only have for the US, but this isn't specific
Speaker 4: to the US, but this data is from the US.
Speaker 4: Of those one point three five million cases, it's estimated
Speaker 4: that over two hundred thousand of them are due to
Speaker 4: antibiotic resistance salmonella. Wow, including an estimated twenty thousand, twenty thousand,
Speaker 4: at least cases a year that are resistant to three
Speaker 4: or more of the essential antibiotics that we would use
Speaker 4: to treat salmonella. Antibiotic resistance it's a really big problem, obviously,
Speaker 4: when it comes to so many infections, not just salmonella,
Speaker 4: but in salmonella. I think part of the reason that
Speaker 4: it's a particular problem is because of the way that
Speaker 4: antibiotic resistance can develop in our food system and then
Speaker 4: spread through that food system. Yeah, right, So, because salmonella
Speaker 4: can be found in so many guts of so many animals,
Speaker 4: especially domestic animals that we use for food, it can then,
Speaker 4: like you were saying, aaron, enter our food system from
Speaker 4: a number of different ways, from the processing to the
Speaker 4: water supply. It can end up on the boots of
Speaker 4: a farmer and then be transferred between locations. It can
Speaker 4: end up in the soil. It can be carried by
Speaker 4: rodents or even insects. Potentially, it can persist on shared
Speaker 4: equipment like you mentioned, It can be in these tanks
Speaker 4: where they're cleaning things that just then get filled with salmonella.
Speaker 4: It can be everywhere. It has a lot of points
Speaker 4: of entry into our food system. Right, that's just salmonilla. Now,
Speaker 4: Antibiotic resistance genes are present not just in bacteria of
Speaker 4: pathogen potential, but antibiotic resistance genes are present in a
Speaker 4: lot of environmental microorganisms. So there's what's often called like
Speaker 4: an environmental resistome that exists, and these genes can then
Speaker 4: also make their way into bacteria of pathogen potential. It
Speaker 4: doesn't have to be that these salmonella making their way
Speaker 4: into our food system have to evolve these resistance genes denovo.
Speaker 4: A lot of the times these genes already exist and
Speaker 4: in many cases are present on plasmids or if let's
Speaker 4: say other like lactic acid bacteria in the soil like
Speaker 4: break open. Now, these genes are in the environment, so
Speaker 4: bacteria like salmonella can then come into contact and pick
Speaker 4: them up via conjugation or transformation. See our antibiotic resistance
Speaker 4: episode for more. But and that too is one of
Speaker 4: the reasons why, like the widespread use of antibiotics, especially
Speaker 4: in our farm system and our domestic animal like animal
Speaker 4: for meat production and things, is so concerning and such
Speaker 4: a big part of the problem that contributes to antibiotic resistance, right,
Speaker 4: because you're selecting for these resistance genes not just in
Speaker 4: the pathogens, but in the environmental bacteria as a whole.
Speaker 2: It is nightmarish, It really is.
Speaker 3: It is.
Speaker 4: Yeah, speaking of nightmarish.
Speaker 2: Great, Yeah, love that segue.
Speaker 3: Right, that's a good one. Thanks for handing it to me.
Speaker 4: I want to give a shout out to a very
Speaker 4: great and thorough article that Aaron you sent me over.
Speaker 4: This article was published in pro Publica. It dives very
Speaker 4: deeply into an outbreak that perhaps is still evolving, perhaps
Speaker 4: has waned, it's hard to say, but an outbreak of
Speaker 4: Salmonella a sarahvar called infantis, which I mentioned at the top,
Speaker 4: that started in twenty eighteen. This is a particularly multi
Speaker 4: drug resistant and particularly infectious and tends to cause relatively
Speaker 4: severe disease sarah var that really ran rampant and was
Speaker 4: found at extremely high prevalence in meat and poultry samples.
Speaker 4: And throughout this outbreak, according to the article, the CDC
Speaker 4: estimated that for every confirmed case of salmonella, an additional
Speaker 4: thirty are never reported, So this outbreak likely had infected
Speaker 4: nearly three thousand people.
Speaker 3: I had never heard of it. No, Yeah, this was.
Speaker 4: Like twenty eighteen, twenty nineteen, Like this just happened. And
Speaker 4: this article does a really great job of kind of
Speaker 4: highlighting some of the major flaws. And this is US specific,
Speaker 4: and they kind of compare to the way the regulatory
Speaker 4: system works in the US versus Canada and Europe and
Speaker 4: other countries. But we have in the US some pretty
Speaker 4: massive holes in our how our regulatory system works in
Speaker 4: terms of what the CDC can do and require and
Speaker 4: investigate and what their investigations can then produce as like
Speaker 4: a recommendation or product versus the FDA versus the USDA
Speaker 4: who oversees meat and poultry and that is separate from
Speaker 4: the FDA that does all of the rest of the
Speaker 4: food right and essentially, just like this system, which probably
Speaker 4: comes as no surprise to anyone who's listened to this podcast,
Speaker 4: is not designed to protect the consumer. No, it's designed
Speaker 4: to protect the industry. You might hear about salmonella in
Speaker 4: your bag of spinach every once in a while, you
Speaker 4: might hear about it every once in a while in
Speaker 4: chicken from this one farm. But the problem is so
Speaker 4: much bigger than that, and to really get a handle
Speaker 4: on it, we have to truly in this country revamp
Speaker 4: the way that our food system works and the power
Speaker 4: that regulatory government bodies actually have to regulate that industry,
Speaker 4: which essentially doesn't exist right now. Salmonella is pretty easy
Speaker 4: to kill. It's not like some of the bacteria that
Speaker 4: we've talked about that have like very environmentally hardy spores
Speaker 4: or anything. So cooking your food properly does kill the bacteria,
Speaker 4: and it does have a really high infectious dose so
Speaker 4: that's also good.
Speaker 3: Yeah.
Speaker 4: It is also though, really easy to contaminate other parts
Speaker 4: of the kitchen, so I think like, yeah, the knives,
Speaker 4: the cutting boards, the counter, your hands. Everything has to
Speaker 4: be really well cleaned, including things that you aren't going
Speaker 4: to cook like salad, greens, or fruits. These things need
Speaker 4: to be washed, and that can really be a challenge
Speaker 4: sometimes it can.
Speaker 2: It really can.
Speaker 3: One of the.
Speaker 4: Biggest tools that we have to use in understanding the
Speaker 4: extent to which salmonella poses a public health problem is
Speaker 4: of course through testing, but not just testing up of
Speaker 4: environmental samples or of meat products or produce, but also
Speaker 4: testing of humans when we get sick. Because while a
Speaker 4: lot of salmonella cases are never reported because the person
Speaker 4: who got sick maybe didn't get sick enough to actually
Speaker 4: go to the hospital or clinic, but there are a
Speaker 4: lot of people who do.
Speaker 3: So if, for example, you.
Speaker 4: Get quite sick, you have really bad stomach cramps, you
Speaker 4: absolutely can't stop pooping, and you decide to go to
Speaker 4: the hospital or a doctor's office. Once you're there, what's
Speaker 4: very likely going to happen is that you might get
Speaker 4: asked to provide a sample of said poop or stool
Speaker 4: to figure out what the cause is of your symptoms.
Speaker 4: But the question is how exactly does all that information
Speaker 4: come to light, Like where does that stool sample go,
Speaker 4: who is the person who's having to sort through it
Speaker 4: and test it, and what else are.
Speaker 3: They working with.
Speaker 4: We are really happy to have the help of medical
Speaker 4: laboratory scientist and TPWKY listener Sarah Zoucha to help us
Speaker 4: answer some of these questions and to shine a light
Speaker 4: on a sometimes very overlooked but crucial field in healthcare,
Speaker 4: medical laboratory science. Will let Sarah introduce herself right after
Speaker 4: this break.
Speaker 5: Hi, I'm Sarah Zoucha. I'm a medical laboratory scientist. I
Speaker 5: have been working in the field for about twelve years.
Speaker 5: I'm ASCP certified as a generalist, which means I can
Speaker 5: work in all areas of the clinical laboratory, including blood bank, hematology, chemistry,
Speaker 5: and microbiology, which is my primary focus and where I
Speaker 5: have been working for the past ten or so years.
Speaker 2: Awesome, thank you so much for being here. Can you
Speaker 2: walk me through what happens in food borne illness testing
Speaker 2: in general, like what's the process from the doctor's office
Speaker 2: to test results and what are the other common pathogens
Speaker 2: that you look for.
Speaker 5: In any kind of laboratory testing, there are three phases.
Speaker 5: There's the pre analytic phase, which is what happens with
Speaker 5: the specimen before it gets to the lab, the analytic phase,
Speaker 5: which would be the actual laboratory testing, and then the
Speaker 5: post analytical phase. So starting in the pre analytic phase,
Speaker 5: that's you know, when the patient goes to the doctor,
Speaker 5: they're not feeling well well, and the doctor will be
Speaker 5: asking about patient symptoms when they began, what their symptoms are.
Speaker 5: Specifically if they're suspecting a food born illness, of course,
Speaker 5: where did they eat, what did they eat, any travel history,
Speaker 5: things like that. The next thing they will do is
Speaker 5: they'll collect the specimen from the patient, so the doctor
Speaker 5: will give the patient everything that they need to do
Speaker 5: that and in the case of food born testing, they're
Speaker 5: going to need a stool sample. So the analytical phase
Speaker 5: of testing is when the specimen is actually received into
Speaker 5: the labs, So the specimen is processed for testing, and
Speaker 5: there's a couple of different ways that this can be done.
Speaker 5: Right now, a lot of labs are moving to a
Speaker 5: more rapid kind of testing versus traditional culture. In traditional culture,
Speaker 5: you have to weigh twenty four hours for the bacteria
Speaker 5: to grow before you can really do anything with it.
Speaker 5: With the new molecular test, it's a panel that will
Speaker 5: test for the most likely suspects in food borne illness,
Speaker 5: so it will give you a preliminary result right away,
Speaker 5: so the doctor kind of has a heads up the
Speaker 5: day that the specimen is received into the lab, and
Speaker 5: these panels typically test for Salmonella, Shigella E. Coli, Arimonas, Plisiomonis,
Speaker 5: Vibrio campilobacter, and your sinea Ento kalitica. You can also
Speaker 5: get expanded panels for other things like parasites and certain
Speaker 5: viruses that may cause gastrointestinal discomfort, depending upon you know
Speaker 5: the hospital and what they determine needs are. So once
Speaker 5: this molecular panel is run, if there is something that
Speaker 5: is identified in this panel, what will then happen is
Speaker 5: that specimen is cultured out and grown in traditional bacterial
Speaker 5: culture for confirmation, and then this is done by different
Speaker 5: biochemical testing and other commercial laboratory instrumentation that will confirm
Speaker 5: the ID. Once this bacteria is identified, then it is
Speaker 5: typically sent out to the local Department of Health or
Speaker 5: other state reporting agencies so they can do kind of
Speaker 5: their follow investigation, and then this kind of leads us
Speaker 5: into the last phase, which is post analytical, where the
Speaker 5: results are reported out to the patient's chart, called to
Speaker 5: the clinician if it's considered a critical value, and then
Speaker 5: any contact tracing or patient follow up is performed.
Speaker 2: So with cases of food poisoning, you have your usual
Speaker 2: suspects that you're looking for, But what if you don't
Speaker 2: know exactly what you might be looking for in a
Speaker 2: suspected infection, Like where do you start your search in
Speaker 2: that case?
Speaker 5: Actually, how it works is we're supposed to be totally
Speaker 5: blind when we have a sample come into the lab.
Speaker 5: We're not supposed to really know too much about the
Speaker 5: patient in their history because that can bias the results.
Speaker 5: So when the specimen comes into the lab, all we
Speaker 5: know is that the doctor wants this kind of test.
Speaker 5: So like in the case of suspected food borne illness,
Speaker 5: they're just going to send a stool culture. So we
Speaker 5: would just set up the testing and basically we have
Speaker 5: a list of what we're looking for and we're ruling
Speaker 5: everything out. If the culture is negative, we're gonna send
Speaker 5: out those results. But if the doctor does suspect that
Speaker 5: there is still something going on, then that's when they
Speaker 5: would order more testing. So like they would know, Okay,
Speaker 5: this patient is exhibiting GI symptoms. It's not bacterial. Well,
Speaker 5: maybe it's viral, so let me order a viral panel.
Speaker 5: You know. If that's negative, then they'll be like, all right, parasitic,
Speaker 5: let me order an OVA and parasite panel.
Speaker 2: You know.
Speaker 5: So it's really up to the doctor to kind of
Speaker 5: make that determination. We in the lab aren't really authorized
Speaker 5: to order testing. Is that constitutes treatment and diagnosis, which
Speaker 5: is out of our skull. The only time we're able
Speaker 5: to order extra testing to rule things out is if
Speaker 5: it's something that's predetermined by the medical director and the
Speaker 5: clinician team, where a test would automatically reflux.
Speaker 2: As a medical laboratory scientist or a technician, what are
Speaker 2: some of the places you can work and what does
Speaker 2: the current job market look like for these careers?
Speaker 5: So the current job market is super excellent right now,
Speaker 5: there is a severe shortage. I went on the Bureau
Speaker 5: of Labor Statistics to find out how short we actually are. So,
Speaker 5: according to the Bureau of Labor Statistics, job growth between
Speaker 5: twenty twenty and twenty thirty is eleven percent faster than
Speaker 5: the national average for most other jobs. What's going on
Speaker 5: right now? If you graduate, wait from college, you can
Speaker 5: get a job anywhere, like anywhere you want, any city,
Speaker 5: any hospital. I mean, everybody is hiring. So some of
Speaker 5: the places that people normally work, hospital labs are the
Speaker 5: most common, but also there's reference labs like lab core
Speaker 5: quest a RUP. A lot of times doctors' offices or
Speaker 5: urgent cares will employ an MLS to run their small
Speaker 5: in house laboratory point of care, which point of care
Speaker 5: is kind of maintaining the devices that the nurses would
Speaker 5: use at a patient's bedside, like glucometers. Public health labs,
Speaker 5: pharmaceutical companies, medical device companies, in research are other areas
Speaker 5: that do employed clinical laboratory or medical laboratory scientists. However,
Speaker 5: I feel like those are little bit less popular and
Speaker 5: also harder to get a job in those industries.
Speaker 2: What is the most unusual sample you've ever worked with?
Speaker 5: The most unusual sample I've ever worked with probably any
Speaker 5: like amputated body part. When you're testing something like that,
Speaker 5: you're generally it's a tissue culture. Like let's say somebody
Speaker 5: has gain green, and so you know, you're trying to
Speaker 5: figure out the cause of the infection. So what's really
Speaker 5: supposed to happen. The doctor's supposed to cut off a
Speaker 5: piece of the tissue and deliver it to the lab
Speaker 5: that way. But there's been times where it's remember one
Speaker 5: time we got something that was like a tupperware container
Speaker 5: and I open it up and it's like half a
Speaker 5: foot and you know, we've gotten fingers, we've gotten tips
Speaker 5: of penises. Yeah, so those would be yeah, some of
Speaker 5: probably like my more memorable ones where I'm just like,
Speaker 5: did they really just do that?
Speaker 2: My goodness, I really cannot get over it.
Speaker 4: That is amazing, amazing and hilarious. Thank you so much,
Speaker 4: Sarah for taking the time to chat.
Speaker 2: Yes, thank you. Well, uh, should we do sources?
Speaker 3: Sources? Definitely?
Speaker 2: I will shout out a few. There were a couple
Speaker 2: of papers by Hardy, one from nineteen ninety nine, one
Speaker 2: from two thousand and three that kind of looked at
Speaker 2: this bigger picture of salmonella and the way that like
Speaker 2: food production changed, and of course the documentary Wild Wild Country.
Speaker 4: I had a number of papers if you want to
Speaker 4: know more about the differences in the epidemiology of.
Speaker 3: The zero of VARs.
Speaker 4: There was a paper in Applied in Environmental Microbiology from
Speaker 4: twenty nineteen that went into a lot of detail on it.
Speaker 4: I really enjoyed a paper from Frontiers in Microbiology twenty
Speaker 4: fourteen that was like comparing and contrasting typhoidal and non
Speaker 4: typhoidal Salmonella sero VARs.
Speaker 3: There was a.
Speaker 4: Bunch of really good ones and I will also link
Speaker 4: to that pro public article if you want to read
Speaker 4: more about that outbreak that happened in the US recently.
Speaker 2: Thank you again so much, Beth for sharing your story.
Speaker 2: We really appreciate it.
Speaker 3: Thank you.
Speaker 4: Thank you also to Bloodmobile for providing the music for
Speaker 4: this episode and all of our episode.
Speaker 2: And thank you to you listeners. We hope that you
Speaker 2: enjoyed this poopy episode.
Speaker 6: Whoope episode Yeah, it wasn't actually that poopy, It actually
Speaker 6: wasn't yea. And a special thank you to our patrons.
Speaker 3: We love you, We love you.
Speaker 2: Okay, Well until next week, my gosh, please wash your
Speaker 2: hands and your fruits and vegetables and us a thermometer.
Speaker 4: And your knives and your cutting boards and your kitchen
Speaker 4: counters and your what do you do about sponges you,
Speaker 4: filthy animals.
Speaker 1: E