Real Life Impacts of Salmonella Infection
What follows are just a few of the personal stories associated with Salmonella enterica outbreaks.
Rick Schiller, Salmonella Heidelberg, 2013
Rick Schiller was one of hundreds of persons sickened in the March 2013 Salmonella Heidelberg outbreak linked to poultry distributed by Foster Farms. The outbreak spanned over a year and sickened 634 people in 29 states and Puerto Rico. On September 27, 2013, Rick was diagnosed with gastroenteritis, yet did not seek medical treatment as he was convinced that he was suffering from a mild case of food poisoning. Rick could not have been more wrong.
On Saturday night, September 28, 2013, Rick went to bed early, hoping to feel better in the morning. When he woke up the next day, his right knee was painful, reddened, and warm to the touch. On Sunday night, Rick went to bed with his right leg propped up and an ice pack on his knee. In the middle of the night, he was awakened by a sharp pain. When he pulled back the covers, he was startled by the sight of his own body—his right leg was dark purple and swollen to about three times its normal size. Rick’s fiancé immediately dialed for an ambulance, but Rick thought it would be faster to have her drive him to the emergency room. However, this was no easy feat. Rick recalls the agonizing experience:
I couldn’t get my leg into the car because it wouldn’t bend. I leaned over into the driver seat and [my fiancé] had to force my leg into the car. It was excruciating. At the hospital, it took five people to help get me out of the car into the ER. As soon as I got in there, they pumped me full of morphine for the pain, then they put Novocaine in my leg and attempted to tap the knee. The first needle they stuck in didn’t work, so they got out a bigger one. They pulled on the syringe and “meat-like” stuff came out. It was excruciating, even on the morphine.
Rick was in so much pain that he felt like he might die. After being admitted to the hospital, Rick took out his cell phone, snapped a photograph of himself, and proceeded to draft a Last Will and Testament on his phone.
During his time at the Kaiser San Jose Medical Center, Rick developed a very high fever and recalls an unpleasant memory of being covered head-to-toe with ice packs. He continued to have pain all over the right side of his body. Both his right leg and right arm were painful. His right eye would crust up and his right ear had intermittently muffled sound.
The following day, doctors ran blood work, and performed an arthrocentesis, a duplex Doppler sonography, and an MRCP (magnetic resonance cholangiopancreatography) on Rick. On October 2, he was diagnosed with colitis—localized Salmonella infection—and arthritis of the right knee, and he was discharged from the hospital.
On October 15, Rick returned to the Kaiser Medical Center for a follow-up. He was seen by Orod Khaghani, MD, who informed him that his gastroenteritis and Salmonella colitis were resolved; however, Rick was diagnosed with reactive arthritis. A few days later, Pradipta Ghosh, MD, performed X-rays on Rick’s lower extremities and diagnosed him with bone spurring and mild joint space loss, consistent with mild osteoarthritis.
Four months after his Salmonella infection, Rick returned to Dr. Khaghani, unfortunately having relapsed with lower left quadrant abdominal pain. He also complained of decreased appetite and loose stools. Dr. Khaghani confirmed his initial diagnosis of reactive arthritis and informed Rick that he was suffering from diverticulitis of the colon. At this point, Rick’s medical bills and estimated wage loss totaled nearly $15,000.
Rick’s reactive arthritis remains symptomatic to this day. He feels as if his “entire right side is now weaker than [his] left.” He constantly worries about his health and feels as if he never fully recovered from his systemic illness. He notices generalized fatigue and is no longer able to do the “handyman” work that he once enjoyed.
According to CDC, the multistate outbreak in which Rick was involved lasted from March 1, 2013 to July 11, 2014. FSIS was first notified of the Salmonella outbreak as early as June 2013. By September 2013, FSIS officials had determined that Foster Farms’ chicken was behind the outbreak, yet they were powerless and unable to force a recall of the tainted poultry until July 2014. While FSIS can certainly request an establishment to recall a product in commerce, the agency indicated that it did not request a recall because “despite its efforts to identify the product causing the illness, no data were available that enabled its investigators to pinpoint the types of contaminated chicken products—for example, chicken breasts, whole chickens, or ground chicken—or production dates or lots.” During these seventeen long months, at least 240 victims were hospitalized, and despite significant epidemiological, microbiological, and traceback evidence linking the illnesses to a common production, Foster Farms was allowed to continue producing and selling potentially tainted chicken. In September of 2013, during a USDA-FSIS in-facility testing for Salmonella at three Foster Farms production plants in California and Washington, FSIS determined that sanitary conditions at the facilities were so poor that they posed a “serious ongoing threat to public health.” The subsequent letters written by FSIS to Ron Foster (Foster Farms’ chief executive) cited “fecal material on carcasses” and findings of poor sanitary dressing practices, insanitary food contact surfaces, insanitary non-food contact surfaces, and direct product contamination.
Steven Romes, Salmonella Newport, 2018
In 2018, Steven Romes, of Gilbert, Arizona, was a healthy and athletic husband, father, and insurance underwriter. On September 3 of that year, he consumed medium-to-well done hamburgers as part of a Labor Day family cookout. Two days later, Steven fell violently ill with painful diarrhea, fever, and stomach cramps. Over the next few days, Steven’s symptoms worsened. He was unable to consume any solids and was forced to lay on his bathroom floor because he did not have the strength to crawl back into bed after severe bouts of diarrhea and vomiting. On September 8, 2018, after his diarrhea progressed to bloody stools, Steven was rushed to the emergency room.
Urine tests in the emergency room revealed that Steven was suffering from acute kidney injury. He was admitted to the hospital and his illness was determined to be one of many illnesses in a nationwide outbreak of Salmonella Newport linked by public health officials to various ground and non-intact beef products manufactured by JBS USA, the world’s largest meatpacker. The outbreak spurred one of the largest-ever recalls of ground beef—over 12 million pounds of ground beef, the meat of an estimated 13,000 animals, were recalled. The recall affected nearly 50 different JBS product lines, including its Grass Run Farms “100% Grass Fed Beef” line and its Cedar River Farms “Natural Beef” line. 255 cases of Salmonella were identified across 32 states, 29% of patients for whom information was available were hospitalized, 6% were admitted to an intensive care unit, and two died.
Fourteen months before the recall, the decades old Tolleson, Arizona plant at the center of the outbreak had received numerous complaints of “egregious” livestock conditions. In July of 2017, FSIS issued a notice to Andre Noqueira, CEO and president of JBS Tolleson, Inc. accusing him of enabling “inhumane handling and slaughtering” practices at his facility. The report states that, during a routine inspection, officials observed a number of “nonambulatory cows […] lying in distress.” One cow was described as “mentally incoherent, having difficulty breathing, and repetitively making a kicking motion with its legs while moaning as if in pain.” Despite these dreadful conditions, JBS was allowed to continue producing meat for human consumption.
JBS USA’s most recent public safety recall is, unfortunately, not their first. In February of the same year, Pilgrim’s Pride Corporation, a Texas-based company operated by JBS USA, recalled more than 101,310 pounds of breaded chicken patties due to potential foreign-matter contamination. In May of 2018, a JBS establishment in North Carolina recalled over 35,000 pounds of raw ground beef products due to plastic contamination. However, unlike the February and May recalls, the October 2018 Tolleson ground beef recall is widely believed to be the consequence of a much more sinister side of the beef industry.
Although JBS and FSIS failed to provide detailed information regarding the original source of the Salmonella Newport outbreak, it is highly probable that the contamination was a result of blending tainted dairy cow meat with untainted meat. Since the mid-1980s, dairy cows have been identified as the primary reservoirs of Salmonella enterica serotype Newport. A paper published by the World Organization for Animal Health in 1997 referred to dairy cows as “the source of Salmonella Newport-contaminated hamburgers causing foodborne illness.” Similarly, a CDC Morbidity and Mortality Weekly Report from April 2018 confirmed that dairy cows were the “ultimate outbreak source” of a multistate ground beef outbreak which lasted from October 2016 to July 2017 and claimed one life.
Sick dairy cows are more likely than healthy ones to be “culled,” or sold for meat. At large-scale, intensive dairy facilities, productivity is the name of the game. Dairy farmers must ensure that their cows are producing as much milk as possible. If their output drops for any reason, cows are sold to the meat industry and replaced. In the beef industry, dairy cow meat is commonly ground up and used as a padding ingredient in millions of patties; it is estimated to make up to 20 percent of the U.S. ground beef market. A 2012 study revealed that “lean beef trimmings from cull cows are often blended with high-fat content beef trimmings […] to facilitate a consistent supply of ground beef that meets certain purchase specifications.” This process is normally of minimal concern but when the filler product—dairy cow meat—harbors Salmonella, the consequences can be disastrous.
Steven Romes was, and remains, a victim of those consequences. After a colonoscopy and three-day in-patient stay at the Dignity Health Mercy Gilbert Medical Center, Steven was finally discharged from the hospital. Unfortunately, his normal bowel habits and appetite never returned, and he was diagnosed with Irritable Bowel Syndrome. Today, Steven can only tolerate bland foods and he still occasionally suffers from stomach cramps and diarrhea.
The Porter Family, Salmonella I 4,,12:i-, 2015
On the afternoon of June 28, 2015, Rose and Roger Porter hosted a going away party at their home in Rainier, Washington. The Porters planned on moving to Costa Rica and wanted to celebrate with their family and friends one last time.
On June 27, Rose Porter picked up a whole hog from Stewart’s Meats in McKenna, Washington. The next day, Rose cooked the pig just the way she was told to by Stewart’s. Hours later, the Porters’ home was filled with friends and family, many of whom were about to become seriously ill with Salmonella poisoning. It all seemed so easy and matter of fact in retrospect, as Rose recalls:
When [the whole roasted hog] was done, I served it up. After everyone left, I cleaned everything up and threw out any food that was left over. We packed everything up and went to bed. The next day, I woke up with explosive diarrhea. I had a very busy day because we were packing up to move to Costa Rica. I had to get out of our house because we had renters coming in. I had to find us a hotel and I was dealing with my daughter not feeling well at all. She went with me for the day because she wanted to sleep in a bed at a hotel. I had to stop every half hour to use the bathroom. The diarrhea kept up.
Once Rose and Mikayla arrived at the hotel, all Mikayla could do was lie down and watch television. She fell asleep at 6 PM. By 2:30 AM, she was up and vomiting. Mikayla woke her mom up and, at 4:30 AM on June 30, they both headed to Providence St. Peter Hospital in Olympia, Washington. Joseph Pellicer, MD, was on duty in the emergency hospital and listed Mikayla’s chief complaints as “abdominal pain, emesis, diarrhea, and fever.” Rose explained that Mikayla had been sick since the morning before with severe diarrhea. By the evening, Rose stated that Mikayla “felt like she was on fire.” Mikayla also described having shaking chills with fever and Rose told Dr. Pellicer that she was having similar symptoms. Mikayla was miserable, wracked with body aches and pain that radiated up into both of her shoulders.
Dr. Pellicer did an exam and found Mikayla tachycardic with a heart rate of 125 and a diffusely tender abdomen. The doctor also observed that Mikayla was dehydrated with turbid urine, ketonuria, proteinuria, and dry mucus membranes. Despite these clinical symptoms, no cultures were sent to the lab and no stool sample was collected. Dr. Pellicer diagnosed Mikayla with “acute gastroenteritis.” Just after 8 AM, he discharged Mikayla from the ER with a prescription for an antiemetic drug and clearance to travel to Costa Rica.
On July 2, 2015, the Porters landed in Costa Rica. Mikayla was still suffering from frequent bouts of diarrhea. Upon logging in to a social media website, Rose discovered that a party attendee’s daughter was being hospitalized for Salmonella poisoning. Rose decided to take her daughter to the local ER—Beach Side Emergency Clinic in Santa Cruz Guancaste. Andrea Messeguer, MD, the medical director of the clinic, evaluated Mikayla and noted that she was lethargic with persistent abdominal pain in the periumbilical area. Because Mikayla was currently afebrile and able to orally hydrate, Dr. Messeguer told Rose she could watch her daughter at home.
Over the next day, Mikayla did little but drink ice water, sleep, and go to the bathroom. Unfortunately, things soon took a turn for the worse. Rose recalls:
She started crying in the bathroom that she could not bear the stomach pains anymore and needed to go back to the doctor. She told me that she had blood coming out of her butt, that it had been that way for a while, and that she didn’t know what to do. The amount of time between her going to the bathroom went from every 20 to 30 minutes to every five to 10 minutes. She was screaming in pain in the bathroom. She said that she felt like someone was stabbing her over and over again in the stomach.
On July 3, Rose brought Mikayla back to see Dr. Messeguer at the urgent clinic and told the doctor that there was now mucus and blood in her daughter’s stools. Dr. Messeguer examined Mikayla and performed a stool smear and culture. While at the clinic, Mikayla’s diarrhea decreased in frequency and she was still holding down fluids, so the doctor diagnosed her with “bacterial gastroenteritis” until proven otherwise and sent her home.
It was not long before it was clear that Mikayla’s condition was deteriorating. By the morning of July 4, her stools were entirely bloody. Rose, once again, rushed her back to the urgent care clinic. Upon their arrival, Dr. Messeguer asked to speak to Rose privately. She informed her that Mikayla was losing a lot of blood and may need a blood transfusion. However, the clinic did not have the equipment or resources necessary to perform the procedure. Dr. Messeguer told Rose that her daughter could die on the four to five-hour drive to Hospital CIMA San Jose, and therefore, Mikayla would need to be airlifted there.
Rose and Mikayla were both transported by helicopter to Hospital CIMA San Jose in Costa Rica. According to a memorandum written by Luis Picado, MD, Mikayla presented with a high-grade fever, bloody stools, general malaise, and moderate dehydration. He wrote, “On admission, she presented with clear signs of bacterial gastroenteritis and required intravenous rehydration and parenteral antibiotics to control the infection. Stool studies were positive for Salmonella.”
Rose does not require a formal medical record to recall how things went for her daughter over the next several days. The memory is still fresh in her mind:
For the next three days, I sat back and watched as my daughter cried in pain. I changed her bloody sheets when she couldn’t make it to the bathroom. I didn’t sleep for the first couple nights because I was so scared that she wouldn’t wake up. [Mikayla] couldn’t process food or water. The doctor told me that the bacteria had gotten into her system and shut it down completely. When she ate or drank, it would go straight through her. She wasn’t getting any nutrition or hydration.
The good news is that she is out of the hospital now. We have cut all pork out of our diets and are fearful of chicken and eggs. I have dealt with a husband over in Afghanistan and this was still the scariest thing I have ever been through. I can’t say that I know what it is like to have a child die, but I do know what it is like to see a child on their deathbed.
I have spent the last couple of months going over every detail that has happened over those two weeks. I felt totally responsible when this happened. I had to question all of my decisions as a mother. I felt like I poisoned my own child and everyone else that ate at my house. I lost friends from all of this. It was weeks later that I found out that, in the end, it wasn’t my fault.
During the time of Mikayla’s illness, Rose and Roger had their own Salmonella illnesses to contend with. On the helicopter ride to the hospital in San Jose, Rose’s blood pressure plummeted, and she lost consciousness. Roger had gastroenteritis with uncontrollable diarrhea for several days. Rose and Roger still suffer from periodic bouts of diarrhea to this day.
The Porters were three of 152 diagnosed victims of a nationwide outbreak of multidrug resistant Salmonella I 4,,12:i:-. Stewart Meats’ distributor of whole hogs was Kapowsin Meats. Laboratory testing of environmental samples at Kapowsin Meats by the Washington State Department of Health confirmed the presence of Salmonella I 4,,12:i:- in the facility. As a result of the investigation, Kapowsin Meats voluntarily recalled 523,380 pounds of pork products.