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A Student Ate 5 Day Old Pasta For Lunch. This Is How His Liver Shut Down [video] (
4 points by shawn to videos medicine chubbyemu 429 days ago | 1 comment

3 points by shawn 429 days ago

I dug into the literature for this case:

The video turns out to be "based on a true story" rather than "a factual recounting of events." But the video is pretty faithful to the case.

The most surprising difference was how quickly he died: just 10 hours after eating the pasta, in the middle of the night. There wasn't any emergency room visit. He also didn't drink any stomach medicine (unless I'm missing something in the report) which seems like an odd thing to put in the video.

> On 1 October 2008, a 20-year-old man became sick after eating a meal of leftovers of spaghetti with tomato sauce, which had been prepared 5 days before and left in the kitchen at room temperature. After school, he warmed the spaghetti in the microwave oven. Immediately after eating, he left home for his sports activities, but he returned 30 min later because of headache, abdominal pain, and nausea. At his arrival, he vomited profusely for several hours and at midnight had two episodes of watery diarrhea. He did not receive any medication and drank only water. After midnight, he fell asleep. The next morning at 11:00 AM, his parents were worried because he did not get up. When they went to his room, they found him dead.

> Legal examination determined the time of death, presumably at 4:00 AM, approximately 10 h after ingestion of the suspected meal. An autopsy could not be performed until 5 days later. Macroscopically, brownish and moderately softened liver and ascites (550 ml of citrine liquid) were found. The heart was macroscopically normal. A total lysis of the pancreas was also found, but it could not be excluded that this finding was due to the autopsy delay.


> The pattern of toxin production for the strains isolated in the present case is presumably classical for strains implicated in emetic poisoning. Nevertheless, some emetic strains producing NHE were found to be very cytotoxic for Caco-2 cells, as previously reported (14). Furthermore, the simultaneous presence of the genetic determinants for cereulide and the genes encoding potential enterotoxins was recently demonstrated for a B. cereus strain (19, 20), which appeared to be particularly virulent. Could this fact have played a role in the necrosis of the colon, even though the cytK PCR was negative, since that this toxin is the one that has been implicated in necrotic enteritis (21)? That is an important question for which no answer can be given at the moment.


> Although we cannot incriminate B. cereus as the direct and unique cause of death, the present case illustrates the severity of the emetic and diarrheal syndromes and the importance of adequate refrigeration of prepared food. Because the emetic toxin is preformed in food and is not inactivated by heat treatment (2, 23), it is important to prevent B. cereus growth and its cereulide production during storage. This toxin production is closely linked to temperature (9) and is not strictly correlated with bacterial counts, as recently demonstrated by Delbrassinne et al. (5; unpublished). The cereulide amounts produced by a B. cereus emetic strain inoculated at 106 CFU/g in cooked rice were higher at 23°C than at 30°C, whereas the opposite situation was observed for the cereulide producer counts. These results suggest that cereulide may be more actively produced at ambient temperatures. In this case, the spaghetti had been kept at room temperature for several days: this allowed B. cereus to grow to the previously mentioned very high concentrations and produced the high toxin concentration (14.8 μg/g) found in the pasta and which is likely responsible for the fatal outcome.


> In conclusion, although the autopsy results were not conclusive, probably due to the delay in analysis, the large number of B. cereus cells and the significant cereulide concentration found in the leftovers are the most likely cause of death of the young healthy man.


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