However, the real story behind this rare and life-threatening infection is more complicated than you might have heard, and it will most certainly make you feel better about noshing on food that’s a day or two old.
Severe Infection Wasn’t Caused by Eating Leftovers
The toxicologist Bernard Hsu, MD, known online as Chubbyemu, introduces the video by saying, “I don’t intend to scare anyone about food or leftovers. … I’ll be eating leftovers for dinner tonight just as I do every day. This was a freak accident, happening in a ‘perfect storm’ sequence of events, as I will show you.” According to the case record, published on March 11, 2021, in The New England Journal of Medicine, the patient had been well up until the day before he came to the hospital. He reported several bouts of vomiting along with stomach pain and nausea that started after he ate the day-old rice, chicken, and lo mein leftovers that had been brought home by his friend. The friend had also thrown up after eating the food, though only once and had no other symptoms. The young man also reported feeling weak, achy, with blurry vision, neck stiffness, chest pain, shortness of breath, and a headache. Five hours before the hospital admission, a purplish rash on the skin appeared.
An Expert Explains the Diagnosis of Meningococcal Purpura Fulminans
A host of treatments were administered in an attempt to revive his failing organs and treat the infection. The diagnosis? Meningococcal purpura fulminans, a rare condition that had nothing to do with eating leftovers, according to Joseph Duncan, MD, PhD, associate professor of medicine and infectious disease expert at the UNC School of Medicine in Chapel Hill, North Carolina. “Perhaps the patients’ doctors were worried at the beginning about a foodborne illness, but this actually turned out to be unrelated to the food,” he says. The way the illness appeared is quite typical for a case of this disease: a fever and not feeling well, sometimes associated with gastrointestinal symptoms, sometimes cough or chest pain, and sometimes severe headache that progresses over hours, says Dr. Duncan. “The development of the rash they describe in the setting of fever should prompt seeking immediate medical attention — without timely antibiotic administration this can progress to death or severe disease over just a few hours,” he says.
1 in 5 Cases Of Meningococcal Purpura Fulminans Results in Death
Purpura fulminans is a disorder caused by a bacterial infection in which the skin bleeds due to blood clots in the dermal layer (the skin layer under the top layer) and dies rapidly, also called skin necrosis, according to Utah Health. The necrosis of the arms and legs and gangrene led to the amputations of the patient, according to the report authors. The blood vessels in the skin also collapse and the proteins that cause the blood to clot become overactive, called disseminated intravascular coagulation (DIC). DIC causes the body to produce too many blood clots, followed by periods of bleeding. The clotting and bleeding interfere with blood vessels bringing oxygen to the tissues; when tissues and organs don’t get enough oxygen, they shut down. “Because of the severity of this type of infection and the rapidity of onset, even with correct treatment there is a high risk of death or permanent disability as a consequence of the infection-perhaps somewhere around 1 in 5 infections,” says Duncan. There can be multiple causes of purpura fulminans. In this case, it was caused by Neisseria meningitidis, a bacteria that lives in the nose and throat, that made its way into the blood stream of this individual, says Duncan. The timing of the infection, occurring after the consumption of the leftovers, was almost certainly a coincidence, says Duncan. “There are no documented cases of foodborne transmission of Neisseria meningitidis,” he says. The food may have triggered the initial vomiting incidence, says Duncan. “It is possible this patient had two things happen — vomiting immediately after food ingestion can be related to foodborne illness, and then they had the Neisseria infection coincidentally just after that. The fact that the roommate and the patient both had vomiting immediately after eating the food is consistent with the food potentially being the cause of the vomiting.”
Neisseria Meningitidis Is Harmless for the Majority of People
About 10 percent of young teens and adults have neisseria meningitidis in their nose and throat, and in most cases, they carry a version that is harmless for individuals with a normally functioning immune system, explains Duncan. Only about 1 out of every 10,000 individuals carrying the bacteria will actually become sick, which translates to about 1 in one million people in the general population. These rare instances can occur when the bacteria have a structure called the bacterial capsule, he says. A capsule can enhance the ability of bacterial pathogens to cause disease, according to Oregon State University. “Occasionally, a strain of the bacteria that is particularly good at causing disease will arise and this leads to outbreaks of the disease. These are most common in settings where young adults have large communal living situations such as dormitories and military barracks,” says Duncan. That’s because the bacteria is passed through respiratory droplets and saliva, he adds.
Meningococcal Vaccines the Best Way to Protect Against Meningococcal Disease
“In the United States, most grade schools and colleges require a vaccination (meningococcal vaccine) which dramatically lowers these teens and young adult’s risk of having severe infection in the blood stream. The required vaccine protects individuals against 4 of 5 bad strains,” says Duncan. There are two different vaccines that are available and provide some protection against the fifth strain, but that vaccine is not strictly required by many schools or colleges, he adds. According to the authors of the case report, the patient had received only one dose of the meningococcal conjugate vaccine, without a booster, and one dose of the serogroup B meningococcal vaccine. It’s recommended that a second (booster) dose be given at age 16, according to the Centers for Disease Control and Prevention (CDC). Vaccine protection does not prevent disease 100 percent of the time, and multiple doses are needed for the best protection, per the CDC. Even though the video teaser might have you think differently, avoiding meningococcal disease as seen in this case has nothing to do with shunning leftovers. It requires vaccination, says Duncan.
