Ep 99 Salmonella: A hard egg to crack

evening out in the town. And the next morning, got up, did the same thing over again. Ate breakfast. I was at working in the head rig, out in the sun all morning, and again it's another hot day, but you know, nothing out of the ordinary.

of feeling the same thing. They were dehydrated, they were some of them had upset stomachs. I eventually got a ride back to my car and headed home. It's about a forty five minute drive from downtown Cleveland to where I was living at the time, and as I'm driving, all of a sudden it hits me just like stomach cramps, stomach pain. I really felt like I had to fart and it I almost made it that last couple miles. Well,

some parts can't be trusted. So I got home. I had actually pooped my pants a little bit, and so I just took off my clothes, through them in the washing machine, start a loae to wash, took a shower, put on pajamas, and went to bed. Woke up a couple times in the middle of the night again with just an urgent need to go to the bathroom, just watery diarrhea every time. Whatever was inside of my intestines was just on the fast track out and that so I spent Sunday night. That's how I spent Monday, and

as I recall, that's how I spent Tuesday too. I mean I tried to eat gland food like cheerios or instant meshed potatoes, but every time I put something in my mouth, it was just on the fast track. Clear through. I started getting messages from some of my friends who were on the ship still, and it wasn't just me. It was at first it was eight or ten of us and twenty of us, and then all of a sudden, almost forty of us were sick and not getting better.

Probably Tuesday, I stopped trying to eat. I'm like, I'll just let my entire digestive system empty out, reset itself, and we'll try food again in a day or two. That didn't fix the illness, but it did let me control my bowels well enough that I could actually go to urgent Care. So I did that. They collected a sample and sent it to the lab, and I went back home and lived on gatory. The next couple of days, Urgent Care called me back and they're like, oh, you

have salmonilla. It should resolve itself, and you know, if not, follow with your primary care doctor. And that's really all they said about it. But you know, a week into this, I still can't eat solid food. So finally, eight and a half days later, I finally got into see my primary care position and she walked into the exam room. First thing she says is you look terrible. And the next question she asked me was did you finish your antibiotics?

And I said, what an aibiotics? So it turns out that the lab results from Urgent Care had actually said you should, you know, treat this patient with this antibiotic. Urgent Care never prescribed that, So my doctor started me on the antibiotics. Four days later, all of a sudden, I can eat food again, like it's a minor miracle. But in that time and that it's about ten or eleven days between when I got sick and when I

started feeling better, I dropped about sixteen pounds. You know, that took me from being a healthy weight to being underweight. And at the same time, this is happening to all of my crewmates too, so we knew that something had gone on in the ship. That weekend when the health department actually started doing surveys and talking to all the

people who were and were not sick. We figured out that the people that were sick were not vegetarians, and they'd eaten dinner on board the ship on Saturday night. Saturday dinner was Mexican castrole, So there was a version with chicken in it, and there's a version that didn't

have chicken in it. An interview with one of the guys that helped in the galley, he says he thinks that chicken had been cooked about six days earlier, and it was put into a wood stove after dinner one night, as the stove cooled off, so the cook goes to start the fire the next morning for breakfast and finds room temperature chicken, and the he throws in the refrigerator and that Saturday night ended up in that cast role.

They also, you know, took a look around the equipment and took a lot of you know, measurements of you know, how hot the windstove got, how cold the refrigerator was, how cold the freezer was, things like that. And one of the things they discovered is there actually was not a food thermometer on board. One of the things about these ships is they have a blackwater tank and so whenever you flush a toilet on the ship, it actually doesn't flush like a toilet. You actually pumped the wastewater

into the blackwater tank. That tank gets emptied basically with a septic haller truck, so those you know, big tank trucks that have the vacuum pumps. So as soon as the ship got back to Eerie, they scheduled that truck to come in and empty the blackwater tank because so many people have been using the heads that the blackwater tank was full. So first thing on Monday morning, his first stop of the day was the ship. He pulls in hooks up to all the connections so he can

suck the poop out. When he emptied the truck the day before, he hadn't flipped the pump from pumping the blackwater out of his truck to sucking it into his truck.

So what he actually did was he pushed a bunch of air into the blackwater tank, which pushed salmonilla contaminated pool water up through the vent and all over the plays where most of the crew sleeps, and they sanitized what they could but start for a lot of people got caught that way too, so we actually had a little secondary outbreak because the back truck was set to blow, not suck. At the end of it all, I believe

there were thirty seven of us in the outbreak. It was enough, It was a large enough percentage of the crew that the ship actually had to miss some of our contracted sales and events. But it managed to take a bunch of young, healthy people and pretty much ruin an entire summer for us. Even though you started feeling better because you didn't have uncontrolled diarrhea anymore, for some of us, it was months before you could just eat

whatever you wanted without thinking about it. And then a lot of us still to this day a decade later, don't eat chicken, and several of us have sworn off gatorade too. That it's just both of those things are things that remind us of that awful week that we all spent not being able to do anything more than five feet away from a toilet, and that was enough to lead to some regulatory changes in that community. And that's my story.

this very specific subspecies. And there are over fifteen hundred different seravars just in this subspecies alone.

typhoid Salmonella group. They definitely have a range in their severity and like I said, their host specificity, so some might really only cause disease in birds or in reptiles and only rarely in humans, where others are much more common in humans, etc. And they can range in their severity, and they can also differ in their susceptibility to antibiotics

for a number of different reasons. We'll get into a little more later, but an important thing to keep in mind is that when characteristics that make a particular sera var more invasive or more likely to cause an invasive disease a more serious disease, combined with characteristics that confer antibiotic resistance, those two things combined can make for a pretty dangerous seraph ar. Yeah yeah, Okay, So let's get into how we get this, shall we? I think everybody

knows at this point. Yeah, just like typhoid, other strains of salmonella in erica, I might refer to them as just nts or salmonella.

But even if they're naturally in the gut of an animal, that doesn't mean that they should be in anywhere that they would come into contact with the food supply, right, Like, Okay, they're in the gut, they shouldn't be in the breast, they shouldn't be in the meat, they shouldn't be in the feathers, they shouldn't be anywhere else except for in the gut, right.

hours of an infection. You see massive amounts of inflammation coming in. To try and fight off these bacteria, we start making a whole bunch of proteins, We start secreting things to try and fend off these bacteria, and then within a few more hours is when the diarrhea starts.

your small intestine are just full of inflammation. It makes your whole guts really angry.

And in general, antibiotics are actually not recommend it, Like the CDC, the World Health Organization, it's generally agreed upon that for this type of self limited diarrhea, you generally don't give antibiotics, and the only times that you do are if there are specific risk factors that make you think that this is likely to become an invasive infection or you have very high risk of it just being a really severe diarrhea, like in our first hand account,

if you're not keeping anything down, then of course something is wrong, or if you're very very young or very elderly, or immunal compromised, especially with something like HIV. And one of the reasons that it's generally recommended not to use antibiotics in the setting of diarrheal disease is that antibiotic administration in some cases can actually prolong the illness, and it can prolong the shedding of the infectious bacteria in

this stool, which I find absolutely fascinating. But now the question, of course is how often does this become a more severe infection? And by more severe, what I mean is that while in general, these Salmonella enterocolitis infections are just limited to this diarrhea, if these bacteria enter through the wall of your colon or your small intestine and make it into your bloodstream, they can cause a systemic infection, right, and that can be really severe, just like typhoid.

that there are inherited deficiencies in certain inflammatory systems. Specifically, if anyone cares, it's like certain inner luken systems IL twelve and ILE twenty three. That people with deficiencies in these systems are at much higher risk of invasive non typhoidal salmonella infection, and they're more resistant to typhoid infections.

out salmonella. But we don't see like we do in typhoid, this carrier state of like a year or two years, or ten years, or your whole life, which I think is really interesting, and it kind of points to like this really is a pathogen.

just in their genome. They have these little clusters of genes that encode a number of different things like flagella and capsules and like type three transport systems that like blah blah blah help them to infect us. But there are also a number of different plasmids that they have that encode not all the other virulence factors that might make them more likely to say, be able to infect a bird or your bearded dragon or your frog and other ones that might make it easier to infect humans.

But also a lot of these plasmids are what end up conferring antibiotic resistance, which of course is a huge problem when it comes to salmonella. And I'll talk a lot more about it at the end of this episode, but that's kind of the like what happens next, because even though we don't use antibiotics to treat all human infections, you have to have antibiotics that work to be able to treat this of your infections.

talk about today. And I have to say that I'm really excited about it because it is I think such a fascinating look into how food preparation and can some has changed over the past one hundred years or so, and how food poisoning kind of grew as a concept during that time. But the thing that I'm most thrilled to talk about is how salmonella was involved in the first act of bioterrorism in the US.

it's there's just too much ground to cover. But I will say that understanding the evolutionary origins of certain serovars that are associated with food poisoning and which types of food poisoning, that's incredibly important in preventing outbreaks because that knowledge can influence control strategies for instance, if one seravar is only present in the guts of diseased animals, animals that are actively showing that they are diseased, you might use a different strategy than if a seravar was a

natural commensal of the guts of like all cows or all pigs or something like that. And it can also help with identifying the source of contamination. So if you're dealing with the diseased animal only seravar and you find it in a bunch of meat, that could point towards fecal contamination in the meat processing aspect of it, which is like really bad, And I mean really in a sense finding someone else in any part of like an

animal product is bad. But I also think that like it might be dependent upon the seravar when you're like, oh, that is really alarming. How did it get all over here? Whereas there might be ones that you more commonly see.

I mean probably. It seems kind of tricky to get estimates of the timing of when salmonella started infecting people based on like molecular clock info, but people have probably been getting sick with salmonella and other food born pathogens forever. And I think that this probably ramped up somewhat with the agricultural revolution. But even though the widespread practice of keeping livestock would have increased exposure to salmonella, the big

outbreaks that we see today were still ways away. Unlike in the typhoid episode where I talked about the plague of Athens and the four hundreds BCE and the impact of typhoid on the residents of Jamestown in like the sixteen hundreds. For more general salmonella food poisoning, I'm going to jump ahead to the mid to late eighteen hundreds, so around the time germ theory was more or less

established as a thing. By this point in history, people had, of course, you know, long recognized for hundreds of years that foods could make you sick with fever or diarrhea or vomiting, but before germ theory, it seemed to generally be ascribed to chemical changes in the food as it decomposed,

or like some element of rotting food. Specifically, it was around the early eighteen eighties that people began to realize that food could look perfectly fine and unspoiled and smell fine, but could contain microbes that would make you sick if you ate it, and one or rather many, I guess of those microbes happened to be salmonella. In eighteen eighty five, researchers Daniel Salmon or Salmon I don't know, because I'm

realizing that we say salmonella, but not sam you know. Anyway, Daniel Salmon and Theobald Smith were the first to identify salmonella causing salmonellosis in pigs that were sick with hog cholera, and they thought that this microbe that they had found was responsible for hog cholera, which it wasn't, but they named it hog Colera bacillus. In nineteen hundred, it and several other microbes were reclassified and renamed salmonella in order

of salmon. But even though this taxonomy was a complete mess, the important thing was that there was now a name for these cases of food poisoning, and it also kind of provided the ability to trace its source via microbiological techniques. Pretty soon after the first identification of salmonella in those pigs in the eighteen eighties, people began finding the bacteria in many different foods, especially pork, chicken, beef, and milk, and also in people who fell ill after eating those foods.

Right like making the link between food and illness, and this period marks a huge turning point in the history of food safety, not just because salmonella had been identified, but also because it represents a shift in the way that people viewed foods that made you sick. So previously it had been specific foods themselves. Oh, this one is spoiled,

this one has undergone a chemical change. But the recognition of salmonella and other microbes as directly causing those illnesses meant that any food could be contaminated without appearing to be, and more optimistically, that those sources of contamination could mostly be eliminated through the way you handled the food. You know, you could kill the bacteria through methods of cooking or preparation,

especially heat. Food poisoning as a general term, like the term itself, came into use around this time, which I think is so interesting because it kind of represents this shift in thinking about microbes spoiling food rather than food just being spoiled on its own.

way that people interacted with food increasingly changed. Food was traveling larger distances, refrigeration wasn't really necessarily a thing yet, and hand hygiene was far from universally practiced. As these things were going on, the rate of food poisoning just continued to increase, Right Like, our knowledge of this group of bacteria way outpaced our ability to do anything about it.

But it wasn't really until the first few decades of the twentieth century that people began to realize the true extent of just how prevalent these pathogens were, and that's

simply because people weren't monitoring food borne illnesses. The primary salmonella related focus throughout the late eighteen hundreds and early nineteen hundreds was typhoid, and so a lot of the efforts were centered more on improving water quality and identifying human care of the disease, as we well remember from our typhoid episode, But salmonellosis kind of was just like

waiting for its moment to shine. In the first few decades of the twentieth century, salmonella seemed to be on the rise, and this was shown to be the case by the nineteen thirties or the nineteen forties, which is around the time that several countries had adopted food borne illness reporting systems. What these early reporting systems were finding

was more and more salmonella. But was there an actual increase always an important question to ask, and it seems to be somewhat debated because screening tools weren't the greatest, although they did improve the nineteen thirties and the nineteen forties, when phage typing began to be used to distinguish among salmonella seravars, and so it's possible that one big part of the apparent increase in cases was due to improvements in screening or our increased ability to trace outbreaks, or

even that more mild illnesses like food born illnesses were finally coming into view as more deadly diseases were being treated or vaccinated against. But I also feel like it's hard to chalk all of the increase up to just those things, because, like I mentioned earlier, the way people were handling food and eating food was changing, especially during World War Two and the years immediately after. So during World War two we saw a huge rise in communal

feeding spots. Large numbers of people were being fed in canteens and cafeterias, and so there was a greater potential for larger outbreaks rather than sporadic cases. And this communal feeding and rationing also led to people reheating food more often, which when done improperly, can of course lead to food poisoning. So there were more opportunities for a larger number of

people to get sick if the salmonella was there. But was salmonella itself growing in its presence or prevalence, and that also seems likely so let's consider things from the food production side, especially in the scaling up and the industrialization of many food products.

more like specialized in a way. Right in the years after World War Two, especially when wartime rationing restrictions were lifted, meat consumption increased in a big way, and to keep up with that, arming expanded and intensified. Small chicken ranches or dairy farms grew into or were largely replaced by huge industrial operations, and with bigger populations of livestock, salmonella could spread more easily and infect more animals, and it

would become much more difficult to control or identify. Not to mention that around the same time post World War two is when widespread antibiotic use started to come into play, and antibiotic resistance was not far behind, and that also grew and grew and grew and grew, and to be honest, it's one of the most terrifying parts of this whole story that like, that's all I'm going to mention about it.

is in slaughterhouses. Yeah, So slaughtering shifted from being mostly at or near the farms where these animals were raised to happening farther away because like, oh, you needed to have more equipment to process more animals, You need to have more specific equipment, Like it was difficult to have to be a jack of all trades as a farmer and do and make a living the way you used to like it, just it became less and less feasible, and so slaughtering began to be done mostly at these

large slaughterhouses that processed many different types of meats in many different ways. So you can see how literally every step along the way of food production or preparation or consumption increased the potential for salmonella to spread, and in some cases these chain just in practices led to some increase in virulence or difficulty in treating, like we talked

about with antibiotic resistance. And also it's important to point out, as I'm sure you will later on, that salmonella was not and is not limited to just the pork or poultry or beef industries. It's everywhere. It's everywhere, and an increase in salmonella in one area frequently leads to an increase in salmonella in all areas. The mid twentieth century did see several new regulations put into place, and testing had also become more refined, but the cat was out

of the bag. Sporadic cases or outbreaks of salmonellosis had just become kind of like almost a regular thing. Wasn't

that unexpected? So in September of nineteen eighty four, when residents of a small community in or began experiencing painful stomach cramps, diarrhea, nausea, fever, fatigue after eating at several restaurants in the area, local public health officials suspected salmonella was to blame naturally, and it was samples from several people who had sought care at hospitals in the area confirmed the presence of Salmonella typhomerium, which is, like you said,

one of the most common causes of salmonilosis associated with the consumption of like contaminated animal products. So by the end of that first week of cases, thirteen of twenty eight employees at Shakey's Pizza, one of the restaurants suspected to be a source, had come down with food poisoning, and dozens of customers had called the restaurant complaining that they had gotten sick after eating there, and that wasn't

the only restaurant affected. By the time the outbreak was over at the end of September, nearly one thousand people had reported symptoms of food poisoning and seven hundred and fifty one cases of salmonella had been confirmed. That's a lot, it's a lot. It was and I think remains the largest outbreak in Oregon's history. But fortunately this samanela did seem to resolve for a lot of people pretty like

easily or pretty well, or was treatable with antibiotics. But people had missed work, they had these large medical bills, and their bodies had obviously been put through the ringer with this illness, and they were left with questions, what happened? Where did this come from?

and ovens for any inconsistencies or faults. They tested cows, milk, septic tank, city water, pond, water, produce, literally everything they could think of for salmonilla, expecting to find a common source linking all of these cases. The fact that the outbreak seemed tied to many different restaurants pointed towards a particular food item that was served at all of them, but they couldn't pinpoint it. They couldn't find it. There

was no single factor linking all of these cases. Which isn't to say that they didn't find salmonella, because they did find it in a few places, like in the coffee creamer at one restaurant, and in the blue cheese dressing in another, but those items weren't eaten by everyone who had gotten sick, and the blue She's dressing was contaminated during its preparation, not like before it got to the restaurant, which pointed towards a human source, but no

one person worked at all of the restaurants. As the investigation went on, cases dwindled and leads dried up, and the CDC was left with the unsatisfying conclusion that the outbreak was I don't know, likely caused by employees at these different restaurants, and you know a lot of them lived together or roommates, and so maybe that's what happened. And you know, that's kind of how it goes sometimes

with food poisoning outbreaks. There's no neat answer. But the people of Wasco County, Oregon would get their neat answer. They just had to wait about a year for it.

to be intentional poisoning by a cult. Okay, so what why?

they had purchased. The group had left Puna, India for Oregon after a lot of political pressure and reports suggesting that the cult was basically a money making scheme which exploited not only it's wealthy members but also did other illegal things to make money. I don't know if it's been confirmed or not, but they wanted out and they wanted to establish.

enlightened by spending money. It's cool, kind of genius and so this is how she decided on this ranch, right, the sixty four thousand acres, plenty of space to grow, beautiful land, all of that stuff. Their arrival was not really met with open arms by the people living in Wassco County, especially those living in the small town of Antelope. And when I say small, I mean like population a few dozen small that was located really near the ranch.

And tensions between the townspeople of Antelope and the ranch continued to mount as the Rajniches built up their community to essentially be a mini city, complete with dozens of modular buildings and mobile homes and a frames, a two point two acre meeting hall, a one hundred and sixty room hotel, a two block long shopping mall, a casino and a disco, a medical lab, a dam, and a lake water sewage and transportation systems, an airstrip for the

five private jet planes and helicopter owned by the cult New Roads. I mean, you get the picture. It was they built a whole city, a whole city. It was a massive undertakings. It's yeah. And this happened within a very short time frame, like when just a matter of a couple of years which was terrifying for the people of Antelope, who started to look for ways to kick these people out of the town or ideally out of

the country. And when the legal way of doing things didn't look like it was going to work to get them gone, some open threats began to be made with a lot of gun carrying around town. It was Yeah, and the Reshine She's they met fire with fire. They were began to stockpile weapons make threats to the town people, and they also used the legal roots available to them.

They ran for town council. Oh okay, and they won handedly. Yeah, because the Ragine She's greatly outnumbered the other residents of Antelope. This meant that the cult now controlled everything in the town, like everything, the roads, the water, the police force. They renamed the town Rajni she And this of course further escalated things because then residents of Wasco County and Antelope ramped up their fight to get rid of the cult.

On both sides, there was violence, there was threats of violence. It's a story of like constantly mounting tensions where cause and effect is really difficult or almost impossible to disentangle. Yeah, and a big reason for this constantly mounting tension was at least in terms of the cult ma Anan Sheila.

So Sheila, who was spokesperson for the cult and effectively its leader during Ragni's four year vow of public silence, she was determined to win, to just gain more power, and that's what she viewed as her life's mission, this movement and making sure that this movement had whatever it needed to grow and expand, and any threat to the movement was a threat to her directly. So she announced that she wasn't going to stop at taking over Antelope. She had set her sites. Next on Wasco County, the

entire county, after that, Oregon, and then the world. The only problem was that the cult members, who numbered like two to three thousand estimates vary, they didn't have the numbers to outvote. The other Wasco County residents, which is around twenty thousand at this time. Okay, but luckily Sheila

had a strategy. She coordinated the buzzing in of thousands of people who were experiencing homelessness into the ranch to then get them to register to vote so that in the next Wasco County election in the fall of nineteen eighty four, they would have stronger representation, but that didn't

work out as planned, again with legal battles. At this point, though, Sheila's position was getting to be a bit tenuous within the cult and she felt increasingly threatened and desperate to not lose her status as like the de facto cult leader. She had to win this. Registering thousands of recently arrived people to try to win an election didn't seem to be working out, but that's okay. Shila had another.

Sila and Poja began reading books like I Kid You Not, How to Kill Volumes one through four stop and The Handbook of Poisons, which, like, I'm sure that like based on what we do for this podcast, our Google search history is also quite bizarre. Yeah, but still, but still. And they also visited a local urologist to ask which poisons and bacteria would be difficult to trace but deadly, And they were like, oh, well, we're worried about people poisoning the cults, so we want to know what we

should keep an eye out for. And he was like salmonella, Like, well, kind of easy to trace, but okay. It seems like they were more concerned about like the logistics of it, and like, how do we best do this. Sheila had tried to coordinate the assassinations of political enemies of the cult, and she had also poisoned people who had wronged her

within a cult. Naturally, Pooja was apparently known by some in a cult as Nurse Mengly because of her obsession with using poisons and pathogens as a weapon, with one report of her trying to weaponize HIV. So, you know, it's I'm sorry, what I know, it's horrifying, And there's so much more to the story that's like this is

just scratching the surface. It's kind of unbelievable. So at the ranch there grew to be increasing conflict between the Rashni She's and these people that had been busted in, and so Pooja's and Sheila's solution was to tranquilize the people the new arrivals, either with sneak injections or by putting it in the beer that they were given every day, but for their sicken the public to prevent voting scheme.

They also toyed with the idea of hepatitis viruses, typhoid and putting beavers for giardia, or just dead rats and mice into the public water system, just dropping it in there to make everyone sick. But salmonella seemed the most promising, not to mention accessible because where do you get salmonella?

County executive and Raymond Matthew Wasco County commissioner. They got a flat tire during their inspection of the ranch, and while changing the tire, they were offered some cups of water which they drank.

dressed up in disguise. They put on wigs, and they changed out their bright red clothes and robes for more neutral toned outfits, and they went around to restaurants and grocery stores in the dolls, mostly sprinkling salmonella on salad bars, in coffee creamers, in dressings, over produced departments and so on, like everywhere. They just literally seeded everything with salmonella.

What we suspect it was this person. There were people who did suspect that it was the cult, it was the Rajniches that were behind it, But there was no apparent evidence at the time linking the rush Niche She's to the outbreak the poisoning, which that was just sort of like a dry run, I guess, because this was in September and the actual voting happened later on, and so when it came time to the actual election, there was, as far as I'm aware of, no like salmonella poisoning,

and the Rajnich candidates in this election lost by a landslide. There was a record ninety three percent voter turnout. Wow, that's really high. Sheila's position, I think, with this loss, continued to slip and her paranoia grew. And on September thirteenth, nineteen eighty five, which is about a year after that Salmonela attack began, Sheila and a few others fled to Europe. A few days later, raj Niche broke his four year vow of public silence. He came out on stage and

was like, I denounced Sheila and her allies. They betrayed my faith. They had done they were responsible for all these criminal things. They're horrible people. They're no longer in the light, et cetera. You know, she attempted murder of followers who challenged her authority. She mismanaged my money and left this commune fifty five million dollars in debt, and so I have to sell my ninety rolls royces. She

tried to poison my doctor and dentist. She did incredibly intensive wiretapping, experimented with different lethal poisons on mice to try to find ones that were untraceable and had coordinated this salmonella attack. And so in the midst of all of this denouncing of Sheila, Rajnische was like, I demand a government investigation. This is on you now, you need

to investigate what's going what happened. And the investigation found glass vials containing salmonella bactrol discs that had been ordered from VWR Scientific and sure enough that salmonella was the same as the one that had made those hundreds of people sick in the Dallas and Rajishi, of course denied knowing any of it. He was like, I knew nothing. So was Shila just escapegoat for all of this? I mean, she clearly was responsible for like a lot, and she

clearly was completely without morals. But yeah, so how does the story end. The story ends with a few of these key players getting some jail time about four years and had to pay some fines. So Sheila, if you are curious, now runs a couple of care homes in Switzerland for seniors and people with degenerative disorders.

And I think that part of the reason for that is because public health officials were like, oh my gosh, this was so easy for them to do. We don't want people to know that this is possible. We don't want any copycats. This is disturbing. And so, as far as I could tell, it didn't really immediately result in any changes to regulations about who could order germs or for what purpose. I imagine I hope that that has

changed somewhat by this point. Interesting in any case, the nineteen eighty four Wasco County salmonella attack was not the last time that salmonella made headlines. There have been many unintentional outbreaks since, including a huge one in Chicago from contamination at a milk processing plant, and it led to sixteen thousand confirmed cases.

just at the diarrheal food born infections. Those cause an estimated two hundred and thirty thousand deaths worldwide, so over half. And salmonella is one of these principal agents that cause

death among those food born diarrheal illnesses. So it's estimated if we now just look more specifically at salmonella, that salmonella enteritis itself in twenty seventeen is estimated to have caused over ninety five million infections worldwide, and there's a really wide margin of error on that estimate, of course, and over fifty thousand deaths. Again wide margin of error.

If we now get even more specific and turn to invasive disease, so invasive salmonella, not typhoid salmonilla, it's estimated that there were in twenty seventeen over five hundred and thirty five thousand cases of invasive non typhoidal salmonella, with the highest incidents in Sub Saharan Africa, and they estimated over thirty four cases per one hundred thousand happened in children under age five, so a huge burden in children, and they are of course some of the highest risk

for severe illness and invasive disease and this paper also estimated over seventy seven thousand deaths in twenty seventeen just from invasive salmonilla. So that's separate from the salmonella enteritis.

here's where it gets even scarier. And this data I really only have for the US, but this isn't specific to the US, but this data is from the US. Of those one point three five million cases, it's estimated that over two hundred thousand of them are due to antibiotic resistance salmonella. Wow, including an estimated twenty thousand, twenty thousand, at least cases a year that are resistant to three or more of the essential antibiotics that we would use

to treat salmonella. Antibiotic resistance it's a really big problem, obviously, when it comes to so many infections, not just salmonella, but in salmonella. I think part of the reason that it's a particular problem is because of the way that antibiotic resistance can develop in our food system and then

spread through that food system. Yeah, right, So, because salmonella can be found in so many guts of so many animals, especially domestic animals that we use for food, it can then, like you were saying, aaron, enter our food system from a number of different ways, from the processing to the water supply. It can end up on the boots of a farmer and then be transferred between locations. It can end up in the soil. It can be carried by

rodents or even insects. Potentially, it can persist on shared equipment like you mentioned, It can be in these tanks where they're cleaning things that just then get filled with salmonella. It can be everywhere. It has a lot of points of entry into our food system. Right, that's just salmonilla. Now, Antibiotic resistance genes are present not just in bacteria of pathogen potential, but antibiotic resistance genes are present in a

lot of environmental microorganisms. So there's what's often called like an environmental resistome that exists, and these genes can then also make their way into bacteria of pathogen potential. It doesn't have to be that these salmonella making their way into our food system have to evolve these resistance genes denovo. A lot of the times these genes already exist and in many cases are present on plasmids or if let's say other like lactic acid bacteria in the soil like

break open. Now, these genes are in the environment, so bacteria like salmonella can then come into contact and pick them up via conjugation or transformation. See our antibiotic resistance

episode for more. But and that too is one of the reasons why, like the widespread use of antibiotics, especially in our farm system and our domestic animal like animal for meat production and things, is so concerning and such a big part of the problem that contributes to antibiotic resistance, right, because you're selecting for these resistance genes not just in the pathogens, but in the environmental bacteria as a whole.

that started in twenty eighteen. This is a particularly multi drug resistant and particularly infectious and tends to cause relatively severe disease sarah var that really ran rampant and was found at extremely high prevalence in meat and poultry samples. And throughout this outbreak, according to the article, the CDC estimated that for every confirmed case of salmonella, an additional thirty are never reported, So this outbreak likely had infected nearly three thousand people.

other countries. But we have in the US some pretty massive holes in our how our regulatory system works in terms of what the CDC can do and require and investigate and what their investigations can then produce as like a recommendation or product versus the FDA versus the USDA who oversees meat and poultry and that is separate from the FDA that does all of the rest of the food right and essentially, just like this system, which probably

comes as no surprise to anyone who's listened to this podcast, is not designed to protect the consumer. No, it's designed to protect the industry. You might hear about salmonella in your bag of spinach every once in a while, you might hear about it every once in a while in

chicken from this one farm. But the problem is so much bigger than that, and to really get a handle on it, we have to truly in this country revamp the way that our food system works and the power that regulatory government bodies actually have to regulate that industry, which essentially doesn't exist right now. Salmonella is pretty easy to kill. It's not like some of the bacteria that we've talked about that have like very environmentally hardy spores

or anything. So cooking your food properly does kill the bacteria, and it does have a really high infectious dose so that's also good.

But the question is how exactly does all that information come to light, Like where does that stool sample go, who is the person who's having to sort through it and test it, and what else are.

Specifically if they're suspecting a food born illness, of course, where did they eat, what did they eat, any travel history, things like that. The next thing they will do is they'll collect the specimen from the patient, so the doctor will give the patient everything that they need to do that and in the case of food born testing, they're

going to need a stool sample. So the analytical phase of testing is when the specimen is actually received into the labs, So the specimen is processed for testing, and there's a couple of different ways that this can be done. Right now, a lot of labs are moving to a more rapid kind of testing versus traditional culture. In traditional culture, you have to weigh twenty four hours for the bacteria to grow before you can really do anything with it.

With the new molecular test, it's a panel that will test for the most likely suspects in food borne illness, so it will give you a preliminary result right away, so the doctor kind of has a heads up the day that the specimen is received into the lab, and these panels typically test for Salmonella, Shigella E. Coli, Arimonas, Plisiomonis,

Vibrio campilobacter, and your sinea Ento kalitica. You can also get expanded panels for other things like parasites and certain viruses that may cause gastrointestinal discomfort, depending upon you know

the hospital and what they determine needs are. So once this molecular panel is run, if there is something that is identified in this panel, what will then happen is that specimen is cultured out and grown in traditional bacterial culture for confirmation, and then this is done by different biochemical testing and other commercial laboratory instrumentation that will confirm

the ID. Once this bacteria is identified, then it is typically sent out to the local Department of Health or other state reporting agencies so they can do kind of their follow investigation, and then this kind of leads us into the last phase, which is post analytical, where the results are reported out to the patient's chart, called to the clinician if it's considered a critical value, and then any contact tracing or patient follow up is performed.

they're just going to send a stool culture. So we would just set up the testing and basically we have a list of what we're looking for and we're ruling everything out. If the culture is negative, we're gonna send out those results. But if the doctor does suspect that there is still something going on, then that's when they would order more testing. So like they would know, Okay, this patient is exhibiting GI symptoms. It's not bacterial. Well, maybe it's viral, so let me order a viral panel.

You know. If that's negative, then they'll be like, all right, parasitic, let me order an OVA and parasite panel.

any hospital. I mean, everybody is hiring. So some of the places that people normally work, hospital labs are the most common, but also there's reference labs like lab core quest a RUP. A lot of times doctors' offices or urgent cares will employ an MLS to run their small in house laboratory point of care, which point of care is kind of maintaining the devices that the nurses would

use at a patient's bedside, like glucometers. Public health labs, pharmaceutical companies, medical device companies, in research are other areas that do employed clinical laboratory or medical laboratory scientists. However, I feel like those are little bit less popular and also harder to get a job in those industries.

that way. But there's been times where it's remember one time we got something that was like a tupperware container and I open it up and it's like half a foot and you know, we've gotten fingers, we've gotten tips of penises. Yeah, so those would be yeah, some of probably like my more memorable ones where I'm just like, did they really just do that?