Losing my religion: Vibrio death following Jesus tattoo

Ben Tinker of CNN reports a 31-year-old Texas man went to get a tattoo on his right leg. Beneath an illustration of a cross and hands in prayer, the words “Jesus is my life” were written in cursive.

As tattoo artists will tell you, there are some critically important rules to follow in the hours and days after getting inked. Most important: keeping your new body art clean and covered while the skin has a heightened susceptibility to bacterial infection.

Every time a tattoo gun pierces your skin, the needle is opening a wound — and another pathway by which germs can enter your body. The larger the tattoo, the more you increase your risk of possible infection.

A report published last week in BMJ Case Reports, a prominent peer-reviewed medical journal, reveals only that the subject was a Latino man living in Texas.

Five days after getting his tattoo, the man decided to go for a swim in the Gulf of Mexico. Just three days after that, he was admitted to Parkland Memorial Hospital in Dallas with severe pain in both of his legs and feet. His symptoms included a fever, chills and redness around his tattoo and elsewhere on his legs.

“A lot of our patients, when they come to our institution, come in sick — and he was certainly among the sicker of the patients that we’ve had come in,” said Dr. Nicholas Hendren, an internal medicine resident at University of Texas Southwestern Medical Center and lead author of the report. “He said he had a lot of pain in [his right leg]. That, of course, drew our attention right away.

“Within a few hours, things had progressed pretty quickly,” he said. “There’s darkening skin changes, more bruising, more discoloration, what we call bullae — or mounds of fluid that were starting to collect in his legs — which, of course, is very alarming to anyone, as it was to us.

“He was already in the early stages of septic shock, and his kidneys had already had some injury,” Hendren said. “Very quickly, his septic shock progressed from … early stages to severe stages very rapidly, within 12 hours or so, which is typical for this type of infection.”

To make matters worse, the man had chronic liver disease from drinking six 12-ounce beers a day. He was immediately placed on a ventilator to help him breathe and given potent antibiotics.

The man tested positive for Vibrio vulnificus, a bacterium commonly found in coastal ocean water. The CDC estimates that this infection, called vibriosis, causes 80,000 illnesses and 100 deaths every year in the United States. The strongest risk factors are liver disease, cancer, diabetes, HIV and thalassemia, a rare blood disorder.

“In the USA, most serious infections appear to occur with the ingestion of raw oysters along the Gulf Coast, as nearly all oysters are reported to harbor V. vulnificus during the summer months and 95% of cases were related to raw

Most of the time, the only symptoms someone will experience are vomiting and diarrhea, according to Hendren. Most healthy people don’t end up in the hospital, he said, because their immune system is strong enough to fight the infection.

But “Infections can also occur with exposure of open wounds to contaminated salt or brackish water; however, this represents an uncommon mechanism of infection,” according to the report.

Hendren never got the opportunity to ask the patient directly whether he was aware of the advice against swimming soon after getting a tattoo but said the man and his family were unaware of how a serious infection can progress so quickly.

For the next few weeks, the man was kept largely sedated. After initial pessimism about the man’s prognosis, Hendren and his colleagues became cautiously optimistic. The patient was removed from the breathing machine 18 days after being admitted to the hospital and began “aggressive rehabilitation.”

Over the next month, however, the man’s condition slowly began to worsen. About two months after he was first admitted to the hospital, he died of septic shock.

“For patients who are healthy, this organism very rarely infects people,” Hendren said. “If they are infected, most people do fine and essentially never present to the hospital. But in patients who do have liver disease, they’re susceptible to much more infection.”

Since most infections are the result of eating raw oysters, Hendren stressed the only way to kill the bacteria is by cooking them. People with liver disease or iron disorders should never eat raw oysters because they’re at such high risk for these infections, he said.

Hendren said the message isn’t that people shouldn’t get tattoos.

“It’s if you choose to get a tattoo, do it safely, do it through a licensed place, and make sure you take care of the wound and treat it like any other wound,” he said. “That’s important.”

 

Japanese group wants to sell livers of toxic fish to diners

Prefectural government officials here are seeking permission to serve a delicacy they say will tantalize taste buds and bring in tourists. But restaurant operators across Japan say the plan could end up killing diners.

torafugu.pufferfishSaga Prefecture on the southern island of Kyushu has, according to The Asahi Shimbun, asked the health ministry to lift a ban on serving the liver of “torafugu,” the tiger pufferfish that carries a poison that is 1,000 times as toxic as potassium cyanide.

Prefectural officials say they have found a cultivation method and safety test system that can ensure the safety of pufferfish liver served at restaurants that meet certain conditions.

A nationwide association of 1,800 pufferfish restaurant owners and others disagree with that claim.

“If the prefecture’s proposal is approved, many consumers will mistakenly believe that pufferfish liver is safe to eat, resulting in more accidents,” said Yuichi Makita, 63, vice chairman of the association. “There is no absolute guarantee of safety.”

An expert panel on natural toxins and mycotoxins of the Food Safety Commission held a meeting on May 20 to discuss the prefecture’s proposal.

Food experts and biologists asked various questions, such as the reliability of the methodology to check the toxicity of the farmed pufferfish.

The commission is expected to decide on the proposal within a year.

The toxin of pufferfish is known as tetrodotoxin, and it is contained in the liver, ovaries and other organs, as well as in the skin and muscles.

Between 2006 and 2015, 356 people became ill after consuming pufferfish poison, and 10 of them died.

On May 24, eight people, including a restaurant manager, were arrested by Osaka prefectural police on suspicion of serving the liver of farmed torafugu, a violation of the Food Sanitation Law.

Osamu Arakawa, a professor of aquatic food hygienics at Nagasaki University who is familiar with pufferfish poison, said the toxin is produced from bacilli in seawater.

The toxic substance becomes concentrated in the bodies of pufferfish, which eat poisonous starfish and snails, he said. The possibility of the toxin accumulating in the fish through other channels has also been pointed out.

But a research team from Nagasaki University has surveyed 10,000 pufferfish raised with nontoxic food and confirmed that all of them were not poisonous.

Vibrio, from raw oysters, and cirrhosis aren’t a good combination

Vibrio is one of the nastier foodborne pathogens, one of the reasons why I don’t go near raw oysters (the other being that I just don’t like them).

It’s particularly a problem with folks with existing liver problems.

Nazir and colleagues provide an example in the British Medical Journal.

Oyster-Vancouver, B.C.- 07/05/07- Joe Fortes Oyster Specialist Oyster Bob Skinner samples a Fanny Bay oyster at the restuarant. Vancouver Coastal Health now requires restaurants to inform their patrons of the dangers of eating raw shellfish. (Richard Lam/Vancouver Sun) [PNG Merlin Archive]

We present a case of a 40-year-old man with decompensated alcoholic liver cirrhosis presenting with atraumatic cellulitis of one extremity and severe sepsis that rapidly progressed to compartment syndrome despite broad-spectrum antibiotics. Local cultures following debridement revealed Vibrio vulnificus, and subsequent history revealed consumption of raw oysters 48 h before presentation. Our case points out the unique susceptibility of those with cirrhosis and elevated iron saturation to Vibrio septicaemia, as well as the rapidity and severity of the disease progression.

Five Japanese men poisoned by puffer fish after ‘eating highly poisonous liver’

Five men have been poisoned in Japan after allegedly asking a restaurant to serve them banned parts of the world’s most toxic fish.


puffer.fish.liverThe men were having dinner on Friday night in the western city of Wakayama when they ate puffer fish liver, which prompted vomiting and breathing difficulties early the next morning.

Puffer fish – also called blowfish or fugu in Japanese – are the world’s most toxic group of fish and their livers, ovaries and skin contain tetrodotoxin, 100 times more lethal than cyanide.

Yet eating the fish’s flesh is a tradition in Japan, where wealthy diners play the Russian roulette of the restaurant world by dining on sashimi slivers so thin they are almost transparent.

According to a city health official, the men asked to eat a banned, toxic part of the fish – which the most foolhardy fugu aficionados are said to enjoy for the tingling it produces on the lips.

The tingling is only the first symptom of tetrodotoxin poisoning, and is seen as part of the thrill for lovers of the fish.

But if the toxin is served in any significant quantity it then paralyses the muscles, suffocating victims as it reaches their chests and diaphragms while they are still conscious.

The health official said the men were in their 40s and 50s and the restaurant was shut down for five days from yesterday amid an investigation.

 

They don’t get Britain in Texas; bad advice on safe chicken livers

Communication by stagecoach may be a Texas tradition but maybe they would have heard of all the outbreaks of campylobacter in poorly pate.beet.dp.mar.12prepared chicken pate in the UK.

David Uygur, chef and owner of Lucia, told the Dallas News, it’s important to cook the livers just to medium doneness, signaled by a rosy-pink center. “I think well-done chicken livers are gross. It’s not the end of the world if you overcook them, but they will have a grainy texture and a more iron-y flavor.”

Color tells a chef nothing. Use a tip-sensitive digital thermometer and stick it in.

barfblog.Stick It In

Fancy food ain’t safe food: £72,000 fine for UK hotel

Add 5-star Frimley Hall Hotel to the embarrassingly long list of fancy-pants eateries that don’t know how to cook chicken to inactivate Campylobacter.

According to Camberley People, dozens of diners celebrating the marriage of a Mr and Mrs Dunsford fell ill after eating a contaminated Frimley Hall Hotelchicken liver parfait, served up at on May 28, 2011.

Now its operators have been ordered to pay a £72,000 fine and costs for the food safety breaches.

Macdonald Frimley Hall pleaded guilty on February 12 to two charges including serving the contaminated chicken dish.

The second charge related to a failure to identify potential food safety hazards that could arise from the parfait so that steps can be taken to reduce or eliminate risk.

Tim Pashen, the council’s executive head of community, said, “In this case, the parfait had been cooked at too low a heat and there was no recording system in place to check how long it had been held at the necessary temperature. The recipe was new to the hotel and no regard had been given to clear and publicised warnings from the Food Standards Agency concerning the need to undertake rigorous checks.”

The judge commented that the failures had resulted in an ‘entirely foreseeable outcome’. 

A Macdonald Hotels spokesman said: “Despite its five star food rating and its on-going due diligence the company would like to apologise for any distress that was caused to guests attending the function in question.”

26 sick; NZ food poisonings spur liver preparation alert

Following a spate of liver-pate-linked campylobacter illnesses in the UK, the colonies are now reaching out to locals as New Zealand grapples with more than two dozen cases of food poisoning in Wellington.

Campylobacter was found in undercooked poultry and lamb’s liver, Margot McLean of Regional Public Health said.

Twenty-six cases of campylobacter, linked to eating liver, had been reported to public health officials in the past year. That figure was likely to be conservative, as they received detailed information on less than a third of campylobacter cases, Dr McLean said.

Microbiological wannabe Jacob Brown, chef at Miramar’s The Larder, said he hoped the public health warning would not put people off eating liver.

Overcooking it was “criminal”, as it became tough and grainy, and that any liver that was looked after correctly once it was removed from the animal should be fine.

The story goes on to say, “Cook liver in small batches for at least five minutes until juices are clear.”

Use a tip-sensitive digital thermometer, and I’d say 165F to eliminate Campylobacter. Color is a lousy indicator.

Careful with that chicken pate; significant source of campylobacter in UK

Campylobacter is usually number 1 or 2 when it comes to causes of foodborne illness, so I’m having trouble with the lede from the BBC that claims over 90 per cent of cases of campy in the U.K. this year were due to people eating undercooked chicken liver pate, often at weddings.

The Daily Mirror specifies that 90 per cent of outbreaks of campylobacter at catering venues in 2011 were linked to people eating chicken pate.

I have no idea what the U.K. Health Protection Agency (HPA) actually said because there is nothing on their website yet, although they apparently analyzed 18 outbreaks of campylobacter in 2011 across England.

In all, 443 people became unwell and one had to be hospitalised.

The Food Standards Agency (FSA) has reminded caterers to cook poultry livers to prevent infection.

Of the 18 outbreaks, 14 occurred in catering venues, and 13 of these were linked to chicken or duck liver pate.

Seven were linked to wedding receptions at hotels, banqueting venues or public houses and six were associated with catering at other functions such as hotels, clubs and restaurants.

The HPA found that livers used to make the parfait or pate were undercooked allowing the liver to remain pink in the center.

The FSA issued updated advice to caterers on the safe handling and cooking of livers twice in 2010, but campylobacter outbreaks associated with the consumption of chicken liver pate have continued to occur.

Last week, some 80 patrons nibbling on hors d’oeuvres during a fundraiser at the fancy Lowry Hotel in Manchester were sickened with campylobacter linked to the chicken pate.

Maybe FSA should try different messages using different media, and perhaps evaluate if any of their advisories actually result in fewer sick people.

PS: The Food Standards Agency subsequently published a statement that says:

New figures from the Health Protection Agency (HPA) reveal that 90% of campylobacter outbreaks at catering venues were linked to undercooked chicken liver pate. Campylobacter is the most common cause of food poisoning in the UK.”

Nice reporting BBC (state-sponsored jazz and bad pop music).

Chicken livers sicken with salmonella

In a new twist to the on-going saga of frozen, not-ready-or-ready-to-eat chicken thingies (below, left), broiled chicken liver products that are linked to a cluster of Salmonellosis illnesses in New Jersey and New York, have been recalled.

No word on how many people are sick.

The illnesses are linked to the consumption of broiled chicken livers which appear to be ready-to-eat, but are in fact partially cooked and need to be fully cooked before consumption. See, it says so on the label (right). Illnesses are also linked to chopped liver made from this product at retail stores. The outbreak strain of Salmonella Heidelberg was isolated by the New York State Department of Agriculture and Market from samples of broiled chicken livers from the establishment, and chopped chicken livers produced at retail from these livers. These products would have been repackaged and will not bear the original packaging information.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) said Schreiber Processing Corporation, a Maspeth, N.Y. establishment, is recalling an undetermined amount of broiled chicken liver products.

The outbreak strain PFGE pattern does not match another strain of Salmonella Heidelberg associated with ground turkey recalled earlier this year. It is not known at this time if this outbreak strain has any drug resistance, but any finding of drug resistance will be made public by FSIS once it becomes available.

The products subject to recall include:
• 10 lb. boxes with two, 5 lb. bags of "Meal Mart Broiled Chicken Liver; Made for Further Thermal Processing"
• 10 lb. boxes of loose packed "Chicken Liver Broiled"