Saturday, February 3, 2018

Possible listeria infection

Here's the timeline for something that happened in our family almost a month ago. Enough time has elapsed that I feel pretty confident that it wasn't a norovirus, so I'm posting a blog entry about it now (February 24, 2018):

Jan. 29, 2018, Monday afternoon: I went shopping and bought some clearance produce, including a 2-lb package of pre-washed whole green beans. As I put them in the cart, I thought to myself, "I'd better wash or cook those before we eat them." The expiration date on the green bean bag was stated to be January 31, 2018.

Jan. 31, 2018, Wednesday afternoon: My teenage daughter needed treats for an activity that were supposed to be red and green colored. I said she could take the bag of green beans and a bag of red apples out of the refrigerator. I thought to myself, "I hope she remembers to wash them," but never said it to her. 

Jan. 31, 2018, Wednesday evening, 7:00-8:30 pm: My teenage daughter ate 2-3 medium-sized handfuls of the green beans at the activity. She didn't notice anyone else eating them. 

February 1, 2018, Thursday morning, 8 am: My teenage daughter made herself a sunny-side-up egg and did not cook the yolk all the way through.

February 1, 2018, Thursday morning, 11:25 am: My teenage daughter noticed "a faint, black rectangle pattern that was shimmering on the edges of her left eye." She thought it was due to looking at her computer screen for too long. It continued for about 15 minutes.

February 1, 2018, Thursday, 11:30-12:00: She ate a large lunch.

February 1, 2018, Thursday, 12:15 pm: While driving in the car, she was suddenly hit with a headache.

February 1, 2018, Thursday, 12:30 pm: While still in the car, her stomach began hurting and she asked for some molybdenum. I gave her some.

February 1, 2018, Thursday, 12:40 pm: I had to pull over because she felt like she was about to throw up. Fresh air and getting out of the car helped her not to throw up. I gave her more molybdenum.

February 1, 2018, Thursday, 1:15 pm: After getting her to our house (with a break for her to sit in a parking lot for a while and try a piece of hard candy to increase saliva), I gave her more molybdenum, a container to throw up in, and a blanket to cover her while she rested on the sofa. She fell asleep on the sofa. She woke up about thirty minutes later and threw up. And then she felt much better. She still had a very mild headache and her stomach didn't hurt anymore.

February 1, 2018, Thursday, 3:30 pm: She was acting normally and eating (practically dancing around in the kitchen next to all the family food preparation surfaces, to my chagrin). She says she had "the faintest headache [she'd] ever had." I gave her some more molybdenum since she'd thrown up the contents of her stomach earlier.

February 1, 2018, Thursday, 6:00 pm: She thinks she was totally recovered by then. She has not had diarrhea at all. To the contrary, she was constipated for a day or two afterward, which makes me wonder if excessive molybdenum can cause constipation.

Based on her headache and gastrointestinal symptoms and the suddenness with which they hit her, the most likely culprit for her illness appears to be listeriosis, i.e., infection with the bacteria Listeria monocytogenes. The incubation period fits (https://www.ncbi.nlm.nih.gov/pubmed/23305174), the visual disturbance symptom sounds similar to what one of her aunts experienced from suspected mild listeriosis in the past, and the apparent source--fresh produce--is a moderately common source of listeria (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368540/). 

My daughter has since checked with other people who were at her Wednesday night event, and only one other person recalled even eating any of the green beans, and that person ate just a few of the green beans. No one else got sick except for my daughter, who ate handfuls of the green beans.

I am fairly confident in ruling out norovirus or a similar virus because of the brain-related symptoms (e.g., visual disturbance and headache) and the fact that no one in the family has had an illness anything like this. After the past few months, we unfortunately have a good knowledge of how the more common gastrointestinal viruses affect our family.

I find it interesting that she hasn't had any diarrhea, as that is the one of the most common symptoms associated with mild listeriosis. (http://www.nejm.org/doi/full/10.1056/NEJM199701093360204) Maybe the molybdenum she took helped prevent it. But molybdenum didn't stop the initial vomiting episode, even if it might have helped delay it. I suspect we've just run up against a limitation of molybdenum. This is the first time, to my knowledge, that we've used molybdenum for a probable bacterial illness. We have since watched this little animation of how the listeria bacteria infects and poisons our cells, and it made me very grateful for my child's well-functioning immune system:



I contacted the customer service hotline of the store and told them about her symptoms. They asked many questions and directed us to freeze the bag of green beans in case it becomes necessary for them to send someone to collect it and test it. I'm happy to see they take possible listeria in their produce so seriously. The green beans are still in my freezer. I wonder how long they expect me to hold on to them?

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