Consequences of foodborne infection need further research, finds review

Burden-of-disease studies and clinical guidelines rely on evidence of the etiologic role of specific agents in specific long-term illnesses.

This data, drawn from epidemiologic studies and clinical practice, ranges from convincing to anecdotal, found the review.

Foodborne infections with Campylobacter, E.coli O157:H7, Listeria monocytogenes, Salmonella, Shigella, Toxoplasma gondii, and Yersinia enterocolitica can lead to long term conditions resulting from a disease to numerous organ systems.

Long term associations​

Batz et al centered on the most prominent: irritable bowel syndrome (IBS), inflammatory bowel diseases (IBDs), reactive arthritis, Guillain-Barre´ Syndrome (GBS), neurologic disorders from acquired and congenital listeriosis and toxoplasmosis, hemolytic-uremic syndrome (HUS) and attendant systemic sequelae.

Over half of the estimated costs in the US associated with Campylobacter are due to subsequent Guillain-Barré syndrome (GBS).*

Prominent sequelae, a pathological condition resulting from a disease of foodborne infection, vary on established associations from STEC leading to HUS to ones that need further research such as it having an association with diabetes, said Michael Batz who was joint researcher.

“A growing number of people recognise it is a problem, not that it wasn’t recognised before, but we have to establish what we know now, how many strong associations there are and how big of a problem they are,” ​he told FoodQualityNews.com.

“Some [illnesses] are suspected and others we need to quantify, regulators need to consider the broader picture and not just three days of diarrhoea.”    ​

Burden of disease​

Evidence-based patient management and estimates of burden of disease used in public health and food policy should feature established and quantified long-term outcomes.

For many chronic sequelae, disease mechanisms and the etiologic role of specific pathogens need further details, as do the relative risks of sequelae following infection.

Integrated approaches to estimating the burden of foodborne disease looking at annual disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), or economic costs, are better able to capture the full scope of symptoms, severities, and outcomes of foodborne disease.

“We hope it raises the visibility of things and the general visibility and puts the information in one place,” ​explained Batz.​

“There are impacts for clinician and doctors treating patients- they need to look out for these things and the public health burden of foodborne disease should be included. There is a lack of certainty so we need more research to establish and understand what is going on.​

“The idea is to frame the broader concern to the audience who might not think of food safety a lot, they need to be aware and on the look out for the signs to treat potential symptoms.”​

Other studies that account for the interactions of host, environment, and microorganism are critical to improving understanding of long-term consequences of foodborne infection.

Only with increased funding of research geared toward understanding the long-term health outcomes of foodborne infection will we be able to develop effective evidence-based clinical treatments or characterize the public health burden of foodborne disease, the review concluded.

Source: Infectious Disease Clinics of North America

Online ahead of print: Volume 27, issue 3 September 2013, pages 599-616 ​

“​Long-Term Consequences of Foodborne Infections”​

Authors: Michael B. Batz, Evan Henke, Barbara Kowalcyk

* = Hoffmann S, Batz MB, Morris JG. Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens. J Food Prot 2012;75:1292–302.