A case report from a team of doctors at Massachusetts General Hospital was published in the New England Journal of Medicine in March of 2021. I am not exaggerating when I say that this disease, caused by a systemic infection with the bacterium Neisseria meningitidis, strikes fear in the hearts of medical professionals at the mere consideration of the possibility of its diagnosis in a sick patient. It is, and again I am quite serious here, an infectious disease that can cause catastrophic injury and even death in a matter of hours.
The young man's condition rapidly deteriorated from nausea and abdominal pain to a high temperature, and then to respiratory failure, hypotensive shock, multiple organ failure, and a disseminated coagulopathy that would ultimately result in the loss of both legs, according to the case report. He went from feeling fine to being critically ill in just 15 hours, and had to be hospitalized for an additional 4 hours. Thanks to the amazing skill of the pediatric intensive care team, a couple of which I have worked with personally since moving to Boston in 2013, and the progress medical science has made in developing life saving pharmacotherapies, the patient survived and was able to be discharged home.
What does this mean for leftover Chinese food? To be honest, not a thing. The ridiculous idea of a case report blaming food poisoning for a patient's illness was posted by a popular medical YouTuber last week.
The video, which involves actors portraying the patient and his roommate, uses a lot of generic stock images and video as well as heavy handed narration that I suppose is meant to add a sense of drama. It also contains a number of assumptions about the events leading up to the patient's initial evaluation at a community emergency department that are presented as established facts of the case. It is geared towards getting the maximum amount of views rather than educating the viewers. The inaccurate assumption that the patient's infection came from contaminated food was perpetuated over and over again, as the video was featured by numerous news outlets.
The authors of the report mentioned that the patient had eaten a meal consisting of rice, chicken, and lo mein that was leftover from the night before. The roommate of the patient had eaten the same meal the night before. The roommate had an episode of nausea and vomiting but did not get sick. During the discussion of the potential causes of his clinical presentation and abnormal lab results, the meal was not brought up again. It is irrelevant to meningococcal disease.
Meningococcal disease is not a foodborne illness and there has never been a documented case of Neisseria meningitidis being spread this way, Bernard, despite this absence of concern from the MGH PICU team regarding the meal consumed prior to the patient becoming ill. The video, which has been viewed more than 1.5 million times, is terrible for a number of reasons, some of which I have already mentioned, but I will stick to an objective assessment of this one huge error for this post. There is a primer on meningococcal disease epidemiology.
Infections with Neisseria meningitidis are serious even more so when they result in Meningitis, an inflammation of the protective membranes covering the brain and spine. This condition was almost always fatal prior to the development of antibiotics and intensive care. Even with early diagnosis and the best medical care in the world, death is still common and patients often suffer long-term disability.
There have been epidemics of meningococcal disease in certain regions of the world. Epidemics are rare in regions that have access to the safe and successful vaccines that reduce the risk of infections from the most likely to cause disease. In the United States, the incidence of meningococcal disease has plummeted since the mid 1990s. Over the past 20 years, this disease has been seen in less than 100,000 people.
There are certain groups that are at higher risk for meningococcal disease even in regions where epidemics are rare. This is due to the fact that Neisseria meningitidis is endemic. It is out there, among us, silently colonizing our nasopharyngeal tissue and jumping from person to person, causing disease whenever it feels like it.
At any given time, between 5% and 35% of the general population and older teens are colonized. It may stay in our throats for weeks to years first, but most people clear it, never knowing it was there. colonized individuals can spread it to others, but only with intimate contact. You are not going to become colonized by simply being near someone for a long period of time. You really need to swap spit, by kissing or sharing objects that one might insert into the oral cavity, be on the receiving end of a juicy coughing fit, or spend a lot of time in very close contact.
The people most at risk are teens and young adults living together, in particular college students in dorms and soldiers in army barracks, and children under two years of age, because they like to slobber all over each other. Smoking is a risk factor for colonization. Most colonized people never get sick and those who do have some bad luck. People with certain immune deficiencies are at increased risk of disease. A recent respiratory illness is an independent risk factor for meningococcal disease.
The 19-year-old patient was in the case report. Is it possible that the lo mein was to blame for his meningococcal disease? No, it wasn't.
This is not spread by food. It isn't. There have been no reported cases of this. desiccation on surfaces that decrease its ability to survive and cause infections is what causes nesseria meningitidis to only live in humans. It takes sustained close contact with other humans to spread, and this usually comes from lots of kissing or inhaling droplets from a cough, although it is possible that sharing a toothbrush in close temporal proximity could do it.
The meal that the professor hypes was a red herring that had nothing to do with the patient's illness. He was colonized with the meningococcal disease. He is an adolescent smoker with a roommate, so he is a high risk for it. Based on his age alone, there was a roughly 35% chance. It was likely much higher if you added in the other risk factors.
It wouldn't make sense if he became sick from leftover food and then was diagnosed with a disease. Illness can take up to 10 days to set in when large numbers of people become ill, and it isn't just colonized people with bad luck. It would be very unlikely to be exposed and then become ill in less than a day.
The patient's initial symptoms of nausea and vomiting may have been related to food poisoning, but that is also a classic early presentation of meningococcal disease. The authors of the report were aware that his illness was not related to any recent meal and that he presented for medical care. It wasn't included in the discussion of his disease process in the report.
There is no excuse for the huge error in Bernard Hsu's video. He has access to experts and expert resources. My hunch is that visions of virality clouded his judgement. I don't plan on watching any of his other videos, but I hope they are better because he reaches a lot of people.
The problem of lazy journalism is even bigger because it wasn't produced by any dedicated science or medical writers. It is irresponsible to simply parrot the views seen on a video on the internet. Maybe this particular example isn't likely to result in any risky lifestyle changes, but I'm confident that readers of SBM can easily think of several that have. Millions of people could be avoiding eating Chinese food, taking out in general, or even leftovers, which could have economic drawbacks. Anti-Asian hate crimes have increased during the Pandemic and this is the last thing they need.
There is a silver lining to this. The fact that there is a vaccine that protects people from such a severe outcome was mentioned in many poorly written news articles. The young adult discussed in the NEJM case report only received the first dose of the recommended vaccine series and did not take advantage of them. Hopefully people will take advantage of these medical marvels and get themselves or their kids vaccinations.
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