Prep School Daily

I like to believe I’m at least a little educated about the causes of the various kinds of food poisoning and how to avoid them. Especially the common ones. So when Becky started talking about fried rice food poisoning earlier this year, I was really skeptical. I had never ever heard of it. She mentioned something about it occurring when rice was left at room temperature for too long and that it wasn’t killed by heat. I think those heat-resistant microbes aren’t playing fair. But I digress….

So I finally decided to research the matter. Of course, there is nothing in the off-grid medicine texts (or else I would have been familiar with it). There is plenty online. And because everybody includes rice in their food storage, and because we’ll be eating all the leftovers and electricity for refrigeration may be unreliable in the future, we ought to learn about this little beast, the symptoms it causes, and how we mighty giants can avoid being taken out by an invisible foe that afflicts about 63,000 people and hospitalizes 20 each year in the US.[1]

Bacillus cereus, the bacteria that causes fried rice food poisoning, can grow and develop on most any foods, but they really are most at home on starchy foods like rice and pasta. And because rice grains are small, they have a lot of surface area for microbes to hide and grow. The illness has come to be known as fried rice syndrome because in the process of making Chinese fried rice, the rice is often cooked and then left on the counter to cool for a few hours.

It’s actually the toxin that the B. cereus spores release that make us sick, partly because they and their toxin are quite heat-resistant. A quick reheat in the microwave or brief frying on the stove causes no fear. Often, however, the foods that the bacteria have set up housekeeping in aren’t even heated again. Like the cooked pasta that is allowed to cool on the counter for a while before being turned into pasta salad. Which then is transported to a picnic and also sits at the buffet table for a few hours. I don’t know if I’ll ever eat pasta salad at a church dinner again.

In addition to causing food poisoning with intestinal B. cereus, these microbes can go elsewhere to cause more serious illnesses (non-intestinal B. cereus).

Fried Rice Poisoning

Diarrheal Form

There are two types of intestinal B. cereus poisoning. With the enterotoxin, or diarrheal, form the toxin is produced in the small intestine. Onset of illness is 6-15 hours after consuming the contaminated food.[2] Symptoms resemble C. perfringens food poisoning.[3] Foods that cause this form are most often:

Fish
Dairy
Meat
Sauces
Soups and stews
Vegetables

Symptoms

Abdominal pain
Fever, never[4]
Stomach cramps
Vomiting, rarely[5]
Watery diarrhea

Vomiting Form

In the emetic, or vomiting, form of the disease, the toxin develops in the food before you eat it. Illness onset occurs within 1-6 hours of consuming the contaminated food.[6] About 95% of cases of this form are associated with rice consumption.[7] And half or more of raw rice samples were found to contain the B. cereus bacteria.[8] The most frequent friendly hosts for this bacteria include:

Rice
Pasta
Pastry
Potatoes
Sushi[9]

Symptoms

Cramps[10]
Headaches[11]
Nausea[12]
Vomiting[13]

The symptoms are quite similar to stomach flu and many other types of food poisoning, especially Staphylococcus aureus[14], and last for a day or two. True stomach flu generally lasts a bit longer.[15]

Non-Intestinal Form

The much rarer non-intestinal B. cereus infection most commonly affects the eyes, respiratory system, or wounds. The bacteria are found in dust, plants, soil, and water.[16] While anyone can develop a non-intestinal B. cereus infection, those at greatest risk include:

Newborns
IV drug abusers
Patients with an indwelling catheter
Those with wounds from surgery or trauma
Those with a weakened immune system[17]

Infections stem from

Contaminated hospital equipment
Inhaling contaminated dust
Infected wounds
Infection outbreaks in hospitals

Non-intestinal B. cereus infections manifest in the following ways:

Bacteremia (bacteria in the bloodstream)
Endophthalmitis, an infection in the eye (symptoms include eye pain, fatigue, fever, high white blood cell count, low vision, red eye, and a ring-shaped corneal ulcer. Some patients will end up losing the eye.)
Brain abscess
Cellulitis
Endocarditis
Meningitis
Osteomyelitis
Pneumonia[18]

Treatment

Do not use anti-diarrheals. The bacteria and toxins causing the illness need to be removed from the body. Anti-diarrheals work to keep that waste in.[19]
Keep hydrated with water, broth, electrolyte drinks, or juice.[20]
Rest.[21]

Herbs that may help

Basil
Catnip
Elder
Japanese honeysuckle
Plantain

Avoidance

Beyond the usual hygiene and sanitation practices, observe the following:

Thoroughly cook rice and pasta in a rice cooker or boiling water. [22]
Serve these foods immediately. [23]
Cool leftovers quickly in shallow containers in the refrigerator. [24]
Reheat leftovers to 165°F, and only reheat once is a common recommendation.[25] However, research shows that the toxin from the emetic form of B. cereus isn’t inactivated until the food reaches 249°F for more than 80 minutes.[26] In a crisis, the fuel cost will be more than the food was worth. We’ll have to throw it out. (Or save it for someone we don’t like.)
Dispose of leftovers after two days.[27]