Feces per Burrito: More Important than Calorie Count

Oddly, or maybe not if you follow foodborne outbreaks, both Chipotle and Qdoba are in the midst of food-borne outbreaks. In the case of Chipotle it is the O26 strain of E.coli to blame while Qdoba has been linked to cases of typhoid fever.

Both of these illnesses share something in common other than the burritos they apparently are lurking within: they are both transmitted through the fecal-oral route. What that means, in terms a kindergartener can understand, is that poop gets into the food. This can happen with suboptimal food handling in a restaurant (which happens to be the case with Qdoba with its own version of Typhoid Mary) or at some earlier point (e.g. during harvesting). 

In my view, E.coli O26 -- which elaborates shiga toxin, a cause hemolytic-uremic syndrome which can progress to kidney failure and death -- is a much more serious outbreak. Typhoid, though deadly in prior decades, is treatable with antimicrobials and because, in this case, the source is known will likely be quickly contained.

What is special about burritos and other similar foods is that they are comprised of myriad ingredients -- just imagine how many herbs, spices, and vegetables are in salsa. These ingredients can come from multiple different suppliers which magnifies the chance of contamination occurring. 

The industrialization of food is an enormously beneficial development that is hugely economical and has driven food prices down. This trend allows the average person the ability to sample exotic cuisines from all over the world. The risk, which is present with all types of food, is that contamination may occur and illnesses such as these can occur highlighting the need to be vigilant once these outbreaks are identified.

Yes, I am a Chickenpox Doctor

Today in the hospital elevator a patient asked me what kind of doctor I am. I replied that I am an infectious disease doctor and the patient replied: "Oh, like chickenpox". 

His reply was accurate but prompted me to think about the fact  that most of the general public's knowledge of my field has to do not with the day-to-day MRSA, C.diff, prosthetic joint, injection drug use related, and diabetic foot infections I am mired in, but with acute contagious diseases such as chickenpox. 

During Ebola and the 2009 H1N1 influenza pandemic the role of infectious disease physicians and the reliance on our expertise by the media, the public, and colleagues was evident. In the clinical workday of an average infectious disease physician, it can be easy to forget that role amongst the bureaucratic processes, the haggling with cardiologists, the frustration with the hospital pharmacy, and the mundane infections one is consulted on.

What makes it worth it, for me, is that amongst all the ordinary causes of pus and infection a zebra may be lurking and it is a supreme intellectual challenge to spot it. To put it simply, I love solving puzzles.

Chickenpox, thanks to vaccination, has become such a zebra in the America -- so yes, I am a chickenpox doctor.

I wear the label proudly.