Foodborne Pathogens: Information for Immune-Compromised People

Listeria
Listeria (lis-ter'e'ah) is a bacteria that causes listeriosis. Listeria are most often found in foods such as raw milk, soft cheeses (especially if made with raw milk), raw meats, raw and smoked fish, raw sprouts, and some ready-to-eat foods including hot dogs, deli meats, lunch meats, refrigerated smoked fish and seafood.

There are many sources of Listeria on foods, including soil and animals. The bacteria are killed by cooking or pasteurization, but can grow in food stored in the refrigerator. Foods that have a risk of contamination with Listeria are ready-to-eat foods that were re-contaminated in the processing plant after cooking or pasteurization.

What is my risk of getting a Listeria infection?

Listeria infections are rare with around 2,500 cases and 500 deaths a year in the United States. An outbreak of Listeria infections in 2002 caused 23 deaths. The outbreak was linked to deli turkey. A study in 1991 found Listeriosis is 300 times more frequent in people with AIDS than in the general population. Symptoms include fever, muscle aches, nausea, diarrhea, or meningitis. Occasionally, Listeria infections occur in the blood or the brain of people who are pregnant or immune compromised. When this happens, serious illness and even death can result.

How can I prevent listeriosis?

Never eat these foods because they may contain Listeria ,Salmonella and many other foodborne pathogens.

• Raw (unpasteurized) milk
• Raw-milk fresh cheese and yogurt (aged hard cheeses made from raw milk are safe)
• Raw or undercooked seafood
• Raw or undercooked meat and poultry

For an added margin of safety from listeriosis, do not eat:

• Soft cheese (Brie, Feta, Camembert, queso fresco and similar soft Mexican-style cheeses) unless it is labeled as made with pasteurized milk.
• Refrigerated cooked or smoked seafood and fish (may be labeled as nova-style, kippered, lox, or jerky) unless it is contained in a cooked dish.
• Hot dogs, deli meats and pâté or meat spreads unless they are reheated to steaming hot.
• Unwashed fruits and vegetables.

Toxoplasma

Where are Toxoplasma (tox'o-plasma) found?

Cats are carriers of the Toxoplasma parasite, and can pass it through their feces to people, food and animals. Toxoplasma can be found in raw or undercooked meat.

What is my risk of getting a Toxoplasma infection?

About 35% of the U.S. population has been infected with Toxoplasma . A Toxoplasma infection ( Toxoplasmosis or toxo for short) generally does not cause illness.

The Centers for Disease Control (CDC) estimates 225,000 cases and 750 deaths occur in the U.S. each year from Toxoplasma infections. Symptoms include flu-like symptoms, central nervous system disease, and inflammation of the heart or pneumonia.

What if I test positive for Toxoplasma?

Testing for prior exposure to Toxoplasma is frequently conducted for HIV infected individuals because a Toxoplasma infection can result in very serious illness when a person is immune compromised (CD4 count below 100). If you test positive for Toxoplasma (seropositive), then, depending on your CD4 count, you may be put on a treatment regimen.

What if I test negative for Toxoplasma?

The following recommendations will help prevent becoming infected with Toxoplasma :

• Use a food thermometer to make sure meat and poultry are cooked to safe temperatures.
• Wash hands often, especially after handling pets and before handling food.
• Do not handle pets while preparing or eating food.
  Have another person clean the cat litter box.  If you must clean the box yourself, wear vinyl or household cleaning gloves and immediately wash your hands well with soap and water right after changing the litter.
• Thoroughly rinse fresh fruits and vegetables under running water before eating.

Cryptosporidium
Where are Cryptosporidium (krip"to-spo-rid'e-um) found?

Cryptosporidium is a parasite that infects many types of animals and humans. You can be exposed to Cryptosporidium from the feces of an infected person or animal, or by eating contaminated food or drinking contaminated water. Cryptosporidium causes the infection cryptosporidiosis (crypto).

What is my risk of getting cryptosporidiosis?

The CDC estimates 300,000 cases and 66 deaths occur in the U.S. each year. Symptoms include diarrhea, stomach cramps and fever.

How can I prevent crypto?

To keep yourself safe from crypto, use these tips:

• Wash hands often with soap and water.
• Avoid touching farm animals.
• Avoid touching the feces of pets or humans.
• Avoid swallowing water when swimming in the ocean, lakes, rivers, or pools, and when using hot tubs.
• Wash fruits and vegetables thoroughly.
• Cook food to safe temperatures. Use a food thermometer
  Drink safe water.*

* The CDC recommends that persons who are immune compromised boil drinking water for 1 minute, drink distilled water, or use a water purifier that uses reverse osmosis or filters water at less than 1 micron.

Links to Water Purifiers:

• www.cdc.gov/ncidod/dpd/healthywater/immuno.htm
• www.fhcrc.org/clinical/ltfu/patient/water_safety.html
• www.NSF.org

Salmonella and Campylobacter

Where are Salmonella (sal"mo-nel'ah) and Campylobacter (campy"lo-bacter) found?

Salmonella and Campylobacter are most often found in protein foods like raw (unpasteurized) milk, raw or undercooked poultry, meat, eggs, salads (chicken, tuna, potato), and cream desserts and fillings made with uncooked eggs. Fresh fruits and vegetables may also have Salmonella and Campylobacter .

What is my risk of getting a Salmonella or Campylobacter infection?

The CDC estimates 1.4 million cases of Salmonella infection and 582 deaths occur in the U.S. each year. It has been estimated that the person with AIDS is 12-20 times more likely to get a Salmonella infection than the general population. Symptoms include diarrhea, fever, abdominal cramps and vomiting.

The CDC estimates 2.4 million cases of Campylobacter and 124 deaths occur in the U.S. each year. Symptoms include diarrhea, cramps, fever, and vomiting.

How can I prevent a Salmonella or Campylobacter infection?

To keep yourself safe from Salmonella and Campylobacter infections follow these tips:

• Do not eat raw or undercooked eggs.
• Use pasteurized eggs or egg products or pasteurize your eggs in uncooked foods containing eggs.
• Use only pasteurized milk, cheese and yogurt.
• Use only pasteurized fruit juices.
• Use a food thermometer to make sure meat and poultry are cooked to safe temperatures.
• Do not eat raw sprouts (like alfalfa).
• Thoroughly rinse fresh fruits and vegetables under running water before eating.
• Wash hands, knives, cutting boards and food preparation areas with hot soapy water after handling foods to avoid cross contamination.

E.coli O157

Where are E.coli found?

E.coli are common bacteria that are found in animals and in the soil. A few types of E.coli , including O157, can cause serious illness. Food sources of E.coli include raw or undercooked meat, dry-cured salami, raw sprouts, raw (unpasteurized) milk, fruits, vegetables, unpasteurized fruit juice and fresh cider.

What is my risk of getting an E.coli infection?

The CDC estimates that 73,000 cases of E.coli O157 infection and 61 deaths occur in the U.S. each year. Symptoms include severe diarrhea that is often bloody, abdominal pain and vomiting.

How can I prevent an E.coli infection?

To keep yourself safe from E.coli O157, follow these tips:

• Use a food thermometer to make sure meat is cooked to safe temperatures.
• Use only pasteurized milk, cheese and yogurt.
• Use only pasteurized fruit juices.
• Do not eat raw sprouts (like alfalfa, bean or any other raw sprout).
• Thoroughly rinse fresh fruits and vegetables under running water before eating.
• Use water from a safe source for drinking and food preparation.

A Guide for the Person Living with HIV/AIDS

Tips for Safe Food Handling

Safe Cooking Temperatures

Choosing Safe Foods