Why did a student die after eating five-day old pasta?

Being able to make an excess of pasta and store a portion away to eat later, rather than eating the whole lot, is a commendable skill. And with meal prepping having become one of the many Instagram/fitness virtues, cooking for the week is becoming increasingly common. Surprisingly, however, there are some very real risks associated with the improper storage of food.

The tale of a student that suddenly died 10 hours after eating five-day-old pasta has been causing a frenzy online. Although the story originates in 2011, it has been receiving renewed attention after it was the case study for a YouTube video posted by Dr. Bernard, under username Chubbyemu, on 21 January 2019.

The story can be summarised briefly. The nameless student (called ‘AJ’ for the purposes of the video), ate pasta that had been sat out for two days, then refrigerated for three days. 30 minutes after eating, he had intensive stomach pains, followed by severe vomiting and diarrhea. Having thought the best way to get rid of the pain was to “sleep it off” and drink “stomach medicine,” he went to sleep.  He had passed by the morning due to acute liver failure.

Following a post-mortem, it was found that he had ingested high levels of the bacteria Bacillus cereus. This bug is normally known for the food poisoning associated with old/unrefrigerated rice but can affect a number of other food types, including pasta. But food poisoning is not known to be a usual cause of death unless the sufferer is in an already weakened state. It isn’t normally associated with liver disease and should have passed out of the system over roughly 24 hours. So, why was it so fatal for the unsuspecting student?

In a similar way to there being multiple breeds of dogs, bacterial species can come in a wide range of ‘strains’. This is the same principle that allows some strains of Staphylococcus aureus to cause MRSA (methicillin-resistant Staph aureus) and others not. In the case of Bacillus cereus, these strain differences allow some strains, but not all, of the bacteria to produce a particularly nasty toxin – cereulide.

In the case of the unfortunate student, it was discovered that his old pasta had particularly high levels of cereulide. Being a spore-forming bacterium, the Bacillus cereus would have infected the pasta (usually this is rice) as a spore and then, when left unrefrigerated, it would start to grow. Once the bacterial colony had grown, heat cannot remove any of the bacteria or unpleasant chemicals produced, particularly cereulide.  And while the bacteria use this toxin for collecting potassium, it has a severe impact on humans.

The human liver is an incredible organ with an immense amount of metabolic functions to carry out. Included in its long job-list is processing of fatty acids and sugar. Cereulide stops this metabolism from happening and causes a build-up of fatty acids in the liver. As the level of fatty deposits rises, the liver stops functioning altogether and shuts down. If it shuts down suddenly enough, it is not able to regenerate itself. For the patient, this can be fatal.

With a young, healthy student, however, this toxin should not have been enough to induce death. The yellowing of his skin and eyes is indicative of liver failure but it is not thought to be entirely from cereulide poisoning. Upon further investigation, it was found that the ‘stomach medicine’ that he took was a brand that used a type of aspirin as the active ingredient. Unfortunately, aspirin also stops the processing of fatty acids in the liver and also contributes to the build-up of fatty deposits. The aspirin together with the cereulide proved to be too much for the student.

As sad as this story is, it is not a reason to stop the usual meal prep. What can be taken from this story is that it is important to refrigerate leftover food within a couple of hours of cooking to prevent Bacillus cereus and call a doctor in the case of severe vomiting and diarrhoea. Let’s hope that with increased awareness, such cases will not be repeated.

 

Image credit: Nick Amoscato

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The Student Newspaper 2016