Typhoid Mamey Strikes

Another in a sobering series of food-borne outbreaks is recognized. This time, Typhoid Mamey was identified as the cause of smoothie (and milkshake) induced episodes of life-threatening typhoid fever here in California, as well as in Nevada.

Why the big alert, if only a few cases have been identified? First, typhoid is a serious infection. Five of the seven cases required hospitalization. Second, the cases that have been identified are not likely to be the only ones out there. Finally, it pays to be informed – you may need to be the one to connect the dots and make your own diagnosis because your average overworked and underpaid primary care provider might not even have “typhoid” on the radar when you, or a loved one, show up feeling really sick, sometimes as long as seven weeks AFTER being exposed.

So what is Mamey? And what the heck does the Victorian-sounding typhoid look like when it strikes? Here’s a checklist for you to store in your own personal diagnostic databank. Be sure to spread the word, so we can all, together, try to stop Typhoid Mamey in her tracks.

1) Mamey is a fruit pulp that is added as a thickener. As the AP reports: “The CDC said five of the victims drank milkshakes or smoothies made with frozen mamey (ma-MAY’) fruit pulp. Four of them used pulp sold by Goya Foods Inc. of Secaucus, N.J.

Mamey is a sweet, reddish tropical fruit grown mainly in Central and South America. It is also known as zapote or sapote. It is peeled and mashed to make pulp, the CDC said.

The company has recalled packages of the pulp, sold in mostly western states. A sample from one package found in Las Vegas tested positive for the bacteria that causes typhoid, the Food and Drug Administration reported Wednesday.” There is now a recall on this product. Be sure to check your shelves at home and discard any that you find. This is the second time mamey has been identified as a cause of a domestic typhoid outbreak, so maybe it’s time to thing about thickening smoothie’s with another ingredient – perhaps psyllium, instead?

2) Typhoid is a disease caused by the Salmonella germ. Many people have heard of Salmonella as a cause of diarrhea. But typhoid is a different type of Salmonella germ. Instead of causing primarily diarrhea, this one causes primarily a fever – hence the name, typhoid fever. In fact, the most distinctive sign of the infection is a sustained, high fever – as high as 103-104 degrees. Not everyone, however, has a typical course. And, even for people who DO have a typical, sustained fever, the fever can, after several days, go away on its own, but then return later (and stay for days again). As the usually understated CDC’s website succinctly puts it, “typhoid fever’s danger doesn’t end when symptoms disappear.” It can become a cyclical fever. And, the person suffering from the infection can become a chronic carrier too – even without symptoms.

3) Important reminders. A person with typhoid can develop a rash – flat, rose colored, speckled blotches on the skin. It’s one of the reasons doctors get more agitated by fever plus rash (as opposed to only fever, or only rash) – the rash can mean an unusual or serious infection (like typhoid). Also, keep in mind that typhoid is pretty common outside the industrial world, all because of poor sewage (and probably poor handwashing too). That’s where Typhoid Mary’s story comes in. Check it out for some interesting insights into how typhoid and its history are still pertinent today. If you ingest an infected milkshake or smoothie, handwashing won’t protect you – but handwashing is still crucial in preventing the spread from and infected person to their family, kids, roommates and (especially if you’re a cook or food-handler) many, many other people. When it comes to typhoid, consistently good handwashing is important for us all since the onset of symptoms can be as late as seven weeks after exposure, and a person can have absolutely zero symptoms and still be shedding the bacteria. Typhoid Mary is just another reminder, as we head into school and flu season, of how very important handwashing is for all of us!

4) Bottom line (so to speak): Clean out your cupboards, be aware of symptoms, spread the word, and get your handwashing groove on.

What do you think? Is the legend of Typhoid Mary still pertinent today? Or is the whole recall a tempest in a smoothie blender? Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.

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