Easter Hol’s with Chocolate Recalls

Last week a well-known chocolate provider had to close its doors and recall millions of their chocolate products right before easter after health and safety concerns were raised following a salmonella outbreak. Ferrero, the Belgium chocolatiers have been reported to have had an outbreak of the bacteria in their Belgian factory which is responsible for the Easter egg which keeps on giving, the Kinder Surprise.
After reports across Germany, UK, France and Belgium, food standards agencies have requested recall on the kinder range including the infamous toy eggs, mini eggs, and maxi buenos. After careful consideration and investigation in to the outbreak, it was decided that the Belgian chocolatiers had to shut down and were requested to withdraw their products from sale and recall the goods across Europe, America and Asia.
Despite the reported outbreaks being linked to the Kinder products, the company has claimed the products which have been recalled have tested negative for salmonella, but they are taking the reports seriously and are putting the consumers first in any action they take.
So, what is Salmonella? how does it affect us? and more importantly how can it affect us in an Orthopaedic way?
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What is Salmonella…

Salmonella (Salmonellosis) is a bacterium that affects our intestinal tract. It typically is a live bacteria in the digestive system which is transmitted through faecal matter and is most commonly transmissible through contaminated food or water. The bacteria are usually found in raw meat, undercooked poultry, eggs, and unpasteurised milks, but can also be found on veggies and fruits from farming produce such as manure, which helps fertilise crops but is then not washed or cleaned sufficiently before eating.
Hygiene, poor hand washing, and food cleanliness are all factors. There is also a risk of increased exposure from international travel to places with poor water sanitation or places which have exotic bird or reptiles, as these are more prone to carry the bacteria.

Symptoms of Salmonella infection…

Salmonella typically will manifest with diarrhoea, vomiting and the usual gastrointestinal tract discomforts. Symptoms can last between 48 hours and a week. Hydration is key and maintaining a healthy water intake under these circumstances is advised. It is worth to mention that headaches, fevers, nausea, and fever like chills, can occur which are linked to the dehydration. Most healthy people will fully recover within the week without needing specific treatment.

Higher Risk Patient Groups…

Salmonella can affect those who are immunocompromised or have other medical problems which increase their risk of getting the bacteria and how the body fights it. The young and elderly are both at higher risk due to insufficient immune systems, either due to being underdeveloped (in the young) or being insufficient due to excessive age and wear. Those who are on medications to alter their immune systems (immunosuppressants) are also at higher risk as the drugs reduce the body’s natural ability to fight off the foreign bacteria’s. Salmonella infection also has transient links for those who are on anti-rejection drugs from organ transplants or on corticosteroids.
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What is autoimmune…

Autoimmunity is where the body’s immune system and its natural ability to fight infection is overactive. The result is the body mistakenly attacks and fights itself in the process of trying to fight a foreign infection. The easiest way to think about it is that your body has its own army ready to defend its own land and castle, however, for no particular reason that army chooses to attack its own people and castle, destroying itself in the process.
One common misunderstanding with autoimmune disease is the confusion between some forms of arthritis. We regularly hear people saying they have rheumatoid arthritis (RA) or rheumatism. In fact, the confusion here is usually between RA and Osteoarthritis. RA is autoimmune and is where the body fights its own cells and structures causing irreversible joint damage. Osteoarthritis is also joint damage, but this is caused by general wear and tear, over use and can be triggered by faulty biomechanics and trauma. For the most, people suffering with arthritis generally suffer from Osteoarthritis.
Other autoimmune conditions which work similarly but effect areas such as organs, the digestive system, our hormone regulation and nervous systems include Lupus, Crohn’s, Graves, Addison’s, and Multiple sclerosis.

Autoimmunity and infection…

These high-risk groups will get complications as the bacteria enters the blood stream. It travels into tissues and organs around the body and the dysfunctional immune systems then attacks the bacteria and itself in the process.
With the bacteria entering the joints and the associated soft tissues, it causes effusion (swelling) which causes joint stiffness, corrosion to the articular surfaces, and causes pains and muscle cramps. The common areas of concern are usually the spine and the lower limbs. Pains and symptoms occur around the hip, knee joint and legs in general. The pains and symptoms could be linked with feelings commonly found in Willis-Ekborn disease (restless leg syndrome). Quick diagnosis can assist with the most appropriate antibiotic choice, where needed, and subsequently results in quicker treatment and relief of the symptoms.
A systematic review from 2021 found that on average, 88% of patients infected with salmonella suffered from localised inflammatory response including erythema (reddening of the skin), moderate to severe swelling, and pain in the affected joints, with 75% of patients achieving a satisfactory recovery after treatment with antibiotics.

More serious / uncommon side effects…

Once in the blood the salmonella bacteria can cause blood infection (Sepsis) and can also cause infection in the bones (Osteomyelitis). These infections can then spread to other parts of the body resulting in other serious life changing conditions. Uncommon but reported, the infection can cause conditions such as meningitis (spinal cord and brain stem infection), endocarditis (heart infection) and can subsequently affect the linings of the arteries and blood vessels which can result in cardiovascular issues and result in higher risk of cerebrovascular accidents (CVA / stroke).
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Conclusion…

In the whole, salmonella poisoning is a fairly low-risk bacterial infection, and in a healthy population is one that our bodies will naturally deal with. Common infection symptoms such as a fever, elevated temperature, headaches and associated gastrointestinal discomforts will all resolve in time. However, in higher risk autoimmune patient groups the infection can be much more serious and can limit mobility, can start an unwanted immune reaction which could result in irreversible damage or other serious health concerns. Considering this, autoimmune and immunocompromised age groups should have their lab findings reviewed stringently to allow for early diagnosis and prompt treatment.
Despite all this, with over 67 cases currently reported this last week in the UK, and reports of children being hopsitalised, it is this which ultimately made worldwide food standard agencies take such a firm approach when considering the company closure. Knowing the affect salmonella can have on some higher risk groups and considering chocolate sales are so high at Easter, is why Ferrero and Kinder have complied with company closures. Be aware however, this shouldn’t stop anyone gorging on chocolate this Easter. Other chocolate brands are available!

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