Should I Worry About the Pasta? The ID Doctor as News Translator

What happens when we get texts about Trader Joe’s fettuccine — and what to do when infections make headlines.

On the Do Not Eat list for pregnant women. (Image by Jill Wellington from Pixabay)

Every medical specialist has an unofficial side job that takes place far from the exam room or research lab. It often involves family, friends, colleagues, and less commonly, the press.

Cardiologists interpret Apple Watch tracings texted by anxious relatives. Dermatologists diagnose mysterious rashes photographed under bad lighting in someone’s kitchen. Orthopedists field questions about sprained ankles and sore knees from those who bravely continued to play basketball into their forties.

And infectious diseases (ID) doctors? We translate the news.

Whenever something ID-related hits the headlines, it’s fair game to ask us to explain what’s going on. Friends, family, neighbors, acquaintances from high school — all asking some variation of the same question:

“Is this something I should worry about?”

We are the explainers-in-chief: the calmers, the myth-busters, the people who say, “This sounds dramatic, but here’s what’s actually happening.”

Or, as in some cases, yes we should worry. Some famous examples: AIDS (1980s), anthrax (2001), H1N1 influenza (2009), Ebola (2014), Zika (2015), and of course Covid (2020).

From 2020-2022, because of Covid, this explainer role reached peak velocity. Reporters had us on speed dial — or whatever the modern equivalent of that is. Every day there was a new uncertainty to interpret. Those calls have quieted, thankfully, but the job lives on — mostly with events of lesser consequence, but occurring with regular frequency.

And a text from a non-physician friend about one recent news item reminded me of these interactions, both small and large.

The Latest Listeria Outbreak

The headline sounded the alarm: Six Dead in Listeria Outbreak Linked to Pasta. Most stories highlighted Trader Joe’s (that’s the price of success, TJs!), but it was much more widespread, highlighting the complexity of our food distribution network:

The source of this misery? The food supplier, Nate’s Fine Foods, which initiated a recall a few months ago after a pasta sample turned up listeria on testing.

Here’s the text from my friend:

“I think I ate that TJ’s pasta dish — am I doomed?”

Before we get to his fate, a refresher. The bacterial species, full name Listeria monocytogenes, can cause severe, even life-threatening illness — especially during pregnancy, in older adults, and in those who are immunocompromised. Others can get gastroenteritis.

Outbreaks occur with surprising frequency, often linked to contaminated ready-to-eat foods. Just since 2022, outbreaks have been tied to:
– Delicatessen meats
– Cold-counter foods
– Soft cheeses
– Prepared salads
– Pre-cooked meals
… and more.

Here, I made you a teaching slide, suitable for framing.

Those delicatessen meats, other foods from cold-counters, and soft cheeses come up with the greatest frequency. These are on the Do Not Eat list for pregnant women, which is quite long.

In 2011, an outbreak occurred due to some contaminated, and very hard to spell, cantaloupe. Yes, cantaloupe! When this outbreak occurred, I realized that not only are listeria outbreaks widely publicized, but that the disease itself holds a particular fascination with medical school curricula; no student graduates without an A+ appreciation of this infection.

Oddly, they know way more about listeria than they do about much more common infections, such as staph, or influenza, or norovirus. A few years ago, one MD/PhD student even taught me about how listeria moves through cells, going so far as to share a research video he’d seen of the process. Here it is, for the the listeria-obsessed among you.

No one knows why medical students know so much about this particular bug — it’s a Mysteriosis about Listeriosis. If someone does know, please enlighten us.

(True story: I walked into an elevator in downtown Boston, and a doctor-looking person looked at me, and said, “A Mysteriosis about Listeriosis”. Clearly a regular reader! His comment made my day.)

Back to the latest outbreak. It has been linked to pre-cooked pasta meals sold at Trader Joe’s, Walmart, Kroger, and several other major retailers. It has caused at least six deaths and 27 hospitalizations across 18 states. The Trader Joe’s product is:

Cajun Style Blackened Chicken Breast Fettuccine Alfredo.

Quite the name. I usually stick to Trader Joe’s items whose names don’t require a paragraph break, but tastes vary.

Back to the question he asked me: Am I doomed?

The short answer is no, you’re not doomed. We probably consume the culprit bacteria on a regular basis, but our immune system regularly handles it, or it might cause mild gastroenteritis. Obviously the recalled products should be discarded; here’s some good advice from the CDC. Trader Joe’s will even give you a refund.

The people who should be concerned? As noted above, those with weakened immune systems, pregnant women, and older adults. If you’re high-risk, have ingested the contaminated food, and have symptoms, please call!

Otherwise, no worries. But feel free to email or text your friendly ID doctor for reassurance. Delighted to help. And thank you, dear friend, for inspiring this post.

There’s another news story — very different from pasta, but ID-related — that’s been on my mind. More on that next time.

(On another topic, over at NEJM Journal Watch, I recount a recent visit to Johns Hopkins, where the ID fellows shared their favorite ID consults. Fun conversation!)