MDLinxWhat is ‘Fried Rice Syndrome,’ and Why is it Killing People?

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Recent attention to “fried rice syndrome” has brought renewed focus to Bacillus cereus (BC) food poisoning, a foodborne illness that can present with two distinct clinical syndromes. Although BC infections typically resolve without intervention, physicians should be aware of rare severe cases, particularly in immunocompromised patients, and understand proper food storage guidance to provide to patients.

Key Points:

• Bacillus cereus presents with two clinical manifestations: diarrheal syndrome and emetic (vomiting) syndrome. The emetic form has been linked to cases of liver failure and death in otherwise healthy individuals, though mortality remains rare among the 63,400 annual US cases.
• Onset of symptoms typically occurs within 30 minutes of consuming contaminated food, though presentation can be delayed up to 15 hours. Primary symptoms include nausea, vomiting, diarrhea, and abdominal pain. BC can occasionally cause extra-intestinal manifestations affecting the eyes, respiratory tract, bones, wounds, and brain.
• Treatment focuses on hydration, potentially requiring IV fluids in severe cases. Antibiotic therapy is generally not recommended for BC food poisoning.
• The bacteria thrives in foods stored between 39.2°F and 140°F (4-60°C). Foods should be reheated to 165°F (74°C) for safety. The two-hour rule is critical: foods left in the temperature danger zone beyond this window require proper reheating or refrigeration.
• Although commonly associated with rice, BC can contaminate various foods including grains, meat, cheese, pasta, spices, soups, baby food, fruits, and vegetables. The key factor is improper temperature control rather than food type.

“The disease is usually brief and self-limiting, [but] it can be severe in higher-risk groups, like those with weakened immune systems.”
– Erika Susky, MS, Infection Control Practitioner at Unity Health in Toronto

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