New perspectives on the persistent scourge of foodborne disease.

This issue of the Journal includes 2 studies that highlight important emerging food-borne-disease threats from very different perspectives. The wide spectrum of ex-traintestinal disease caused by potentially foodborne Escherichia coli is often under-appreciated. Johnson et al. [1] present provocative data suggesting that antimi-crobial-resistant E. coli and extraintesti-nal pathogenic E. coli (ExPEC) represent a newly recognized group of foodborne pathogens and raise a number of issues that deserve further attention. Helms et al. [2] describe adverse health effects of infection with antimicrobial-resistant Cam-pylobacter strains, much of which are also ultimately traceable to foodborne sources. The study by Johnson et al. is based on microbiologic examination of food. One of its fundamental observations is the high rate of bacterial contamination of many common food products, including both processed foods and those typically eaten raw. They found, for example, that 125% of samples of cucumber/zucchini and shrimp and 190% of poultry were contaminated with E. coli. Contrary to popular perception, food is not sterile. Others have demonstrated similar findings, although studies of food-handling behaviors have suggested that a substantial proportion of the population either has not received this message or does not understand its implications [3]. Continuing emphasis on safe handling and thorough cooking is worthwhile but clearly will not solve the problem alone. Efforts must continue to better understand the routes by which consumed food becomes contaminated , to appropriately focus preventive strategies. Their study serves as an important reminder that not all foodborne disease presents with diarrhea and vomiting. The most commonly recognized foodborne pathogens, such as Salmonella species, usually cause gastroenteritis but occasionally have extraintestinal presentations. Other common foodborne diseases—such as botulism and those associated with Listeria species, Vibrio vulnificus, and scom-broid poisoning—are usually associated with extraintestinal symptoms. E. coli is one of the most commonly isolated organisms from clinical specimens, and Johnson et al. raise the provocative possibility that a substantial proportion of those infections may disseminate from the food supply. At present, invasive ExPEC is rarely cited on lists of " food-borne diseases, " but, with further investigation , this could change. At present, we have little insight into what proportion of extraintestinal E. coli infections have a foodborne source, and this question deserves more attention. The study by Johnson et al. is based on molecular and serologic characterization of microbial isolates from foods. These isolates were compared with a collection of referral specimens from urinary tract and …