How did leftover spaghetti kill a healthy 20-year-old?

The tragic story of a 20-year-old Belgian man who died after eating days-old spaghetti is getting renewed interest after an American professor highlighted the story on his popular YouTube page.

The person who posted the video, who claims to be an adjunct clinical professor at the University of Illinois, based his post on a 2011 case study published in the Journal of Clinical Microbiology.

On Oct. 1, 2008, the young man in Brussels became sick after eating leftover spaghetti and tomato sauce that had been prepared five days before and left out in the kitchen at room temperature.

According to the study, he warmed the spaghetti in the microwave. Immediately after eating it, he left home for his sports activities but returned half an hour later because of headache, abdominal pain, and nausea. He went on to vomit profusely for several hours and, at midnight, had two episodes of watery diarrhea. He then fell asleep.

The next morning, his parents found him dead.

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The otherwise healthy young man apparently died due to complications from food poisoning from a foodborne pathogen called Bacillus cereus. Although the exact cause of death wasn’t determined because the autopsy wasn’t performed for several days, the study suggests the man had liver failure. It also pointed to necrosis of the colon mucosa. His pancreas, heart, and lungs were also indirectly affected.

The autopsy found the presence of Bacillus cereus, which was also detected in the pasta.

The bacteria is an organism that can cause two types of food poisoning: emetic (meaning to induce vomiting) and diarrheal.

The emetic type is caused by what’s called a cereulide toxin, which is heat-resistant.

“The toxin cannot be killed by heat,” says Lynn K. Richards, a trainer with TrainCan, which offers food-safety training and certification, and a former health inspector. “Bacteria that produce toxins can’t be controlled; you can’t just cook it all out. A toxin is not a microbe; it’s a chemical. It’s a poisonous substance.”

“Toxins do not smell,” she adds. “You can’t see them, taste them, or smell them. That’s why they’re so dangerous.”

Food that has been left out at room temperature should be thrown out after two hours, Richards says.

She says she “shudders” to think about the levels of toxin that would have built up in those spaghetti noodles over five days; in the right conditions, bacteria will divide in half at room temperature approximately every 20 minutes. That means two becomes four, four becomes eight, and so on.

After 10 hours, a single bacterium will have split into more than one billion.

The cereulide toxin is produced in certain foods, such as rice, pasta and noodles,

The frequency of outbreaks of emetic food poisoning are scarce, since the symptoms are often mild and therefore not reported.

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According to the Clinical Microbiology study, four deaths have been recorded. One was in Belgium in 2003, when a child died due to the presence of the toxin in pasta salad she had eaten during a picnic. In the Netherlands in 2000, 116 students got ill after eating a rice dish.

Because neither cooking nor heating eliminates the toxin, proper food handling is crucial.

It all comes down to the time-temperature factor.

Microorganisms grow quickly when the temperature is between 4 degrees Celsius (40 F) and 60 degrees Celsius (140 F), according to TrainCan. This range is called the temperature danger zone. The longer that food is in the danger zone, the more bacterial will grow.

Hot food needs to stay hot and cold food needs to stay cold.

The Belgian man’s story is a reminder about the importance of teaching young people, those who are living on their own for the first time, about proper food handling.

“With students, they’ve had food cooked for them quite often,” Richards says. “If they learn how to cook, that’s great, but often they don’t have food safety information that would help them.

“Reheating or cooking does nothing for a toxin,” she adds. “As a health inspector, I think about how the food could have been prepared and who do I trust preparing my food? It’s about risk reduction.”

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