Here's how food poisoning occurs and why you can die from it

It's really shocking when we read about Singaporeans who die from food poisoning. It seems such an innocuous way to go, when for most of us the worst-case scenario is a bloated tummy, charcoal pills, and feeling ill and uncomfortable for a couple of days, and swearing off eating too-spicy food ever again.

But for Mr Fadli Salleh, who was married with two young children, it was far more lethal, as he passed away allegedly after eating bento boxes prepared by Spize's River Valley outlet, with 72 others suffering from gastroenteritis.

In 2014, a four-year-old boy died four days after eating contaminated food bought from a nasi padang store in a food court.

In Jan 2018, Shayne Sujith Balasubraamaniam, together with his mother and two-year-old sister, came down with food poisoning, a day after his mother had bought food, including tauhu goreng and curry chicken, from a nasi padang stall at Kopitiam food court at Northpoint Shopping Centre.

All three were taken brought to Bukit Batok Polyclinic the next day. Shayne was assessed to be severely dehydrated and was prescribed medication.

He showed apparent signs of recovery, but deteriorated on Jan 22 when his mother found him unconscious at home. He died in hospital about two hours later from salmonella septicaemia.

And in 2009, two Singaporeans died and more than 40 were hospitalised after consuming rojak from a popular stall in the Geylang Serai market - still known as the worse case of mass food poisoning in Singapore.

Apparently, the chopping board at the stall was found to have faecal matter on it, utensils used on raw seafood was not cleaned properly and used to handle cooked food. Scary stuff. But how exactly does food poisoning take such a severe and deadly turn?

According to a case study reported in the Journal of Clinical Microbiology, these food-poisoning organisms are far, far more destructive than most of us realise. A 20-year-old man in Brussels, Belgian, had died followed the ingestion of pasta contaminated with a strain called Bacillus cereus.

He had eaten a meal of leftovers of spaghetti with tomato sauce, which had been prepared 5 days before and left in the kitchen at room temperature.

After school, he warmed the spaghetti in the microwave oven. Immediately after eating, he left home for sports activities, but returned home half an hour later because of a headache, abdominal pain, and nausea.

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He vomited profusely for several hours, and at midnight had two episodes of watery diarrhoea. He didn't receive any meds and drank only water, but the next morning his parents went to his room and found him dead.

Why? B. cereus is a well-known food-poisoning organism. It can cause two types of food poisoning, described as the emetic and diarrheal syndromes.

The emetic type is caused by a heat-stable cereulide toxin that is pre-formed in food. The symptoms are usually mild but can be severe in some cases.

The results from tests run on his food provided evidence for B. cereus food poisoning in a young, healthy man. Clinical data and the rapid onset of symptoms, together with microbiological and molecular study, pointed to B. cereus as the most likely cause for this fatal outcome.

The case study also mentioned that certain strains of food poisoning organisms can cause mitochondrial damage - which is to your DNA itself! On top of that fulminant hepatic failure, or liver damage, is also one of the most feared complications that can ensue.

Jaclyn Reutens, a dietitian at Aptima Nutrition & Sports Consultants, shared more about how someone dies from food poisoning.

"Some of the bacteria range from salmonella to e-coli," she reveals, adding: "Generally people don't get hit that hard from salmonella - in more advanced cases when the bacteria enters the intestinal tract and gets into the bloodstream, they'll then need antibiotics urgently. The symptoms range from abdominal cramps, bloody stool, nausea, and vomiting for an extended period."

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So, how does death from food poisoning happen?

"Dehydration is more serious than people realise - all your cells need water to function, and if cells in the brain, liver or any major organ start dying your body functions will break down, and this is irreversible. Very high fever also usually indicates that inflammations and infections have occurred - and if the bacteria gets into the blood and moves into vital organs, like the brain, liver and heart, it's a form of blood poisoning that will lead to shutting down of the body system," Jaclyn adds.

What's the difference between who gets just the runs, and who dies, is really quite complex, but two factors she shared was the strength of each individual's immune system, and also how much of the bacteria was ingested.

In the case of the recent Spize food poisoning case, Jaclyn shared, given how many fell sick it must be due to the core food items in the bento box, which could be bacteria in the meat and eggs.

This article was first published in Shape.