THE RISKS OF FOOD CONTAMINATION: FRIED RICE SYNDROME EXPLAINED

Medically Reviewed by Dr. Rae Osborn, Ph.D. - September 27, 2024

In this article, we will explore what fried rice syndrome is, its symptoms, and how to prevent it.

What is Fried Rice Syndrome?

Bacillus cereus is the causative agent of Fried Rice Syndrome, sometimes referred to as Bacillus cereus food poisoning.^[1] This bacteria, which is frequently found in soil, can contaminate food by producing spores. It is especially known to thrive in rice and other starchy foods, like pasta, potato, and cheese.

Other foods that are susceptible to foodborne illness include:

• Sauces
• Soups
• Casseroles
• Puddings and pastries
• Salads

When rice and other starchy food are cooked and left at room temperature for an extended period, the bacteria can multiply and produce toxins. When consumed, these toxins can result in food poisoning, which can produce symptoms like nausea, vomiting, and diarrhea.

How Common is Fried Rice Syndrome?

While fried rice syndrome is not as well-known as other foodborne illnesses, it is more common than you might think. According to the Centers for Disease Control and Prevention (CDC), Bacillus cereus is responsible for 2-5% of all foodborne illnesses in the United States.

Risk Factors for Fried Rice Syndrome and Other Foodborne Illnesses

There are several risk factors that can increase the likelihood of developing fried rice syndrome and other foodborne illnesses. It is important to be aware of these risk factors and take appropriate measures to prevent them. Here are some common risk factors:

• Improper Storage: Bacterial growth can occur when cooked rice or any other food is kept at room temperature for a prolonged period of time.
• Inadequate Heating: Insufficient heating of rice, meat, and other foods can lead to the survival of bacteria, including Bacillus cereus.
• Cross-Contamination: When bacteria from raw or undercooked food come into contact with cooked food, it is known as cross-contamination.
• Poor Personal Hygiene: Inadequate handwashing, especially after handling raw food or using the restroom, can increase the risk of spreading bacteria that cause foodborne illnesses.
• Contaminated Ingredients: Using contaminated ingredients, such as spoiled or expired food, can introduce harmful bacteria into your meal and increase the risk of foodborne illnesses.

Fried Rice Syndrome Symptoms

Fried rice syndrome usually starts with gastrointestinal symptoms, sometimes accompanied by a fever and headache. Sometimes, bacillus cereus can get in the eyes, lungs, and open wounds, leading to infections in these areas with added symptoms.^[2]

There are two main types:

• Emetic Syndrome (vomiting syndrome)

In the vomiting syndrome type, symptoms include nausea and vomiting. Diarrhea is less common, and if it occurs it is late onset.

Symptoms usually start 60 minutes to 6 hours after eating contaminated foods that have been left out at room temperature, even after reheating.

This type happens because of a substance called cereulide found in contaminated food. Cereulide is a small compound unaffected by pH changes, enzymes, or reheating.

• Diarrhea Syndrome

Symptoms of this type include lots of watery diarrhea, stomach pain, and cramps. Vomiting and nausea are rare. Symptoms begin within 6 to 24 hours of eating food that was left out at room temperature for more than 2 hours.

The toxin that causes this type of illness is called an enterotoxin and is made in the small intestine of the patient after they eat the bacteria or spores. The ingested bacterial cells release pore-forming cytotoxins (e.g., hemolysin BL, nonhemolytic enterotoxin, and cytotoxin K) that cannot handle the heat and will be destroyed after reheating food.

How Long Does Fried Rice Syndrome Last?

Gastrointestinal symptoms usually go away within 24 hours of onset.

In some, symptoms may last for several days and often require medical treatment. In the most extreme cases, fried rice syndrome may be deadly.

It is essential to seek medical help if you experience any of the above symptoms after consuming fried rice or other starchy foods.

Can Leftover Food Really Be Fatal?

The specific enterotoxins produced by B. cereus can be fatal if an infected person is left untreated. However, mortality is exceedingly rare.

Some strains of B. cereus house toxins similar to Bacillus anthracis, which is a known cause of potentially deadly illness.

In 2008, a 20-year-old man from Belgium died from fried rice syndrome after consuming leftover spaghetti with tomato sauce that had been left outside the fridge for 5 days.^[3] More than a decade later, this tragic incident has brought attention to the dangers of fried rice syndrome and the importance of food safety.

What to Do if You Get Fried Rice Syndrome?

If you suspect that you have contracted fried rice syndrome, it is important to take the following steps:

Seek Medical Attention: If you experience severe symptoms or they persist for an extended period, it is advisable to seek medical help. A healthcare professional will be able to provide a proper diagnosis and recommend appropriate treatment.

Stay Hydrated: It is crucial to stay hydrated when dealing with symptoms of foodborne illness. Drink plenty of water to prevent dehydration. If severe, you may want to purchase some electrolytes from your local pharmacy to rehydrate properly.

Rest and Recover: Allow your body to rest and recover. Avoid strenuous activities and get enough sleep to support your immune system and aid in the healing process.

Prevention is always better than cure when it comes to foodborne illnesses like fried rice syndrome. To avoid getting sick in the first place, it is important to avoid the risks and practice good food safety habits.

How to Prevent Fried Rice Syndrome?

By following some simple food safety guidelines, you can reduce the risk of getting fried rice syndrome and other foodborne illnesses.

Proper Food Storage

The key to preventing fried rice syndrome is proper food storage. Cooked rice should not be left at room temperature for more than two hours. If you plan to eat the rice later, it should be stored in the refrigerator within this time frame.

When storing rice, make sure to use shallow containers to allow for quick cooling. The bacteria would not be able to grow and produce toxins as a result of this. It is also essential to reheat rice thoroughly before consuming it.

What Temperature Range is Safe to Store Foods to Avoid Contamination?

To avoid contamination with any foodborne pathogens, the US FDA recommends storing^[4]:

• Hot foods above 57ºC (135ºF). This temperature should be maintained when exhibited or kept outdoors and permitted to cool within a maximum of 6 hours.
• Cold foods below 5ºC (41ºF)

Good Hygiene Practices

Good hygiene practices are crucial in preventing foodborne illnesses. Always wash your hands before and after handling food, especially when cooking. You can reduce the possibility of bacteria transferring from raw to cooked food by doing this.

It is also essential to clean and sanitize all cooking utensils and surfaces after use. As a result, there will be less chance of cross-contamination and food poisoning.

Avoiding Cross-Contamination

When bacteria are transported from one food item to another, it is known as cross-contamination. To prevent this, raw and cooked foods should be handled using separate utensils and chopping boards. This is particularly important when working with raw poultry, seafood, and meat.

When storing food in the refrigerator, make sure to keep raw and cooked foods separate. This will stop any bacteria from invading other foods.

Cooking with spoiled or expired food is another form of cross-contamination that can occur. It is also important to use fresh ingredients to lower the risk of cross-contamination.

Cooking Rice Properly

It is crucial to cook rice correctly to lower the danger of fried rice syndrome. Rice should be cooked at a high temperature (above 140°F) to kill any bacteria that may be present. It is also important to stir the rice occasionally while cooking to ensure that it is evenly heated.

After cooking, rice should be served immediately or stored in the refrigerator within two hours. If you plan to eat the rice later, make sure to reheat it thoroughly before consuming it.

Conclusion

Fried rice syndrome may not be as well-known as other foodborne illnesses, but it is a serious health concern. You can lower your chance of becoming ill from contaminated food by adhering to the recommended food safety guidelines.

Remember to store cooked rice properly, practice good hygiene, avoid cross-contamination, and cook rice thoroughly.

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