It was the largest bioterrorist attack in American history. In 1984, followers of the mystic Rajneesh contaminated salad bars at ten restaurants in The Dalles, Oregon with Salmonella. 751 people suffered food poisoning, 45 of whom had to be hospitalized.
The followers of Rajneesh lived in Rajneeshpuram, a religious commune. They hoped that by incapacitating voters in The Dalles, they could get their own candidates to win the upcoming Wasco County election and thereby gain political influence. Two Rajneeshpuram officials, Ma Anand Sheela and Ma Anand Puja, purchased Salmonella enterica Typhimurium from a medical supply company. The enterica subspecies of Salmonella accounts for around 99% of Salmonella-related diseases in humans (Chen et al., 2013). Several other Rajneeshees then helped spread the bacteria by sprinkling it on ingredients in salad bars.
As a result, 751 people suffered from acute gastroenteritis. The victims ranged in age from infancy to 87 years old. Symptoms included diarrhea, fever, chills, nausea, vomiting, headaches, and abdominal pain. According to the IDSA guidelines, if you suspect a patient to have infectious diarrhea and they are presenting with fever or bloody diarrhea, you should evaluate the patient for enteropathogens including Salmonella and Shigella, typically by testing a stool sample (Shane et al., 2017). Doctors did just that and lab testing determined that Salmonella was the culprit.
Salmonella is “the most common bacterial pathogen causing gastrointestinal infection worldwide” (Chen et al., 2013). Salmonella can be divided into two types: those that cause nontyphoidal gastrointestinal illness and those that cause typhoid illness (FDA). S. Typhimurium, which was used in this case, belongs to the first category. Don’t get this confused with S. Typhi, which is typhoidal. We’re focusing on non-typhoidal Salmonella here when discussing symptoms and treatment.
Acute gastroenteritis can appear anywhere from four to 72 hours post-infection; fever is likely to subside naturally within 3 days and diarrhea within 3-7 days (Chen et al., 2013). When treating salmonellosis (i.e. salmonella infection), it is important to ensure the patient is not suffering from dehydration; fluid replacement is often necessary (Shane et al., 2017). Antimicrobial treatment is typically not necessary, but in severe cases ceftriaxone has been shown to be helpful (Chen et al., 2013). Additionally, antinausea and/or antiemetic agents can be considered (Shane et al., 2017). With proper treatment, mortality is less than 1% (FDA). All of the victims in this attack survived.
Oregon health officials initially believed that the poisonings were due to the restaurants’ unhygienic environments. But residents of The Dalles suspected the Rajneeshees of a deliberate attack. A year later, the Rajneeshees were confirmed to have committed the act when a sample of bacteria exactly matching the known contaminant was discovered in a Rajneeshpuram laboratory. Sheela and Puja, who had led the attack, were convicted of attempted murder (as well as other crimes unrelated to this story, including assault and wiretapping) and both served 29 months in prison.
Do you know of another interesting true crime case with medical connections? Email Rachel Brill at rgbrill@gwu.edu.
References
Chen HM, Wang Y, Su LH, Chiu CH. Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy. Pediatr Neonatol. 2013 Jun;54(3):147-52. doi: 10.1016/j.pedneo.2013.01.010. Epub 2013 Mar 1. PMID: 23597525. https://proxygw.wrlc.org/login?url=https://www.clinicalkey.com/service/content/pdf/watermarked/1-s2.0-S1875957213000119.pdf?locale=en_US&searchIndex=
Food and Drug Administration. Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins. Second Edition. [Salmonella spp., pp. 9-13]. 2012. https://www.fda.gov/media/83271/download
Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):1963-1973. doi: 10.1093/cid/cix959. PMID: 29194529. https://proxygw.wrlc.org/login?url=https://academic.oup.com/cid/article/65/12/e45/4557073?login=true
