'Fried rice syndrome' is going viral years after a 20-year-old died. What is it?

What is fried rice syndrome? Recently, this type of food poisoning with an ironically delicious-sounding name has entered the spotlight after a death 15 years ago due to fried rice syndrome resurfaced on social media.

The condition started gaining traction on TikTok after user @jpall20 posted a now-viral video highlighting the story of a young man who died after eating five-day-old, unrefrigerated, leftover pasta.

"For all the students and meal preppers out there, do not make your food, put it in a Tupperware, and then leave it on your counter for a week," the user warned.

Fried rice syndrome death

The death was originally published as a case report in the Journal of Clinical Microbiology in 2011. In the report, researchers describe a 20-year-old student in Belgium who died suddenly in 2008 after eating leftover spaghetti with tomato sauce, which he had cooked five days prior and left on the kitchen counter at room temperature instead of storing it in the refrigerator.

Shortly after reheating and eating the pasta, he became ill with severe vomiting and gastrointestinal symptoms. The next morning, the otherwise healthy young man was found dead. An autopsy revealed he had acute liver failure, and testing revealed large amounts of a bacteria called Bacillus cereus in the pasta.

While the exact cause of death could not be determined because the autopsy was delayed, evidence pointed to Bacillus cereus as the most likely cause, the case report authors wrote.

Eating pasta that's been sitting on the counter for five days may sound unappetizing to most people, but infections with Bacillus cereus — also referred to as "fried rice syndrome" — are not uncommon.

A B. cereus infection can also develop after eating food that's sat at room temperature for far shorter periods of time, even just hours.

What is fried rice syndrome?

Fried rice syndrome refers to food poisoning caused by Bacillus cereus, a type of bacteria that forms spores that release harmful toxins, Robert Gravani, Ph.D., professor emeritus of food science at Cornell University, tells TODAY.com.

People become infected when they ingest food contaminated with the bacteria, which causes diarrhea and vomiting. In severe cases, an intestinal infection with Bacillus cereus can result in acute liver failure and death.

"We’ve known about it for a long time. This organism is very common in the environment, and it’s naturally occurring in soil, vegetation, and in a range of plant and animal food products," says Gravani.

Intestinal Bacillus cereus infections are common in many countries and often mild, Gravani says. About 63,400 outbreaks of B. cereus occur each year in the United States, according to the Cleveland Clinic.

Illness usually occurs when contaminated food is improperly cooled and left to sit at room temperature for long periods of time, allowing the bacteria and its spores to multiply to unsafe levels, Gravani explains. (B. cereus spores are heat-resistant and can survive in cooked food at temperatures that kill many other bacteria.) It can only take a few hours for this to happen, which is why the USDA recommends refrigerating food within two hours of cooking.

Foods that lead to fried rice syndrome are already contaminated with B. cereus prior to them being cooked and left out. The initial B. cereus contamination usually comes from the environment or cross-contamination during harvesting, handling or cooking.

“We do a pretty good job of controlling it,” says Gravani.

Bacillus cereus thrives in pre-cooked starchy foods, like rice and pasta, per the USDA, and optimal growth occurs between 40 degrees and 140 degrees Fahrenheit (also known as the “danger zone”), TODAY.com previously reported.

The name "fried rice syndrome" comes from early documented cases linked to cooked white rice that wasn't refrigerated and was later used to make fried rice dishes at restaurants, Dr. Cynthia Sears, an expert on food-borne infections and professor of medicine at Johns Hopkins University, tells TODAY.com.

“Basically, the rice is cooked and then kept at an inappropriate temperature, warm enough that the spores can germinate ... and the spores make what’s called a heat-stable toxin,” says Sears.

Reheating food won’t kill or deactivate the toxins or spores that can make you sick, the experts stress.

The name "fried rice syndrome" is a bit of a misnomer, Gravani clarifies. While the bacteria is commonly associated with rice and pasta, it can also contaminate vegetables, meat and dairy products.

Rarely, bacillus cereus can cause non-intestinal infections which affect other parts of the body, such as the eyes and wounds, per the Cleveland Clinic.

Fried rice syndrome symptoms

Bacillus cereus causes two forms of gastrointestinal illness, says Gravani, a vomiting syndrome and a diarrheal syndrome, which is the most common. They have different symptoms and incubation periods, and each type is associated with different foods.

Vomiting (emetic) syndrome

Fried rice syndrome is the vomiting type, says Gravani. "This occurs when the organism grows in the food and produces the toxin, then a person consumes the toxin and becomes ill," says Gravani.

It's most commonly associated with rice, per the Cleveland Clinic, but it's also linked to pasta, potatoes, pastries, sushi and cheese.

The incubation time is very short, and symptoms usually start within one to six hours after ingesting the contaminated food, says Gravani. These include:

• Nausea

• Vomiting

• Abdominal pain

"There might be some diarrhea, but it's usually vomiting-dominated," says Sears.

Diarrheal (enterotoxin) syndrome

The diarrheal syndrome occurs when a person ingests food contaminated with only the bacteria or its spores, says Sears. The spores then germinate in the stomach, and the toxins are released in the intestines, says Sears.

Foods associated with the diarrheal type of bacillus cereus infection include meat, vegetables, soups, stews and sauces, says Gravani.

The incubation period is longer, and it often takes six to 15 hours for symptoms to develop, the experts note. These include:

• Watery diarrhea

• Abdominal cramping

How to treat fried rice syndrome

Although fried rice syndrome is unpleasant, it will go away on its own most of the time without any specific medication.

"In normal healthy people, it usually resolves itself in 24 hours or so," says Gravani. Treatment involves supportive care, including plenty of rest and fluids. In severe cases of vomiting or diarrhea, a person may need intravenous fluids to maintain hydration.

People who are immunocompromised or have underlying health conditions are more likely to develop serious illness and consequences from a b. cereus infection, says Gravani.

In the case of the healthy 20-year-old in the case report, Gravani speculates that the period of five days allowed the bacteria to grow to extremely high numbers and produce deadly levels of toxins the pasta.

Most people probably aren't eating leftovers that sat on the counter for five days, but bacillus cereus is still a common cause of food poisoning.

How to prevent fried rice syndrome

You can reduce your risk of becoming infected with bacillus cereus by cooking, cooling and storing food properly. The experts recommend taking the following steps, which will also help prevent illness from other food-borne pathogens:

• Cook all foods thoroughly to a safe internal temperature, per USDA guidelines.

• Eat cooked food as soon as possible.

• Keep hot foods at 135 degrees or higher until they are served

• Refrigerate all cooked or perishable foods within two hours and make sure the fridge is set to 40 degrees Fahrenheit or cooler.

• If the surrounding temperature is higher than 90 degrees, leftovers need to be refrigerated after one hour.

• Divide leftovers into small containers to help them cool faster

• Reheat leftovers to an internal temperature of 165 degrees Fahrenheit before eating.

• Do not eat leftovers in the fridge that have been there for more than four days.

• When in doubt, throw it out.

This article was originally published on TODAY.com