Julie Parsonnet, MD; Susan C. Trock, DVM; Cheryl A. Bopp, MS; Cynthia J. Wood, BA; David G. Addiss, MD; Frank Alai, MPH; Leo Gorelkin, MD; Nancy Hargrett-Bean, PhD; Robert A. Gunn, MD, MPH; Robert V. Tauxe, MD, MPH
Parsonnet J, Trock SC, Bopp CA, Wood CJ, Addiss DG, Alai F, et al. Chronic Diarrhea Associated with Drinking Untreated Water. Ann Intern Med. 1989;110:985-991. doi: 10.7326/0003-4819-110-12-985
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Published: Ann Intern Med. 1989;110(12):985-991.
Purpose: To determine the cause of an outbreak of chronic diarrhea and to define the clinical profile of the illness.
Design: A case series of patients with chronic diarrhea and case-control and cohort studies to determine the vehicle and cause of the illness.
Setting: Rural Henderson County, Illinois.
Patients: Seventy-two patients who had onset of chronic diarrheal illness between May and August 1987. Controls were local residents and eating companions who did not have diarrheal illness. A cohort study included 80 truck drivers from a local firm.
Methods and Measurements: Nonbloody diarrhea was characterized by extreme frequency (median, 12 stools/d), marked urgency, fecal incontinence, and weight loss (mean, 4.5 kg). The median incubation period was 10 days. Nine patients were hospitalized; none died. Diarrhea persisted in 87% of patients after 6 months. Antimicrobial therapy produced no clinical improvement. No bacterial, mycobacterial, viral, or parasitic agents known to be enteropathogenic were detected in stools or implicated water. Three of five small-bowel biopsies showed mild inflammatory changes. Mild inflammation was also seen in two of nine colonic biopsies. Case-control studies implicated a local restaurant (P = 0.0001, odds ratio = 19) and subsequently the untreated well water served in the restaurant (P = 0.04, odds ratio = 9.3) as the vehicle of transmission.
Conclusions: This is the first outbreak of chronic diarrhea linked to drinking untreated water. The causative agent and pathophysiologic mechanism of the illness remain elusive.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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