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- Title
Chronic diarrhea associated with drinking untreated water.
- Authors
Parsonnet, Julie; Trock, Susan C.; Bopp, Cheryl A.; Wood, Cynthia J.; Addiss, David G.; Alai, Frank; Gorelkin, Leo; Hargrett-Bean, Nancy; Gunn, Robert A.; Tauxe, Robert V.; Parsonnet, J; Trock, S C; Bopp, C A; Wood, C J; Addiss, D G; Alai, F; Gorelkin, L; Hargrett-Bean, N; Gunn, R A; Tauxe, R V
- Abstract
<bold>Purpose: </bold>To determine the cause of an outbreak of chronic diarrhea and to define the clinical profile of the illness.<bold>Design: </bold>A case series of patients with chronic diarrhea and case-control and cohort studies to determine the vehicle and cause of the illness.<bold>Setting: </bold>Rural Henderson County, Illinois.<bold>Patients: </bold>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.<bold>Methods and Measurements: </bold>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.<bold>Conclusions: </bold>This is the first outbreak of chronic diarrhea linked to drinking untreated water. The causative agent and pathophysiologic mechanism of the illness remain elusive.
- Subjects
ILLINOIS; HENDERSON County (Ill.); UNITED States; DIARRHEA; CHRONIC diseases; CONTAMINATION of drinking water; AGE distribution; DISEASE outbreaks; EPIDEMIOLOGICAL research; FECES; LONGITUDINAL method; PSYCHOLOGICAL tests; RESTAURANTS; WATER supply; FAMILY relations
- Publication
Annals of Internal Medicine, 1989, Vol 110, Issue 12, p985
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-110-12-985