title: Multifocal colitis associated with an epidemic of chronic diarrhea.
abstract: An outbreak of a chronic diarrheal syndrome was detected between May and August 1987 in rural Henderson County, Illinois. Seventy-two individuals were affected. Epidemiological studies performed by the Center for Disease Control implicated the water of a local restaurant as the source of the outbreak. Five patients underwent a comprehensive evaluation. Their mean age was 51 years, and they had a mean of 12 watery stools daily (range, 6-40). Detailed microbiological evaluations failed to identify a pathological organism. Stool studies showed a mean stool weight of 392 g/24 h with a normal fat content. Results of all biochemical studies of serum were normal. Chemical analysis of stool water suggested a secretory diarrhea. Colonoscopy revealed patchy erythema, and light microscopic examination of colonic biopsy specimens revealed multifocal areas of acute inflammation in the superficial mucosa in 4 of 5 patients. Electron microscopy of the affected areas revealed no viral particles. After 2 years, all of our patients continued to experience chronic diarrhea. One patient agreed to a follow-up colonoscopy; histological abnormalities of the colonic mucosa persisted after 2 years. We speculate that an infectious process arising from a contaminated water system induced a chronic, secretory diarrhea characterized by multifocal colitis. This histological abnormality may serve as a marker of an infectious, chronic diarrhea.
authors.affiliation: Department of Internal Medicine, University of Iowa College of Medicine, Iowa City.
authors.forename: R C
authors.initials: RC
authors.lastname: Janda
authors.forename: J L
authors.initials: JL
authors.lastname: Conklin
authors.forename: F A
authors.initials: FA
authors.lastname: Mitros
authors.forename: J
authors.initials: J
authors.lastname: Parsonnet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002908:Chronic Disease; D003092:Colitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000473:pathology; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007413:Intestinal Mucosa / Q000473:pathology; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014876:Water Pollution; D014881:Water Supply