Chronic diarrhea associated with drinking untreated water.
OBJECTIVE
To determine the cause of an outbreak of chronic diarrhea and to define the clinical profile of the illness.


METHODS
A case series of patients with chronic diarrhea and case-control and cohort studies to determine the vehicle and cause of the illness.


METHODS
Rural Henderson County, Illinois.


METHODS
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
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.
Parsonnet
J
J
Centers for Disease Control, Atlanta, Georgia.
Trock
S C
SC
Bopp
C A
CA
Wood
C J
CJ
Addiss
D G
DG
Alai
F
F
Gorelkin
L
L
Hargrett-Bean
N
N
Gunn
R A
RA
Tauxe
R V
RV
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D012147:Restaurants; D012307:Risk Factors; D014881:Water Supply