title: Chronic diarrhea associated with drinking untreated water.
abstract: 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.
authors.affiliation: Centers for Disease Control, Atlanta, Georgia.
authors.forename: J
authors.initials: J
authors.lastname: Parsonnet
authors.forename: S C
authors.initials: SC
authors.lastname: Trock
authors.forename: C A
authors.initials: CA
authors.lastname: Bopp
authors.forename: C J
authors.initials: CJ
authors.lastname: Wood
authors.forename: D G
authors.initials: DG
authors.lastname: Addiss
authors.forename: F
authors.initials: F
authors.lastname: Alai
authors.forename: L
authors.initials: L
authors.lastname: Gorelkin
authors.forename: N
authors.initials: N
authors.lastname: Hargrett-Bean
authors.forename: R A
authors.initials: RA
authors.lastname: Gunn
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
mesh_terms: 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