title: An outbreak of a newly recognized chronic diarrhea syndrome associated with raw milk consumption.
abstract: A previously undescribed chronic diarrhea syndrome affected 122 residents of Brainerd, Minn, between December 1983 and July 1984. The illness lasted at least one year for 75% of case-patients and was characterized by acute onset, marked urgency, a lack of systemic symptoms, and a failure of response to antimicrobial agents. Clinical and laboratory data indicate that the diarrhea was caused by a secretory mechanism. Consumption of raw milk from a single dairy was associated with illness (odds ratio, 28.3; 95% confidence interval, 9.0 to 89.0). A median incubation period of 15 days was determined for seven case-patients. Possible secondary transmission was noted in one family. Extensive laboratory examination did not identify an etiologic agent. Outbreaks or sporadic cases of a similar illness have occurred in at least seven states; the outbreaks were less extensively investigated and findings were not published, but raw milk consumption was common in the affected persons. This illness appears to represent a previously unrecognized but important clinical entity and public health problem. The etiology and effective therapy for this illness must be determined by further studies of sporadic cases and outbreaks.
mesh_terms: D000368:Aged; D000818:Animals; D002417:Cattle; D002675:Child, Preschool; D002908:Chronic Disease; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks; D004311:Double-Blind Method; D004338:Drug Combinations / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005242:Fecal Incontinence / Q000209:etiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005516:Food Microbiology; D006801:Humans; D008297:Male; D008892:Milk / Q000009:adverse effects*; D008910:Minnesota; D013420:Sulfamethoxazole / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D004338:Drug Combinations; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole