An outbreak of a newly recognized chronic diarrhea syndrome associated with raw milk consumption
M. T. Osterholm, K. L. MacDonald, K. E. White, J. G. Wells, J. S. Spika, M. E. Potter, J. C. Forfang, R. M. Sorenson, P. T. Milloy and P. A. Blake
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.
