An outbreak of a newly recognized chronic diarrhea syndrome associated with raw milk consumption

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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. (JAMA1986;256:484-490)