Julie Parsonnet

Publication Details

  • CHRONIC DIARRHEA ASSOCIATED WITH DRINKING UNTREATED WATER ANNALS OF INTERNAL MEDICINE Parsonnet, J., Trock, S. C., Bopp, C. A., Wood, C. J., Addiss, D. G., ALAI, F., GORELKIN, L., HARGRETTBEAN, N., Gunn, R. A., Tauxe, R. V. 1989; 110 (12): 985-991


    To determine the cause of an outbreak of chronic diarrhea and to define the clinical profile of the illness.A case series of patients with chronic diarrhea and case-control and cohort studies to determine the vehicle and cause of the illness.Rural Henderson County, Illinois.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.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.This is the first outbreak of chronic diarrhea linked to drinking untreated water. The causative agent and pathophysiologic mechanism of the illness remain elusive.

    View details for Web of Science ID A1989AB29600007

    View details for PubMedID 2729809

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