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An Outbreak of a Newly Recognized Chronic Diarrhea Syndrome Associated With Raw Milk Consumption

Michael T. Osterholm, PhD, MPH; Kristine L. MacDonald, MD; Karen E. White, MPH; Joy G. Wells, MS; John S. Spika, MD; Morris E. Potter, DVM; Jan C. Forfang, MPH; Ronald M. Sorenson, MD; Paul T. Milloy, MD; Paul A. Blake, MD, MPH
JAMA. 1986;256(4):484-490. doi:10.1001/jama.1986.03380040058029.
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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.

(JAMA 1986;256:484-490)


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