Brainerd Diarrhea: A Newly Recognized Raw Milk-Associated Enteropathy

In the not-so-distant past, raw milk-associated diseases were so prevalent that "milk-scarlatina" and "milk-diphtheria" were part of our language. The realization that the hazards posed by raw milk consumption could be essentially eliminated by pasteurization led to its nearly universal implementation in the United States and other developed countries.¹ However, raw milk consumption persists today, despite the well-recognized risks of bacterial infection. Streptococci, Brucella, corynebacteria, and Listeria can cause systemic illnesses, but acute enteritis is the most common health problem associated with raw milk consumption.² The major recognized milk-borne enteric pathogens— Campylobacter jejuni and Campylobacter fetus³; Salmonella, especially Salmonella dublin⁴; and Yersinia enterocolitica⁵— usually cause acute self-limited diarrheal disease. However, these pathogens may also cause pseudoappendicitis, leading to unnecessary laparotomy. Severe illnesses, including bacteremias, infectious abortion, and distant abscesses, or death may result, especially in previously compromised hosts. Ironically, pregnant women and compromised hosts