Restaurant-associated outbreak of brainerd diarrhea in the red river valley, Texal, 1996
In June 1996, the Texas Department of Health identified an outbreak of chronic diarrhea among residents of Fannin County. We initiated case finding and conducted case-control studies and extensive laboratory testing. We defined a case as diarrhea lasting 24 weeks with onset after March 31, 1996, in a person who visited or lived in Fannin County. Ninety-nine persons (median age 63 years; 60% female) met the case definition; associated symptoms included fecal incontinence (73%), weight loss (72%), and absence of fever. Patients reported a median of 15 watery stools per day at onset, and 86% had diarrhea lasting 26 months. Fifty-five (90%) of 61 patients living in Fannin County ate at Restaurant X in the 4 weeks before becoming ill, compared with 8 (13%) of 61 neighborhood-matched controls (matched odds ratio [OR] 63; 95% confidence interval [CI] 18-237). At the restaurant, patients were more likely than well meal controls to have drunk tap water (OR=2.6; CI 0.9-7.3) and less likely to have drunk iced tea made from boiled water and store-bought ice (OR=0.3; CI 0.07-0.9). Inspection of the restaurant revealed many sanitary deficiencies, a malfunctioning ice machine, and the absence of devices to prevent backflow into water lines. Although no bacterial or mycotic pathogens were detected, virus-like structures were identified in stool specimens, and spore-forming protistan-like organisms were cultured from duodenal aspirates from 3 of 3 patients. Efforts to identify the causative agent are ongoing.
Kimura, AC; Mead, P; Walsh, B; Durso, L; Kolavic, S; Puhr, N; Wells, J; Humphrey, C; Monroe, S; Glass, R; Alfano, E; Visvesvara, G; Shieh, W; Brandt, M; Mintz, E; Anderson, B; Ando, T; Bopp, C; Bresee, J; Dingley, D; Eberhard, M; Flemister, M; Frankhauser, R; Gorelkin, L; Greene, K; De Moura, H; Nance, E; Noel, J; Oberste, S; Padhye, A; Pierce, G; Pruitt, W; Rosen, B; Simons, S
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