What is Brainerd diarrhea?
Brainerd diarrhea is a syndrome of acute onset of watery diarrhea ( 3 or more loose stools per day) lasting 4 weeks or longer, which can occur in outbreaks or as sporadic cases. It is named after Brainerd, Minnesota, the town where the first outbreak occurred in 1983. Patients typically experience 10-20 episodes per day of explosive, watery diarrhea, characterized by urgency and often by fecal incontinence. Accompanying symptoms include gas, mild abdominal cramping, and fatigue. Nausea, vomiting, and systemic symptoms such as fever are rare, although many patients experience slight weight loss.
What causes Brainerd diarrhea?
Despite extensive clinical and laboratory investigations, the cause of Brainerd diarrhea has not yet been identified. Although it is thought to be an infectious agent, intensive searches for bacterial, parasitic, and viral pathogens have been unsuccessful so far. The possibility remains that Brainerd diarrhea is caused by a chemical toxin, but no such toxin has yet been found.
Are there long-term consequences to Brainerd diarrhea?
Brainerd diarrhea is a self-limited illness. Symptoms may last a year or more, and typically have a waxing and waning course. Long-term follow-up studies have shown complete resolution in virtually all patients by the end of 3 years. There have been no known cases of sequelae or relapse once the illness has completely resolved.
How common is Brainerd diarrhea?
Seven outbreaks of Brainerd diarrhea have been reported since 1983. Six occurred in the United States, five of which were in rural settings. One outbreak occurred on a South American cruise ship based in the Galapagos Islands. The original Brainerd outbreak, which involved 122 persons, was the largest outbreak. An outbreak in Henderson County, Illinois, involved 72 persons; the Galapagos Islands outbreak involved 58. A survey of gastroenterologists suggested that many patients who are not associated with a recognized outbreak seek treatment for illness compatible with Brainerd diarrhea. Further work needs to be done to establish the incidence of sporadic cases of Brainerd diarrhea.
How do people get Brainerd diarrhea?
In the original Brainerd outbreak, raw (unpasteurized) milk was implicated as the vehicle for disease transmission. Contaminated and inadequately chlorinated or unboiled water has been identified as a source of Brainerd diarrhea in several other outbreaks. For example, illness was strongly associated with drinking untreated well water in theHenderson County outbreak. Persons who drank the same water after it was boiled did not get sick. Contaminated water was also implicated in the Galapagos Island outbreak. The diarrheal illness does not spread contagiously from one person to the next.
What can a person do to prevent this illness?
Avoiding drinking raw (unpasteurized) milk and water that has not been properly chlorinated or boiled will help reduce the risk for Brainerd diarrhea and many other diseases. Once the cause of Brainerd diarrhea is identified, more specific prevention measures can be formulated.
What is being done about Brainerd diarrhea?
Outbreaks of Brainerd diarrhea have been extensively investigated by Centers for Disease Control and Prevention and state health departments. Laboratory investigation continues at CDC to try to identify the etiologic agent.
