A Restaurant‐Associated Outbreak of Brainerd Diarrhea in California
ABSTRACT In a rare outbreak of Brainerd diarrhea in California, we identified 23 patients, many of whom had diarrhea persisting for > or =6 months. Case-control studies revealed that illness was associated with 1 local restaurant but not with any specific food or beverage. A Campylobacter species was detected in some patients' stool specimens, but its role in the outbreak remains unclear.
Chapter: Chronic Idiopathic Diarrhea[Show abstract] [Hide abstract]
ABSTRACT: Chronic diarrhea is defined as passage of loose stools for more than 4 weeks. In most instances the cause of chronic diarrhea can be discovered and treated effectively. A few less common causes also play a role: laxative abuse, small bowel bacterial overgrowth, and even bile acid malabsorption. Rarer syndromes account for a much smaller percentage of chronic diarrheas but may be more difficult to identify and treat. In a small number of patients, a cause for chronic diarrhea cannot be found and they are said to have chronic idiopathic secretory diarrhea, a fairly homogeneous disorder that can be sporadic or epidemic. This disorder can be diagnosed after excluding other causes of chronic diarrhea; it is associated with moderate weight loss and gradually subsides after 1.5–3 years. A sensible approach to the patient with chronic diarrhea of unexplained cause is based on a comprehensive history, focusing on the stool characteristics (watery, bloody, fatty), the occurrence of weight loss, aggravating and mitigating factors (with special emphasis on the diet); on a thorough physical examination and on the careful use of selected laboratory investigations such as complete blood count, comprehensive metabolic panel, thyroid tests, and of course stool tests such as bacterial cultures and extensive search for parasites; electrolytes, pH, occult blood test, leukocytes (or lactoferrin/calprotectin) and fat assessment. Subsequent analysis will depend on the findings from history, physical exam, and stool analysis and may or may not include more aggressive investigations such as CT enterography, small bowel follow-through radiograms, and videocapsule enteroscopy. Additional tests may have to be occasionally utilized, including plasma peptides (chromogranin, gastrin, calcitonin, VIP, somatostatin) and urine chemistry tests (5-HIAA, metanephrines, histamine). Key WordsChronic diarrhea-Osmotic diarrhea-Secretory diarrhea-Brainerd diarrhea-Idiopathic diarrhea-Stool tests10/2010: pages 311-324;
- [Show abstract] [Hide abstract]
ABSTRACT: This study used an adapted cultural protocol for the recovery of fastidious species of Campylobacter, to gain a more accurate understanding of the diversity of Campylobacter populations in fresh meats. Chicken (n=185), pork (n=179) and beef (n=186) were collected from supermarkets and butchers throughout the Republic of Ireland. Samples were enriched in Campylobacter enrichment broth for 24h under an atmosphere of 2.5% O(2), 7% H(2), 10% CO(2), and 80.5% N(2). The enriched samples were then filtered onto non-selective Anaerobe Basal Agar supplemented with lysed horse blood using mixed ester filter membranes. Isolates were identified by both genus and species-specific PCR assays and biochemical testing. The incidence of campylobacters on beef (36%) was significantly higher than on pork (22%) or chicken (16%), and far exceeds previously reported prevalence levels. The method was successful in recovering 7 species of Campylobacter, including the fastidious spp. C. concisus and C. mucosalis, from chicken meat, and 10 species, including C. concisus, C. curvus, C. mucosalis, C. sputorum, and C. upsaliensis, from minced beef. The isolation of C. concisus and C. upsaliensis from meat in this study is of particular significance, due to their emerging clinical relevance. The results of this study confirm that the diversity of Campylobacter species on fresh meats is greater than previously reported and highlights the bias of cultural methods towards the recovery of C. jejuni.International journal of food microbiology 08/2011; 150(2-3):171-7. DOI:10.1016/j.ijfoodmicro.2011.07.037 · 3.16 Impact Factor