the broad street pump revisited dairy farms and an ongoing outbreak of inflammatory bowel disease in forest, virginia宽阔的街道泵重新审视奶牛场和炎症性肠病的疫情森林,维吉尼亚州.pdf

Pierce et al. Gut Pathogens 2011, 3:20 /content/3/1/20 CASE REPORT Open Access The Broad Street pump revisited: dairy farms and an ongoing outbreak of inflammatory bowel disease in Forest, Virginia 1 2* 3 Ellen S Pierce , Stephen M Borowitz and Saleh A Naser Abstract We report an ongoing outbreak of ulcerative colitis and Crohn’s disease in Forest, Virginia involving 15 unrelated children and teenagers who resided in close proximity to dairy farms. Some of our cases demonstrated serologic evidence of Mycobacterium avium subspecies paratuberculosis infection, suggesting its potential role as an etiologic agent. Keywords: inflammatory bowel disease, paratuberculosis, cluster, outbreak, aerosolization, fecal-oral waterborne transmission Findings play an etiologic role in Crohn’s clusters. Some investi- On December 4, 1854, at a meeting of the London Epide- gators have proposed that MAP may cause some cases miological Society, Dr. John Snow presented a map illus- of Crohn’s disease [2,8] and the other major form of trating multiple cases of cholera deaths earlier that year in inflammatory bowel disease ulcerative colitis [9]. an area of London near a now famous pump on Broad While the existing medical literature suggests MAP is Street (Figure 1) [1]. The word “outbreak” was used to transmitted to humans through milk and milk products, describe the deaths from cholera occurring within houses it seems more likely that most people are exposed to that obtained water from the Broad Street pump, and the the organism through water contaminated with bovine map of