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A Survey of Connecticut Physicians

Craig A. Morin, MPH; Christine L. Roberts, MBBS, MPH; Patricia A. Mshar, BGS; David G. Addiss, MD, MPH; James L. Hadler, MD, MPH

Arch Intern Med. 1997;157(9):1017-1022.

Abstract
Background
Cryptosporidiosis, an intestinal parasitic infection, has gained considerable media attention since a 1993 waterborne outbreak in Milwaukee, Wis, in which more than 400 000 persons became ill. However, the incidence of and risk factors for human cryptosporidiosis in the general US population are unknown. It has been suggested, but not documented, that physicians are generally unaware of the need to specifically request testing for this organism.

Objective
To assess physician awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts.

Methods
A self-administered questionnaire was mailed to a stratified random sample of Connecticut physicians. Specialties were limited to physicians in internal medicine, gastroenterology, infectious diseases, pediatrics, and family or general practice. Responses were compared among specialties.

Results
While most physicians were aware that cryptosporidiosis causes watery diarrhea (range, 67%-98%), particularly in patients with acquired immunodeficiency syndrome (>85% of all specialties), many did not know the symptoms or failed to identify other groups at increased risk. More than 75% of gastroenterologists, general or family practitioners, internists, and pediatricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidiosis. More than 30% of physicians assumed Cryptosporidium testing was included in a standard ova and parasite examination.

Conclusions
Cryptosporidiosis is likely to be unrecognized and underdiagnosed in Connecticut. This may occur because many physicians are unaware of cryptosporidiosis, unsure of the symptoms, do not test for it, or do not order the appropriate test. Unless there is more widespread use of specific tests, it will be difficult to evaluate specific preventive initiatives to limit the overall health impact of cryptosporidiosis.

Arch Intern Med. 1997;157:1017-1022

Author Affiliations
From the Connecticut Department of Public Health, Epidemiology Program, Hartford (Mr Morin, Ms Mshar, and Dr Hadler); The Australian National University, National Centre for Epidemiology and Population Health, Canberra, Australia (Dr Roberts); and Centers for Disease Control and Prevention, Atlanta, Ga (Drs Roberts and Addiss).

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