WHAT DO PHYSICIANS KNOW ABOUT CRYPTOSPORIDIOSIS - A SURVEY OF CONNECTICUT PHYSICIANS

Background: Cryptosporidiosis, an intestinal parasitic infection, has gained considerable media attention since a 1993 waterborne outbreak i n Milwaukee, Wis, in which more than 400 000 persons became ill. Howev er, the incidence of and risk factors for human cryptosporidiosis in t he general US population are unknown. It has been suggested, but not d ocumented, that physicians are generally unaware of the need to specif ically request testing for this organism. Objective: To assess physici an awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts. Methods: A self-administered questionnair e was mailed to a stratified random sample of Connecticut physicians. Specialties were limited to physicians in internal medicine, gastroent erology, infectious diseases, pediatrics, and family or general practi ce. Responses were compared among specialties. Results: While most phy sicians were aware that cryptosporidiosis causes watery diarrhea (rang e, 67%-98%), particularly inpatients with acquired immunodeficiency sy ndrome (>85% of all specialties), many did not know the symptoms or fa iled to identify other groups at increased risk. More than 75% of gast roenterologists, general or family practitioners, internists, and pedi atricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidio sis. More than 30% of physicians assumed Cryptosporidium testing was i ncluded in a standard ova and parasite examination. Conclusions: Crypt osporidiosis is likely to be unrecognized and underdiagnosed in Connec ticut. This may occur because many physicians are unaware of cryptospo ridiosis, 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 initiative s to limit the overall health impact of cryptosporidiosis.