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 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 disease, 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.

Variant Influenza Associated with Live Animal Markets, Minnesota.

Variant influenza viruses are swine-origin influenza A viruses that cause illness in humans. Surveillance for variant influenza A viruses, including characterization of exposure settings, is important because of the potential emergence of novel influenza viruses with pandemic potential. In Minnesota, we have documented variant influenza A virus infections associated with swine exposure at live animal markets.

Induction of mixed function oxidase activities in Cynomolgus monkey hepatocyte cultures.

Previous work has demonstrated that primary rat hepatocyte cultures may be used to screen compounds for induction of xenobiotic-metabolizing enzyme activities. In this study we have examined the effect of some known enzyme inducers in cynomolgus monkey hepatocytes. Cynomolgus monkey hepatocytes were isolated by a wedge perfusion technique and could be cultured in RPMI 1640 medium for at least 5 days. Hepatocytes were cultured for 70 hr with 10 mug Aroclor 1254/ml, 10 mum beta-naphthoflavone (BNF), 2 mm phenobarbitone (PB) and 100 mum Wy-14,643. All four compounds induced 7-benzoxyresorufin O-debenzylase activity to 160-280% of control levels, whereas 7-ethoxyresorufin O-deethylase activity was induced by WY, PB, BNF and ARO to 165, 215, 605 and 1165% of control, respectively. These results demonstrate that cultured Cynomolgus monkey hepatocytes respond to some known enzyme inducers and hence may be useful for screening chemicals for induction of xenobiotic metabolism in primate liver.

Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998.

This study retrospectively analyzed the magnitude and epidemiology of community-onset Staphylococcus aureus (COSA) infections and methicillin-resistant S. aureus (MRSA) infections in 4 Connecticut metropolitan areas (population, 1.1 million). The study looked at hospital medical records of persons admitted with S. aureus bacteremia in 1998. COSA was categorized as "health care associated," "with underlying medical condition," or "no underlying medical condition." Overall, 48% of S. aureus bacteremic infections were COSA (incidence, 17 cases/100,000 persons). Incidence increased with age and higher population density. In all, 62% of infections were health care associated; 85% of the remaining cases had underlying medical conditions. MRSA accounted for 16% of health care-associated cases and cases with underlying conditions but no cases with no underlying conditions. COSA bacteremic infections are as common as those due to pneumococci. MRSA is a well-established cause of COSA among persons at high medical risk for S. aureus infection. Additional study to understand community-onset MRSA acquisition is needed.

Radioiodinated N-[3-(4-morpholino)propyl]-N-methyl-2-hydroxy-5-iodo-3-methylbenzylamine (ERC9): a new potential melanoma imaging agent.

The role of nuclear medicine in the management of patients with malignant melanoma has expanded in recent years with the introduction of lymphoscintigraphy and sentinel lymph node biopsy, intense interest in positron emission tomography (PET) imaging using 2-[18F]fluoro-2-deoxyglucose (18F-FDG) as a tracer, and encouraging reports of several new single-photon-emitting radiopharmaceuticals. While PET imaging with FDG exhibits a high sensitivity for imaging patients with melanoma, specificity may not be as high and access to the technology remains limited. Single-photon emission tomography (SPET) imaging remains standard technology for most nuclear medicine departments. We report a novel radiopharmaceutical--radioiodinated N-[3-(4-morpholino)-propyl]-N-methyl-2-hydroxy-5-iodo-3-methylbenzylamine (ERC9)--which appears to show a sensitivity and specificity that are commensurate with expectations of a radiopharmaceutical for routine clinical imaging. In this phase II trial, 110 patients at risk for recurrence, with suspected recurrence or being restaged have been imaged with this novel tracer, demonstrating an overall sensitivity of 91% and specificity of 89%. The results of our study support a phase III trial to establish the clinical role of ERC9 in staging melanoma patients at presentation who are at high risk for metastasis, or restaging patients with known relapse to assess the extent of their disease, particularly if therapy or enrollment into a clinical trial is being considered.