Gastrointestinal disorders: are health care professionals missing zoonotic causes?

Acute gastrointestinal disorders (AGIDs) of presumed infectious origin are common illnesses and among the most frequent infective diseases referred to hospital. Much is known about the diagnosis and aetiology of AGIDs, but relatively little work appears to have been done regarding the assessment of relevant general practitioner (GP) history-taking and the potential for under-recognition of sources such as zoonoses. Established sources of zoonosis (for example exotic pet-keeping, farmyards and zoological parks) seem either rarely considered or annotated. Surveillance of food-borne illness and its aetiology attracts rapidly increasing attention in the public health community and these infections have been targeted for serious reduction. Zoonoses may present as food-borne illness. The aim of this study was to assess the potential for under-ascertainment and under-reporting of important sources of gastrointestinal infection. The study examined history-taking habits among GPs with reference to their general scope for either detecting or missing diverse sources of acute gastrointestinal infections. From a medical practice perspective, more specific identification of pathogenic factors may potentially promote wider preventive measures by alerting the public to unconsidered or recurrent problems. The study was conducted at a busy British health centre that currently accommodates eight GPs and several training personnel. The health centre has approximately 12,000-13,000 patients. The patient presentation records and GP notes were accessed via the health centre's computer database. Data on acute gastrointestinal disorders were obtained using the Read codes for both 'diarrhoea of presumed infectious origin' (DPI) and 'gastroenteritis of presumed infectious origin' (GPI). The first 35 cases were selected from the DPI list (10% of 'names'), and the first 24 cases were selected from the GPI list (10% of 'names'). Symptoms were unspecified in 11 out of the 24 GPI presentations compared to four unspecified out of 35 DPI presentations. Potentially significant history was unspecified in 22 out of the 24 GPI presentations compared to 27 unspecified out of 35 DPI presentations. Among potential sources of infection are: pet shops; exotic and domestic pets; farm animals/environments; and zoos and other wildlife centres. These established sources of potential infection are, however, only infrequently enquired into by GPs; thus their pathological significance may be easily overlooked. By using a standard setting 'pathogen source questionnaire' GPs might alert themselves to domestic or wider media of infection as well as enable more precise cues regarding when to sample and when to refer to hospital.