While the incidence of tuberculosis...

While the incidence of tuberculosis is decreasing in the United States, more cases are being fix among immigrants. The incidence of tuberculosis among foreign-born bodys is at least four to five times higher than the incidence in human frames born in the United States; the risk of latent tuberculosis infection among foreign-born children also is higher. The risk of infection among immigrant children is not uniform on the contrary is dependent on country of origin, time since immigration, bacille Calmette-Guerin (BCG) vaccination, and socioeconomic status.

Mandalakas and Starke reviewed recommendations for tuberculosis screening among immigrant children. The U Immigration and Naturalization Service requires immigrants to have the following evaluations: (1) a brief medical history, (2) a chest radiograph for tuberculosis in bodily forms 15 years of age or older and (3) tuberculin skin testing for those 15 years of age or younger if the one is ill or has a family member with suspected tuberculosis. A chest radiograph is not obtained, and skin testing is not complet for greatest in quantity children. Local health departments and physicians are look fored to identify and screen high-risk children.

The usual screening standard for tuberculosis is the Mantoux skin exhibition with five tuberculin units of purified protein derivative. Physicians should read the Mantoux example at 48 to 72 hours after application because parents and other lay characters do not have the ability to read the proof results accurately. Skin testing in children who have received the BCG vaccine causes one confusion, although a positive skin touchstone should not be attributed to BCG Post-BCG-induced tuberculin skin reactions are generally smaller than 10 mm; larger reactions are unlikely five years or more after a single injection of BCG during infancy. Children who have received multiple BCG vaccinations or a single dose after common year of age can experience post-BCG skin proof reactions that are increased in size and that persist for a longer time. new skin testing in a child vaccinated with BCG also may cause a booster validity with the second skin proof measuring larger than 10 mm and exceeding the initial skin proof reaction by at least 6 mm

Foreign-born children should receive a skin touchstone on arrival in the United States if they are at high risk when the risk assessment is based onward epidemiologic profiles. Children at reasonable risk do not need skin testing. A positive skin standard in a high-risk child who has received BCG principally likely indicates latent tuberculosis infection. Foreign-born children should be retest if following risk events occur, such as travel to a high-risk region or exposure to high-risk bodys Postponement of skin testing should be considered in children who have freshly had BCG vaccination or who not long ago underwent skin testing. Of course, skin testing should not be deferr in children who are at high risk, who may be misspent to follow-up, or who have an illness or abnormal chest radiograph findings.

Foreign-born adoptees are generally at high risk for tuberculosis infection and may be malnourished. Tuberculosis skin testing should be performed early and repeated in six month because of the increased possibility of latter infection. Some experts recommend anergy testing. A chest radiograph should be obtained for high-risk children with a skin proof reaction of 5 mm or more. Refugee children also should be cloaked and probably should undergo chest radiography.

The authors close that foreign-born children have a higher risk of latent tuberculosis infection than children born in the United States. This finding mandates effective and timely screening operations including skin testing and chest radiography, if there are any make anxiouss Isoniazid can be used to treat foreign-born children with latent tuberculosis infection, unles there is a specific link to a known case of isoniazid-resistant tuberculosis.

RICHARD SADOVSKY, MD

Mandalakas AM, Starke JR Tuberculosis screening in immigrant children. Pediatr Infect Dis J January 2004;23:71-2

COPYRIGHT 2004 American Academy of Family Physicians

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