Figure 1. a) Structures of the

Orphan infectious diseases

Medical Resources :: Common Diseases :: Infectious Diseases & Parasites :: Tuberculosis

as published in the International Primer

The epidemiology of Tuberculosis abroad is well-understood. The high prevalence countries are Mexico, the Philippines, Vietnam, Cambodia, India, China, Haiti, South Korea, and the former Soviet Union. Children living in orphanages abroad are the unwitting victims of this disease. They are exposed to adult caretakers with active tuberculosis who are living and working in the orphanage and have no access to medical care. Caretakers in orphanages are often ill for weeks and months without any medical attention making the spread of TB easy. Orphans have poor nutrition leading to inevitable immunosuppression (decreased ability to fight infection) making them more susceptible to tuberculosis. The incubation period can be weeks, months, and even years. A child arrives in the U.S. well-appearing and can begin to have symptoms over time. The symptoms in a newly adopted children can be very subtle. The child may present to a pediatrician's office with a fever, cough, weight loss, or with a gradual change in mood and loss of developmental milestones. There may be no symptoms at all, in fact, as the disease is just beginning. There may just be a fever and no other symptoms. Unless the doctor is aware of the increased risks of Tuberculosis in orphanages, the diagnosis of TB can be easily missed.

It is recommended that a child who is adopted from abroad be tested with a Mantoux skin test (PPD or purified protein derivative). The skin test is placed on either forearm (under the skin so that there is at least a tiny blister formed initially that resorbs within a few minutes) and should be read by a medical professional between 48 and 72 hours. Multiple puncture skin tests are no longer considered appropriate for TB skin testing. A positive skin test means that the diameter of the raised skin is greater than or equal to 10 mm. In an international adoption clinic at the Floating Hospital in Boston, one hundred and twenty-nine children were medically evaluated between...

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