Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e610-e616 (doi:10.1542/peds.2006-2817)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mandalakas, A. M. Articles by Johnson, D. Search for Related Content PubMed PubMed Citation Articles by Mandalakas, A. M. Articles by Johnson, D. Related Collections Infectious Disease & Immunity Related AAP Red Book topics: Tuberculosis Social Bookmarking                         What's this?

ARTICLE

Predictors of Mycobacterium tuberculosis Infection in International Adoptees

Anna M. Mandalakas, MD^a, H. Lester Kirchner, PhD^a, Sandra Iverson, MS, RN, CPNP^b, Mary Chesney, MS, RN, CPNP^b, Mary Jo Spencer, BSN, RN, CPNP^b, Angela Sidler, MD^b, Dana Johnson, MD, PhD^b

^a Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
^b Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota

OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees.

METHODS. A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed.

RESULTS. Adoptees (mean age: 26 months; range: 1–200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M tuberculosis infection. The odds of M tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children 24 months of age at baseline screening, and increased 15% with each additional year of age for children >24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region.

CONCLUSIONS. Our study demonstrated a high prevalence of M tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.

---

Key Words: tuberculin test • malnutrition • tuberculosis • adoption • immigrants • pediatrics

Abbreviations: TST—tuberculin skin test • BCG—bacille Calmette-Guérin • OR—odds ratio • CI—confidence interval • aOR—adjusted odds ratio • PPD—purified protein derivative

---

Accepted Jun 30, 2007.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. Harmon TB Infection and Malnutrition Are Prevalent Among Internationally Adopted Children AAP Grand Rounds, February 1, 2008; 19(2): 14 - 15. [Full Text] [PDF]