Medical Resources :: Common Diseases :: Infectious Diseases & Parasites :: Tuberculosis in Children Adopted from Abroad

Tuberculosis is quite common in countries all over the world, but especially in the former Soviet Union, Eastern Europe, China, Southeast Asia, India, and Central America. Tuberculosis can occur in the lungs and in many other organs of the body. Children contract TB from adults, not usually from other children. For children in orphanages, the staff who cares for them is usually the main source of infection. BCG vaccine (Bacille-Calmette-Guerin) is given to children early in life to help prevent TB, but it has a very limited effect. The BCG vaccine is used in all countries, except the Netherlands and the United States. You can recognize the vaccine site by a visible scar on most commonly the left upper arm.

In order for physicians to determine whether a child has been exposed to TB, we use the PPD (purified protein derivative) Mantoux test. The multiple puncture test (MPT) or Tine test is not recommended any longer for TB screening. The PPD involves inserting a small needle superficially under the skin of either forearm and instilling 0.1 cc of PPD. A small blister is produced which resorbs in a few minutes. The skin test must be interpreted by a skilled medical person like a physician, nurse, nurse practitioner, or physician assistant 48-72 hours after the administration of the PPD. It should never be interpreted by a parent or any other non-medical individual caring for the child.

Because of the increased prevalence of adults with tuberculosis in orphanages abroad, the reading of the PPD should be in the "high risk" category. If the PPD is greater than or equal to 5 mm, a chest x-ray should be performed and the child should then be given a preventive medicine called isoniazid (INH) for 9 months if the chest film is normal. Liver enzymes should be performed and evaluated before starting INH since it can have an effect on the liver. The liver enzymes do not need to be followed during the course of therapy unless the child develops rash, fever, nausea, vomiting which may be consistent with the side effects of INH.

Children who have received BCG vaccine can still be skin tested for tuberculosis. The BCG vaccine does cause the skin test to react, but the reaction is usually only a few mm of induration or no reaction at all. Usually exposure to tuberculosis causes the skin test to be very positive. It can be difficult to distinguish the BCG effect from exposure to tuberculosis on some occasions and then we need to be very conservative. Tuberculosis in young children is usually a life-threatening illness and it usually occurs within a few months to a few years from the time of initial exposure. As many as 40% of untreated infected infants develop disease within 2-12 months. 10% of children adopted from China have positive PPD tests. It is because of this known epidemiology that the PPD becomes such an essential part of the comprehensive screening tests for the newly arrived internationally adopted child.

For more information about tuberculosis, read International Adoptions Pose Extra TB Risk, Latent Tuberculosis, TB and Other Infectious Diseases, or Tuberculosis in the Medical Resources/Information on Common Diseases/Infectious Diseases and Parasites section of this site.

For more information, you can also refer to http://pediatrics.medscape.com/Medscape/pediatrics/AskExperts/2001/07/PED-ae15.html (Registration required to view article)