RESUMEN
Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.
Asunto(s)
Adopción , Emigrantes e Inmigrantes , Enfermedades Endémicas , Hepatitis A/diagnóstico , Tamizaje Masivo , Enfermedad Aguda , Adolescente , Niño , Preescolar , China/etnología , Colombia/etnología , Etiopía/etnología , Femenino , Guatemala/etnología , Haití/etnología , Hepatitis A/epidemiología , Hepatitis A/etiología , Hepatitis A/inmunología , Humanos , Lactante , Liberia/etnología , Masculino , Tamizaje Masivo/métodos , Minnesota/epidemiología , Nepal/etnología , Filipinas/etnología , Prevalencia , Factores de RiesgoRESUMEN
Tuberculosis (TB) in children is an important warning sign in a community, as it could signal recent infection of a cavitary form in an adult. Thus, while early diagnosis is crucial for effective treatment in children, it is also imperative for the control of tuberculosis at the public health level since it allows rapid identification of contagious adult cases. Here we report four cases of difficult and delayed diagnosis of TB in children. From this experience we highlight the need for an extensive medical history of the patient during diagnostic work-up. This includes: the positive history for contact with infected adults, especially for immigrant children; exclusion of TB diagnosis for persistent respiratory symptoms (2-3 weeks) after antibiotic therapy; and the need for high-definition CT scan when the radiological picture is not specific, especially for children under 5 years of age.