Mycobacterium tuberculosis infection in foreign born adoptees

Korean adoptees placed by Associated Catholic Charities of Baltimore between January, 1985, and December, 1988 (N = 873), underwent surveillance for tuberculosis (TB). Overall tuberculin reactivity or active TB was documented in nine placements. Two children had active disease; both were skin test-negative and one died of tuberculous meningitis. The median age of the seven asymptomatic tuberculin reactors, none of whom had received Bacillus Calmette-Guérin vaccination, was 1 year. This reactivity rate is approximately 50 times greater than that of age-matched United States-born children. We conclude that high risk pediatric groups for TB, in addition to refugees, displaced persons and black and Hispanic minorities, include children involved in international adoption. Total reliance cannot be placed on screening tuberculin skin tests, and TB must be included in the differential diagnosis of high risk children presenting with recurrent pneumonia, fever of unknown origin, failure to thrive and altered mental status.