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Stagi S, Papacciuoli V, Boiro D, Maggioli C, Ndambao NN, Losi S, Chiappini E, Toni S, Ndiaye O. Auxological and endocrinological features in internationally adopted children. Ital J Pediatr 2020; 46:82. [PMID: 32522220 PMCID: PMC7288436 DOI: 10.1186/s13052-020-00832-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/11/2020] [Indexed: 01/17/2023] Open
Abstract
In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Valeria Papacciuoli
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Djibril Boiro
- Service Universitaire de Pediatrie, UCAD, Dakar, Senegal
| | - Chiara Maggioli
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | | | - Stefania Losi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Elena Chiappini
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Sonia Toni
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Ousmane Ndiaye
- Service Universitaire de Pediatrie, UCAD, Dakar, Senegal
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Nielsen AV, Kjærgaard J, Pedersen TM, Helmuth IG, Nygaard U, Nielsen HW, Christensen VB, Kurtzhals JAL, Poulsen A. Infectious diseases detected by screening after arrival to Denmark in internationally adopted children. Acta Paediatr 2020; 109:1004-1010. [PMID: 31580515 DOI: 10.1111/apa.15045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/05/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Abstract
AIM To show the prevalence of selected infectious diseases among internationally adopted children (IAC) in Denmark. BACKGROUND Each year approximately 200 IAC arrive in Denmark. These are at increased risk of infectious diseases rarely seen in Danish children. Studies from the 1990s showed that 60% of IAC had infectious diseases and that the majority of these were undetected without screening. METHODS The study is a prospective study of medical records from children seen in the adoption clinic at Copenhagen University Hospital in the period 2009-2013. Screening was done for hepatitis A (HAV), B (HBV) and C (HCV), syphilis, HIV, tuberculosis (TB) and intestinal parasites. RESULTS In 245 IAC tested, 2% had evidence of recent HAV infection, 3% with HBV and one child with HCV, and no cases of HIV were found. One child had antibodies against syphilis (anti-Trpa AB positivity), and 2% were latently infected with tuberculosis. We found 30% infected with pathogenic intestinal parasites. Only 46% had serologic evidence of immunisation against HBV. CONCLUSION The prevalence of infections in IAC was lower than previously reported but compared to the general population, a higher prevalence of intestinal parasites, hepatitis and tuberculosis was found. We recommend that IAC are offered screening shortly after arrival.
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Affiliation(s)
- Agnethe Vale Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jesper Kjærgaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tine Marie Pedersen
- Copenhagen Prospective Studies on Asthma in Childhood Health Sciences University of Copenhagen Naestved Denmark
- Department of Pediatrics Naestved Hospital Naestved Denmark
| | - Ida Glode Helmuth
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ulrikka Nygaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Helle Winter Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Vibeke Brix Christensen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jørgen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology at Department of Clinical Microbiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - Anja Poulsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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de Martino M, Galli L, Chiappini E. The internationally adopted child: overview of challenging issues. Acta Paediatr 2019; 108:396-397. [PMID: 30152882 DOI: 10.1111/apa.14425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maurizio de Martino
- Department of Health Sciences, Meyer's Children's University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer's Children's University Hospital, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Meyer's Children's University Hospital, University of Florence, Florence, Italy
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Mastrolia MV, Sollai S, Totaro C, Putignano P, de Martino M, Galli L, Chiappini E. Utility of tuberculin skin test and IGRA for tuberculosis screening in internationally adopted children: Retrospective analysis from a single center in Florence, Italy. Travel Med Infect Dis 2019; 28:64-67. [DOI: 10.1016/j.tmaid.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 06/08/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Chiappini E, Bortone B, Borgi S, Sollai S, Matucci T, Galli L, de Martino M. Infectious Diseases in Internationally Adopted Children and Intercountry Discrepancies Among Screening Protocols, A Narrative Review. Front Pediatr 2019; 7:448. [PMID: 31788456 PMCID: PMC6853896 DOI: 10.3389/fped.2019.00448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Internationally adopted children (IAC) require thorough health assessments at time of arrival in the host country. As these children are at higher risk for infectious diseases, such as gastrointestinal parasites, tuberculosis, hepatitis, syphilis, and human immunodeficiency virus, early diagnosis of infectious diseases is fundamental for the optimal management of the child and, also, to reduce the risk of transmission to the adopting community. Comparative analysis of the screening protocols adopted in Europe, the United States, and Canada revealed different approaches to the adopted children. A homogeneous and internationally shared standard of care in the management of IAC should be provided.
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Affiliation(s)
- Elena Chiappini
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Barbara Bortone
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Borgi
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Sollai
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Tommaso Matucci
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Clinical, virological and immunological features of HIV-positive children internationally adopted in France from 2005-2015. PLoS One 2018; 13:e0203438. [PMID: 30265670 PMCID: PMC6161872 DOI: 10.1371/journal.pone.0203438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objective(s) To describe the clinical, virological and immune characteristics of internationally adopted children on arrival in France and after 6-months follow-up. Design Multicenter retrospective study. Methods 30 centers from 24 cities were asked to include, after informed consent, HIV+ children living in France and internationally adopted between 1st Jan 2005 and 1st Jan 2015. Sociodemographic, medical and biological variables collected during the first medical evaluation in France and 6 months later were analyzed. Results 41 HIV+ adoptees were included (female: 56%; median age: 3.91 years) in 14 centers. Adoptees tend to represent an increasing part of newly diagnosed HIV positive children over the years. The majority came from East-Asia. At arrival, one child was diagnosed with lymphobronchial tuberculosis and three with latent chronic hepatitis B, cleared HBV infection and chronic active hepatitis C, respectively. The mean CD4% was 32.8 ± 9% (range: 13–49%). The 34 children (83%) have been initiated on treatment from their countries of origin. Of these, 25 (74%) had an undetectable viral load (VL) on arrival. Resistance to ART was detected in five. At 6 months, 36 adoptees received ART, and the VL was undetectable in 29 children (71%), with one acquired resistance to NRTI & NNRTI. Conclusions An increasing number of HIV-infected children have been internationally adopted in France since 2005. Most of the children have been initiated on treatment from their countries of origin, had good immunity, with few opportunistic infections, and infrequently detectable VL. Low level of mutation conferring resistance was detected.
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Chiappini E, Zaffaroni M, Bianconi M, Veneruso G, Grasso N, Garazzino S, Arancio R, Valentini P, Ficcadenti A, Da Riol MR, La Placa S, Galli L, de Martino M, Bona G. Italian multicentre study found infectious and vaccine-preventable diseases in children adopted from Africa and recommends prompt medical screening. Acta Paediatr 2018; 107:1581-1586. [PMID: 29364534 DOI: 10.1111/apa.14237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/07/2017] [Accepted: 01/19/2018] [Indexed: 11/26/2022]
Abstract
AIM This study evaluated the prevalence of infectious diseases and immunisation status of children adopted from Africa. METHODS We studied 762 African children referred to 11 Italian paediatric centres in 2009-2015. Clinical and laboratory data were retrospectively collected and analysed. RESULTS The median age of the children (60.3% males) was 3 years and 6 months, 52.6% came from Ethiopia and 50.1% had at least one infectious disease. Parasitic infections accounted for the majority of the infectious diseases (409 of 715), and the most common were Giardia lamblia (n = 239), Toxocara canis (n = 65) and skin infections (n = 205), notably Tinea capitis/corporis (n = 134) and Molluscum contagiosum (n = 56) Active tuberculosis (TB) was diagnosed in nine children (1.2%). Latent TB infections were diagnosed in 52 (6.8%) children, and only 23 had concordant positive tuberculin skin tests and Quantiferon Gold In-Tube results. Discordant results were associated with Bacille de Calmette-Guérin vaccinations (odd ratio 6.30 and 95% confidence interval of 1.01-39.20, p = 0.011). Nonprotective antitetanus or antihepatitis B antibody titres were documented in 266 (34.9%) and 396 (51.9%) of the 762 children. CONCLUSION The prevalence of infectious conditions and not-protective titres for vaccine-preventable diseases observed in our population underlines the need for prompt and complete medical screening of children adopted from Africa.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Mauro Zaffaroni
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Martina Bianconi
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Giuseppina Veneruso
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Nicolino Grasso
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Piero Valentini
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gemelli Hospital, Catholic University A, Rome, Italy
| | - Anna Ficcadenti
- Pediatric Division, Department of Clinical Sciences, Polytechnic University of Marche, Ospedali Riuniti, Presidio Salesi, Ancona, Italy
| | | | - Simona La Placa
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
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Sollai S, Ghetti F, Bianchi L, de Martino M, Galli L, Chiappini E. Infectious diseases prevalence, vaccination coverage, and diagnostic challenges in a population of internationally adopted children referred to a Tertiary Care Children's Hospital from 2009 to 2015. Medicine (Baltimore) 2017; 96:e6300. [PMID: 28328809 PMCID: PMC5371446 DOI: 10.1097/md.0000000000006300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious diseases are common in internationally adopted children (IAC).With the objective to evaluate infectious diseases prevalence in a large cohort of IAC and to explore possible risk factors for tuberculosis (TB) and parasitic infections, clinical and laboratory data at first screening visit of all IAC (<18 years) consecutively referred to our Center in 2009 to 2015 were collected and analyzed.In total, 1612 children (median age: 5.40 years; interquartile range: 3.00-7.90) were enrolled, 123/1612 (7.60%) having medical conditions included in the special needs definition. The most frequent cutaneous infections were Molluscum contagiosum (42/1612; 2.60%) and Tinea capitis (37/1612; 2.30%). Viral hepatitis prevalence was <1% (hepatitis B virus [HBV]: 13 children, 0.80%; hepatitis C virus: 1 child, 0.10%; hepatitis A virus: 6 children, 0.40%). A parasitic infection was diagnosed in 372/1612 (23.10%) children. No risk factors for parasitosis were evidenced. Active TB was diagnosed in 4/1355 (0.3%) children, latent TB in 222/1355 (16.40%). Only 3.7% (51/1355) children had concordant positive tuberculin skin test (TST) and QuantiFERON-TB-Gold In-Tube (QFT-G-IT) results. Risk factors for TST+/QFT-G-IT- results were previous Bacille de Calmette-Guérin vaccination (adjusted odds ratio [aOR]: 2.18; 96% confidence interval [CI]: 1.26-3.79; P = 0.006), and age ≥5 years (aOR: 1.49; 95% CI: 1.06-2.11; P = 0.02). The proportion of children with nonprotective titers for vaccine-preventable diseases (VPD) ranged from 15.70% (208/1323) for tetanus to 35.10% (469/1337) for HBV.Infectious diseases were commonly observed in our cohort. The high rate of discordant TST/QFT-G results brings up questions regarding the optimal management of these children, and suggests that, at least in children older than 5 years, only QFT-G-IT results may be reliable. The low proportion of children protected for VPD, confirms importance of a timely screening.
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Soriano-Arandes A, Sulleiro E, Zarzuela F, Ruiz E, Clavería I, Espasa M. Discordances Between Serology and Culture for Strongyloides in an Ethiopian Adopted Child With Multiple Parasitic Infections: A Case Report. Medicine (Baltimore) 2016; 95:e3040. [PMID: 26962825 PMCID: PMC4998906 DOI: 10.1097/md.0000000000003040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 11/25/2022] Open
Abstract
RATIONALE infectious diseases screening of international adoptees is complex because of the concurrence of different pathogens in a child at same time. We describe an international adopted child born at Ethiopia infected by 5 different pathogens (Hymenolepis nana, Giardia intestinalis, Entamoeba histolytica, Strongyloides stercoralis, and Trichuris trichiura), 2 of them S. stercoralis and E. histolytica with a capacity to develop severe clinical complications if not detected promptly with appropriate diagnosis tests.Concerns of the patient: according to the screening protocol a stool sample is always processed for culture addressed to find out protozoan and helminthic pathogens but not specifically for S. stercoralis. Only, when eosinophilia is detected 3 serial stool samples are collected to rule out intestinal parasitic infection including S. stercoralis. INTERVENTIONS in our case, S. stercoralis would not have been detected if we had followed the protocol because eosinophilia was absent and its specific serology was negative. Fortunately, the initial inclusion of the feces charcoal culture for S. stercoralis allowed us to detect this infection. OUTCOMES discordances between direct methods such as culture and indirect as serology or antigen test forces us to be very cautious before ruling out S. stercoralis or E. histolytica infection, respectively. Also, if a child from tropical areas has persistent symptoms (such as diarrhea or fever) that have not been treated we have to rule out other infections that have not been detected yet.Main lessons: The introduction of different sequencing tests and the insistence to find out pathogens such as S. stercoralis or E. histolytica was determinant to be able to cure this symptomatic child and to prevent potential severe clinical forms in case of immunosuppression.
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Affiliation(s)
- Antoni Soriano-Arandes
- From the Pediatric Infectious Diseases and Immunodeficiencies Unit, Unit of International Health-Tuberculosis Drassanes-Vall Hebron, Hospital Universitari Vall d'Hebron (AS-A); Unit of International Health Drassanes-Vall Hebron, Programa Especial de Malalties Infeccioses (PROSICS), Hospital Universitari Vall d'Hebron (FZ, ER, IC); and Department of Microbiology, Hospital Universitari Vall Hebron, Barcelona, Spain (ES, ME)
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