Mycobacterium tuberculosis disease in Somali immigrants in Minnesota

Study objective: To characterize pulmonary and extrapulmonary Mycobacterium tuberculosis cases in the Somali community in Minnesota. Design: Retrospective chart review of active tuberculosis cases in Somalis reported to the Minnesota Department of Health between January 1993 and Jun e 1998. Patients: Ethnic Somalis in the state of Minnesota with M tuberculosis diag nosed by positive culture or radiographic findings consistent with tubercul osis and clinical improvement when treated with antituberculous drugs. Results: Eighty-two Somali patients were diagnosed with tuberculosis during the study period, Extrapulmonary disease (typically lymphadenopathy) was p resent in 46% (n = 38), The 1997 incidence of tuberculosis in Minnesota's S omali population was estimated at 170 cases per 100,000 population compared with a national incidence of 20.5 per 100,000 among African Americans and 2.5 per 100,000 among whites. Ninety percent of Somali patients were < 40 y ears of age; 63% were diagnosed within 1 year of immigration, and > 90% had positive results with the purified protein derivative skin test. M tubercu losis was confirmed in 24 of 25 isolates from extrapulmonary cases, Multidr ug resistance was present in 3.4%, and only two patients had AIDS. Conclusions: Somalis have a high incidence of active disease, with frequent extrapulmonary involvement in the absence of AIDS, clinical presentation s hortly after immigration, and infrequent infection with resistant organisms , Health-care providers should maintain an increased awareness for tubercul osis when evaluating Somali immigrants.