Last week I was talking to a woman at the Book Expo in New York. She told me that one of her daughters was in the Peace Corp and going to work in a small, very poor third world country. The young woman had already served in another poor country. I could see how proud the mother was of her daughter and I agreed that the young woman sounded like a caring, remarkable person.
"I would want to be sure", I said, "that your daughter has a yearly TB skin test and wonder if the Peace Corp does that?" The mother said she didn't know the answer and wondered about my concern. I explained that as a pediatrician, even in a small, affluent town, I had picked up two active cases of tuberculosis. I told her that the incidence of TB in poor countries is high and if a screening skin test for TB is performed only every two years, a fresh case may be missed for over a year. Treatment should always be started as soon as possible.
I saw a ten-year-old boy with Duchenne muscular dystrophy a few years ago. He had just come from Asia and the referring doctor had found a fresh, untreated case of tuberculosis. When I was a pediatric resident I had a little child one night as a patient who was found at autopsy to have widespread TB, as well as congenital heart disease. The girl had been in the Los Angeles Children's Hospital for a few days and the TB had not been diagnosed. The child was not one of my patients, but died the night I was on duty in her ward. Fortunately, my TB skin test remained negative although the hospital doctors had wanted me to be treated for a year with anti-TB drugs. I was very lucky.
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