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* From the University of Washington, Seattle, WA (Dr. Kempainen); University of California/Los Angeles, Los Angeles, CA (Dr. Nelson); Department of Medicine, Hennepin County Medical Center, and Department of Medicine, University of Minnesota Medical School (Drs. Williams and Hedemark); and Community Health Department, Hennepin County Tuberculosis Control Center (Dr. Hedemark), Minneapolis, MN.
Correspondence to: David N. Williams, MB, ChB, Hennepin County Medical Center, Department of Medicine, 701 Park Ave, Minneapolis, MN 55415; e-mail: david.williams{at}co.hennepin.mn.us
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 June 1998.
Patients: Ethnic Somalis in the state of Minnesota with M tuberculosis diagnosed by positive culture or radiographic findings consistent with tuberculosis 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 present in 46% (n = 38). The 1997 incidence of tuberculosis in Minnesota’s Somali 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 years of age; 63% were diagnosed within 1 year of immigration, and > 90% had positive results with the purified protein derivative skin test. M tuberculosis was confirmed in 24 of 25 isolates from extrapulmonary cases. Multidrug 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 shortly after immigration, and infrequent infection with resistant organisms. Health-care providers should maintain an increased awareness for tuberculosis when evaluating Somali immigrants.
Key Words: extrapulmonary involvement • Minnesota • >Mycobacterium tuberculosis • Somali immigrants
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