A 25-year surveillance of disseminated Bacillus Calmette–Guérin disease treatment in children in Southern Iran

Abstract

Disseminated Bacillus Calmette-Guérin (BCG) disease is one of the most serious complications of BCG vaccination, mainly among immunocompromised children with high morbidity and mortality.Currently, there is no any consensus with regard to the standard regimen of antituberculosis (anti-TB) agents and duration of treatment in healthy or immunocompromised host in children. The aim of this study is to investigate the effect of various combination treatment strategies for disseminated BCG disease in children.In this cross-sectional study, the outcome of 3 different combination protocols was investigated in 59 patients.All patients were younger than 6 years old. Both possible immunocompetent and proven immunodeficient children were included in a period of 25 years (1991-2014) in a Nemazee referral teaching hospital.The minimum age was 1 month and the maximum was 60 months. The average age of patients was 8 months (8.26 ± 9.73). Out of 59 cases, 32 (54.2%) were female and 27 (45.8%) were male. Based on the primary work up, 52.5% of cases were classified as definite immunodeficient and 47.5% were classified as possible immunocompetent. Overall mortality rate was 50.8%. Mortality rate of disseminated BCG disease in immunocompetent and immunodeficient children was 28.6% and 71%, respectively. The mortality rate was not statistically different between patients treated with different treatment protocols. These results were not affected by immune status and the type of immunodeficiency.More than 2 anti-TB drugs combination will not change outcome of patient with disseminated BCG disease.

A New Patient with Inherited TYK2 Deficiency

“…In Iran, due to the lack of awareness of individuals and the lack of proper and timely diagnosis of the disease, mortality may be consistent with this range. Early diagnosis is a fundamental aspect for prevention of generalized BCG infectious disease and growth of intracellular microbes (14). Local and generalized complications of BCG vaccine have been observed in patients with complete AR TYK2 deficiency, often associated with other clinical manifestations such as Brucella, Salmonella, and Herpes infection (2).…”

Development of a multiplex real-time PCR assay for BCG and validation in a clinical laboratory

“…A rapid method of differentiating BCG from other mycobacterial species is essential to providing optimal care for BCG infection, particularly in cases of disseminated BCG which is associated with a mortality rate of ~60% 4,[18][19][20][21][22][23] . A method of determining whether an early or late strain is causing a case of disseminated BCG may also provide an opportunity for pharmacosurveillance, to determine whether certain strains are linked to a higher rate of adverse events 2,24 .…”

Infección por Mycobacterium bovis en una adolescente con síndrome febril prolongado

“…Es por ello que, frente a una infección por micobacterias diferentes de tuberculosis se sugiere realizar estudio de la inmunidad celular y de la vía del interferón. 11,12 La prevención a través de la información a la población acerca de las medidas higiénicodietético ambientales, la detección temprana de los animales afectados y el diagnóstico y tratamiento adecuados de la población infectada permitirán mejorar el control de esta enfermedad, a fin de disminuir su impacto. 13 El consumo de leche no pasteurizada debe ser contraindicado en todas las situaciones.…”