Atteinte respiratoire sévère et choc septique à Mycobacterium bovis

Rival, Gilles; Garot, Denis; Mercier, Emmanuelle; Narciso, Bérengère; Legras, Annick; Perrotin, D.; Dequin, Pierre‐François

doi:10.1016/s0755-4982(06)74732-7

Cited by 14 publications

(6 citation statements)

References 8 publications

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“…These high levels fall after adequate treatment and are considered as a useful marker in the diagnosis and follow-up of patients with TB peritonitis. 15 Although our case is not the first case report on such a severe complication as similar cases were previously reported in the literature, 6 , 7 , 16 it adds to previous reports and reinforces the recommendation that all patients should be made full aware of the potential systemic and delayed complications of BCG immunotherapy.…”

Section: Discussionsupporting

confidence: 86%

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Disseminated Mycobacterium Bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Elzein

Albogami

Saad

et al. 2016

Clin Med Insights Case Rep

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BACKGROUNDIntravesical instillation of Bacillus Calmette–Guérin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although its use is relatively safe, severe complications such as granulomatous hepatitis, osteomyelitis, pneumonitis, and sepsis occur in few patients. Complications of intravesical instillation of BCG can be local or systemic, with early or late presentation.CASE PRESENTATIONHere, we report an 88-year-old man who developed fever, rigors, and episodes of syncope following fourth intravesical BCG instillation for the treatment of superficial transitional cell carcinoma of the bladder. Pancytopenia, disseminated intravascular coagulation, ground glass appearance on computerized tomography of the chest scan in addition to multiple bone marrow granulomas, suggested the diagnosis of disseminated BCG infection. All these features recovered on antituberculosis treatment.CONCLUSIONOur case study highlights the importance of early recognition and prompt treatment of patients with disseminated BCG infection following intravesical instillation. Although isolation of mycobacterium is desirable to make the diagnosis, it is not unusual to have negative smears and cultures and this should not be used to dismiss the possibility of BCG infection.

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Section: Discussionsupporting

confidence: 86%

“…5 This acute presentation is probably due to high levels of cytokines released directly into the bloodstream as a part of the hypersensitivity response rather than mycobacterium dissemination. 6 …”

Section: Discussionmentioning

confidence: 99%

Disseminated Mycobacterium Bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Elzein

Albogami

Saad

et al. 2016

Clin Med Insights Case Rep

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“…Therefore, we included a total of 201 articles comprising 271 cases of BCG infection after intravesical instillation published since 1975. 1 – 14 , 17 – 19 , 21 – 31 , 33 – 39 , 41 – 49 , 51 – 71 , 73 – 80 , 82 – 84 , 87 – 97 , 99 , 101 , 102 , 104 , 105 , 107 – 119 , 121 – 138 , 140 – 151 , 153 – 168 , 170 , 171 , 173 – 180 , 182 – 189 , 192 , 193 , 195 – 202 , 205 – 208 , 210 – 214 , 218 , 219 , 221 – 223 , 225 – 232 Of these, 170 were individually detailed cases, and 31 were summarized in reports containing 2–13 cases. All data shown here were extracted from these case reports and case series, but occasionally articles lacked relevant clinical or microbiologic data.…”

Section: Methodsmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0–9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

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“…BCGitis occurs in less than 5% of treated patients, more frequently in case of vascular breach and present most often as miliary tuberculosis [118]. Case reports of severe BCG sepsis have been reported, most of which occurring early after administration of intravesical BCG [119][120][121][122].…”

Section: Bacillus Calmette-gue ´Rin Therapymentioning

confidence: 99%

Severe infections in recipients of cancer immunotherapy: what intensivists need to know

Joseph

Lafarge

Mabrouki

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewGiven the increased number of cancer patients admitted in the ICU and the growing importance of immunotherapy in their therapeutic arsenal, intensivists will be increasingly confronted to patients treated with immunotherapies who will present with complications, infectious and immunologic.Recent findingsApart from their specific immunologic toxicities, cancer immunotherapy recipients also have specific immune dysfunction and face increased infectious risks that may lead to intensive care unit admission.SummaryChimeric antigen receptor T-cell therapy is associated with profound immunosuppression and the risks of bacterial, fungal and viral infections vary according to the time since infusion.Immune checkpoint blockers are associated with an overall favorable safety profile but associations of checkpoint blockers and corticosteroids and immunosuppressive drugs prescribed to treat immune-related adverse events are associated with increased risks of bacterial and fungal infections.The T-cell engaging bispecific therapy blinatumomab causes profound B-cell aplasia, hypogammaglobulinemia and neutropenia, but seems to be associated with fewer infectious adverse events compared with standard intensive chemotherapy.Lastly, intravesical administration of Bacillus Calmette-Guérin (BCG) can lead to disseminated BCGitis and severe sepsis requiring a specific antibiotherapy, often associated with corticosteroid treatment.

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Atteinte respiratoire sévère et choc septique à Mycobacterium bovis

Cited by 14 publications

References 8 publications

Disseminated Mycobacterium Bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Disseminated Mycobacterium Bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Severe infections in recipients of cancer immunotherapy: what intensivists need to know

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