Disseminated BCG infection: a four case study

Bahri, I.; Boudawara, T.; Makni, Saadia; Kharrat, Madiha; Triki, A.; Hamed, S. Ben; Jlidi, R.

doi:10.1016/s0399-077x(01)00264-5

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…The explanation is not fully clear for the noted increase in BCG related complications [6], [7]. The frequency of the lymphadenitis after vaccination correlates with the type of vaccine used.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of BCG lymphadenitis develops around 8 weeks after BCG vaccination. The time of node swelling correlates with the peak of local cutaneous reaction to the vaccine [5], [6], [7], [8], [9].…”

Section: Discussionmentioning

confidence: 99%

“…Disseminated BCG infection is rare complication with estimated incidence of 0.1–4.3 per one million vaccinated children but is lethal in 50–71% of the cases [12], [13]. The death rate is especially higher in cases of immunodepression (83%) and it is important to note that a temporary or permanent immune deficiency is observed in 86% of the cases [6], [7], [8], [9], [10], [11], [12]. However, in some area, the rate of Disseminated BCG infection even higher which is reaching 22.9% and the mortality rate is 72.8% [14].…”

Section: Discussionmentioning

confidence: 99%

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BCG related complications

AlFawaz

Alshehri

Alshahrani

2015

International Journal of Pediatrics and Adolescent Medicine

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Background and objectivesAlthough the BCG vaccine is usually a safe vaccine, a number of complications can occur, such as adverse local reactions, regional lymphadenitis, osteomyelitis and disseminated infection in immunocompromised children, with lymphadenitis being the most common complication. Our objective to describe the associated clinical characteristics and outcomes.Materials and methodsThis was a prospective observational study conducted over two year's period.Results100 patients were enrolled with (62%) males and (38%) females. 93 cases (93%) have nodes involvement with a total of 103 nodes was reported as follow: Axillary, supraclavicle, cervical with number of 75(72.8%), 23(22.3%), 5(4.9%) respectively. (55.3%) resulted in suppuration, and (44.7%) with non-suppuration. Only 3 cases (3%) had severe disease with dissemination, (88.3%) had small size nodes (< 3 cm), and (11.7%) with large size nodes (>3 cm). (88%) had self-limited disease, and node disappears between (8–168 weeks).ConclusionIn the Majority of BCG related lymphadenitis is a benign condition with spontaneous healing. Also there is Increase incidence of association between BCG vaccine and serious disseminated infections in immunodeficiency cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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BCG related complications

AlFawaz

Alshehri

Alshahrani

2015

International Journal of Pediatrics and Adolescent Medicine

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“…In our study, four children had disseminated infection; immunological work up revealed that they had severe combined immunodeficiency syndrome. Literature review revealed 28 cases of disseminated infection after BCG vaccination with a mortality rate of 71% [8,9]. The explanation for the noted increase in BCG related complications is not fully clear [8,10].…”

Section: Discussionmentioning

confidence: 99%

Bacille Calmette-Guerin Lymphadenitis: A single center experience

Abu-Zeid

Dahabreh

Habashneh

et al. 2015

J Pediatr Infect Dis

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To describe the clinical presentation, course and management of infants that presented with the diagnosis of lymphadenitis after Bacille Calmette-Guerin (BCG) vaccination. This is a descriptive study of 89 patients that were referred to the pediatric infectious disease clinic at King Hussein Medical Center in Jordan with regional lymphadenitis after BCG vaccination. The presentation, course and treatment options of these cases were discussed. The study was conducted between September 2006 and September 2007. Eighty-nine patients (47 males (53%) and 42 females (47%) were studied. All infants received the same type of vaccine used by our Ministry of Health, which is the Danish strain. Unilateral axillary lymph node enlargement was the most commonly seen (47%). Cervical lymph nodes were noted in 22 patients (25%) and supraclavicular lymphadenopathy was seen in 16 (18%). Sinus formation was seen in 16 (18%) patients. 27 cases (30%) had fluctuating lymph nodes. Four infants had disseminated infection. The majority (65%) of patients had their symptoms starting within the first 2 months after BCG vaccination. Forty-two (47%) infants had conservative observational management. Anti-tuberculosis medications were commenced in 27 (30%). Surgical excision was performed in 10 (11.5%) cases. All infants but one had complete recovery by the end of the study period. BCG lymphadenitis is a potential complication that necessitates an early recognition and implementing appropriate treatment protocols. Complete healing of suppurative lymphadenitis after BCG vaccine can be achieved using different treatment protocols.

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“…Disseminated infections are even rarer and their estimated incidence is 0.1 to 4.3 per one million vaccinated children but is lethal in 50 to 71% of the cases [ 6 - 8 ]. The death rate is especially higher in cases of immunodepression (83%) and it is important that a temporary or permanent immune deficiency observed in 86% of the cases [ 6 - 9 ]. Disseminated BCG infections have occurred in children with immunodeficiency disorders such as severe combined immunodeficiency (SCID), chronic granulomatous disease (CGD), complete Di George syndrome, AIDS and idiopathic immunodeficiency of genetic origin or mendelian susceptibility to mycobacterial disease(MSMD) with underlying genetic defects, but only rarely in apparently normal individuals[ 6 , 8 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran

et al. 2009

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BackgroundAdverse reactions induced by BCG vaccination are rare, disseminated mycobacterial BCG infection in particular, which is often fatal and results from impaired immunity. The aim of this study is to determine the nature of the immunodeficiences in patients with disseminated BCG infection in northwest region of Iran.Materials and methodsThrough 2 years all infants with BCG adenitis or other complications of this vaccine that had suspicious BCG infection were referred to children's hospital and health centers of Tabriz.Evaluation of immune system and in some cases genetic survey was performed in infants with evidence of histopathologic demonstration of acid-fast bacilli. Then frequency of infants who had disseminated BCG infection with immunodeficiency was defined.ResultsFrom 48 selected infants with complications of BCG vaccine in the range of 2 to 62 months, 28 infants (58.3%) were male and 20 infants (41.7%) were female. Disseminated BCG infection was diagnosed in 11 cases, almost all of whom had immunodeficiency as follows:Seven cases had severe combined immunodeficiency and one cases had chronic granulomatous disease. MSMD in two cases and IL12 R deficiency in another one was diagnosed.Overall, the mortality rate was 72.8% (8 cases) which 7 cases of them were SCID and another one CGDConsanguineous was found in more than half (7 cases) of patients and family history of disseminated BCG infection or immunodeficiency was found in nearly one third (3 cases) of patients.DiscussionBCG vaccine is administered world wide to prevent tuberculosis and is considered to have excellent safety profile. However in some immunodeficient patients it can cause severe and fatal complications, like in our region, where all cases of disseminated BCG infection with severe immunodeficiency died.ConclusionBCG vaccination is necessary in some countries such as Iran, so it seems that development of a more safer vaccine and change of vaccine program in the families with history of inherited immunodeficiency can be identifies such high risk infants and prophylaxis of severe complications or dead in such patients.

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Disseminated BCG infection: a four case study

Cited by 4 publications

References 17 publications

BCG related complications

BCG related complications

Bacille Calmette-Guerin Lymphadenitis: A single center experience

Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran

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