Mycobacterium bovisBCG spinal osteomyelitis in a patient with bladder cancer without a history of BCG instillation

Abstract

BCG has been used as intravesical immunotherapy for the treatment of bladder carcinoma. However, this treatment is not harmless and may lead to complications, with a reported incidence of systemic BCG infection ranging from 3% to 7%. We report a case of culture-proven (BCG) vertebral osteomyelitis in a 72-year-old patient with bladder carcinoma who was treated with intravesical mitomycin C but did not receive BCG. Cultures from biopsy recovered isolate resembling biochemically, but resistant to pyrazinamide (PZA). The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol and PZA. After genotypic analysis identified the organism as (BCG), the regimen was changed to isoniazid and rifampin for 12 months. The patient responded well tothis treatment. This case is unique as the patient received only intravesical mitomycin and did not receive BCG, implying the possibility of transmission from contaminated equipment.

Mycobacterium bovis Bacillus Calmette-Guérin Cross-Contamination in the Operating Room: A Case Report

“…Although fomite-based transmission following improper cleaning of bronchoscopes or infected cystoscopes is well established and has been associated with both false-positive cultures and potential exposure to M. tuberculosis , 4 , 5 aside from this report, we did not find any other reports of MTBC false-positive cultures due to cross-contamination in the OR. While only our case patient’s samples were cross-contaminated in this incident, it is plausible that any material or device on the OR table that was placed into another patient could have resulted in serious complications, including inoculation of M. bovis or contamination and infection of wound beds.…”

Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

“…Septic side effects are rare, between 0.4% and 1/15,000 according to Lamm [5], and the benefit of the treatment remains higher than the risk of such events. However, other distant infections are described in the literature, mostly vascular aneurysms in a recent literature review [43], but also disseminated infections also called BCGitis [44], small-vessel central nervous system vasculitis [45] and even nosocomial infections, including vertebral osteomyelitis [46]. Some risk factors of distant infections could be suggested: a traumatic catheterisation during instillation [5], haematuria, instillations in the few days around an urological trauma [28] (pelvic radiation, surgery, bladder resection), arterial catheterisation [13], and general immunosuppressive factor such as HIV infection.…”

Bacille Calmette-Guérin preparation and intravesical administration to patients with bladder cancer: Risks to healthcare personnel and patients, and mitigation strategies

“…Several case reports detail suspected or confirmed BCG infections related cross contamination within the healthcare facility where BCG was prepared or administered (Table 2). 21,[25][26][27][28][29][30][31] Serious BCG infections, including meningitis and disseminated disease, have been reported among immunocompromised patients who received chemotherapy or other products mixed in the same biological safety cabinets (BSC) as BCG. 20,24,25,27 Some investigations never identified gaps in preparation or administration procedures, despite extensive review.…”