Meningitis Due to Iatrogenic Bcg Infection in Two Immunocompromised Children

Nosocomial Transmission of Mycobacterium bovis Bacille Calmette-Guerin to Children Receiving Cancer Therapy and to Their Health Care Providers

“…BCG is also used as adjuvant therapy for treatment of superficial bladder cancer. A previous report of nosocomial infection due to M. bovis BCG in 2 children who developed BCG meningitis implicated contamination of chemotherapy solutions that were reconstituted under the same biosafety hood as the BCG vaccine used for bladder cancer therapy [3]. We report 3 more instances of similar nosocomial transmission of BCG vaccine infections, including 1 patient with localized CNS infection and 2 with disseminated disease.…”

“…The other patient's isolate was very similar to these 2 BCG strains except for a single band-shift with DraI. PFGE after low-frequency-cleavage endonuclease restriction has been used successfully by others to show that tuberculous lesions in immunocompromised patients were caused by BCG strains that were identical to the vaccine strain previously administered to each patient [3,7]. The 2 patient strains, the Organon Teknika sample, the BCG Tice (source CDC) and BCG Connaught (source CDC) were identical to one another with use of all 4 restriction enzymes.…”

“…However, we cannot exclude the possibility that the chemotherapeutic agents were innoculated by contaminated gloves or by other equipment used to prepare these agents after preparation of BCG under the same hoods or by the same personnel. In a similar investigation, no definitive route of transmission was identified for the 2 children reported with BCG meningitis, but the investigators also postulated aerosol transmission [3]. It is of interest that another 6-year-old girl who was being treated with intrathecal chemotherapy for acute lymphocytic leukemia developed a BCG brain abscess.…”

NosocomialMycobacteriumbovis–Bacille Calmette‐Guérin Infections Due to Contamination of Chemotherapeutics: Case Finding and Route of Transmission

“…Although the use of BCG for vaccination or local therapy is considered to be relatively safe, case histories describing local or disseminated infectious complications have raised concern [1, 2]. A few case reports proved or suggested that M. bovis-BCG was introduced by cross-contamination of chemotherapy [3,4].In the Erasmus MC in Rotterdam, The Netherlands (hospital A), 3 patients received a diagnosis of disseminated M. bovis-BCG infections. The most recent patient had not been vaccinated with BCG and was admitted in the hospital for 13 months at the time of infection, which led us to investigate whether the infections were iatrogenic and to search for more patients with this iatrogenic infection.…”

“…Although the use of BCG for vaccination or local therapy is considered to be relatively safe, case histories describing local or disseminated infectious complications have raised concern [1, 2]. A few case reports proved or suggested that M. bovis-BCG was introduced by cross-contamination of chemotherapy [3,4].…”