Role of Needle Aspiration in Diagnosis and Management of Suppurative Bacille Calmette–Guerin Adenitis: An Institutional Study of 30 Cases

Abstract

Context:Regional lymphadenitis is the most common complication of bacille Calmette–Guerin (BCG) vaccination. Most of the BCG lymphadenitis cases are nonsuppurative, but some suppurate and follow abscess formation, rupture, ulceration and cicatrization. Needle aspiration is the rapid, safe and cost-effective method for diagnosis as well as management of suppurative BCG adenitis.Aims:The aims of the present study were to assess the clinical and cytological spectrum of BCG lymphadenitis and to evaluate the role of needle aspiration in the management of suppurative BCG lymphadenitis.Settings and Design:We have approached every cases of ipsilateral axillary lymphadenopathy having history of BCG vaccination. We designed to aspirate the suppurative axillary lymph nodes and follow-up of nonsuppurative cases.Subjects and Methods:30 cases of BCG adenitis were studied during a period of 2 years. 12 cases of suppurative lymphadenitis were approached by needle aspiration and cytologically evaluated, and all the cases were followed-up for 12 weeks after diagnosis. Anti-tubercular drugs were not applied, and surgical excision was reserved for nonhealing lesions.Statistical Analysis Used:Data tables.Results:Ipsilateral axillary lymph nodes were commonest site and none had constitutional symptoms. Acid-fast bacilli were detected in 11 (91.67%) cases of suppurative BCG lymphadenitis. On follow-up all nonsuppurative adenitis were resolved spontaneously, and 8 suppurative lymphadenitis cases were resolved after 4 weeks of needle aspiration. Four cases needed repeat aspiration among which 3 resolved in 8 weeks, and one needed surgical excision.Conclusions:We recommend needle aspiration as a simple, safe, chief and effective modality, which helps in diagnosis as well as in management of suppurative BCG lymphadenitis.

Bacillus Calmette-Guérin vaccine related lymphadenitis in children

“…Moreover, it is associated with an unpleasant cosmetic outcome. In contrast, needle aspiration can shorten the duration of healing, and lessens the complications [8], [14], [16], [29], [30], [33], [34], [35], [36].…”

“…Needle aspiration is considered to be a safer option when compared with surgical excision, which likely will require general anesthesia in young infants. Incision and drainage should be avoided due to the risk of persistent draining wound, delayed wound healing and unpleasant cosmetic outcome with scar formation [14], [35], [36].…”

“…Surgical excision should be considered for children who failed needle aspiration or failed to respond to repeated needle aspirations more than twice, after balancing the risks of general anesthesia and potential surgical complications [14], [16], [33], [36].…”

Recommendations for the Management of Tuberculosis in Children—KOMPASS TB. Part 1: Tuberculosis Prevention

“…In suppurative lymphadenitis, the following are recommended: -slight reactions: observation only, -signs suggesting a fistula (fluctuation of the purulent content, skin thinning over the affected node): aspiration puncture and collection of the material for bacteriological examination for the concomitant infection. The puncture shortens the duration of the reaction, lowers the risk of spontaneous perforation and formation of a disfiguring scar [22][23][24]. Lymph node removal is not recommended as it is the last resort in persisting purulent inflammation.…”

Fine‐needle aspiration cytology of Bacille Calmette‐Guerin adenitis: A perplexing distinct clinical entity

“…BCG vaccination helps to avert various complications of tuberculosis (TB) such as meningitis and dissemination of TB 2 . In India, this vaccine is routinely administered to newborns at the left deltoid region 3 . Intradermal inoculation of BCG vaccine may produce as cutaneous nodule at the injection site and subclinical involvement of regional lymph nodes, which is self‐limiting 2 .…”