Spectrum of Bacille Calmette‐Guerin (BCG) Infection after Intravesical BCG Immunotherapy

González, Oscar; Musher, Daniel M.; Brar, Indira; Furgeson, Seth B.; Boktour, Maha; Septimus, Edward; Hamill, Richard J.; Graviss, Edward A.

doi:10.1086/344908

Cited by 181 publications

(218 citation statements)

References 45 publications

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“…M. bovis BCG intravesical instillations have been anecdotally associated with skeletal infections, particularly spondylitis [26,46,50], which may present as late as 12 years after the procedure, and with hip or knee arthroplasty [61]. The diagnosis is established by culture and recently, by PCR-based genomic analysis.…”

Section: Mycobacterium Bovis Bcg Osteoarticular Infectionsmentioning

confidence: 99%

Bone and joint tuberculosis

2012

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Section: Mycobacterium Bovis Bcg Osteoarticular Infectionsmentioning

confidence: 99%

Bone and joint tuberculosis

2012

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“…10) On the other hand, some cases of disseminated BCG infection have been proven to induce granulomatous hepatitis, sepsis and multiple organ failure in these patients. 11) Several animal experiments have confirmed that BCG infection could induce the immune hepatic injury and production of inflammatory cytokines, active free radicals and nitric oxide (NO). 12) Moreover, it was reported that microsomal P450 content and activity were suppressed by NO from inducible nitric oxide synthase (iNOS) during BCG infection in rodent liver.…”

mentioning

confidence: 99%

Effects of Ganoderma lucidum Polysaccharide on CYP2E1, CYP1A2 and CYP3A Activities in BCG-Immune Hepatic Injury in Rats

Wang

Zhao

et al. 2007

Biological & Pharmaceutical Bulletin

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Ganoderma lucidum (LEYSS, ex FR., G. lucidum) KARST has been prescribed to improve health and longevity in the traditional Chinese medicine, and it was used for the treatment of neurasthenia, hypertension, hepatopathy and carcinoma for thousands of years.1) More than one hundred species of bioactive components have been isolated from G. lucidum,2) such as polysaccharides, triterpenoids and alkaloids, in which that Ganoderma lucidum polysaccharide (GLPS) is one of the major active components. Its multiple pharmacological effects, such as antitumor, 3) antioxidation, 4) immunomodulation 5,6) and especially hepatoprotection against chemical or immune hepatic damage, 4,7) have been demonstrated in many animal models in vivo and in vitro. However, the accurate protective mechanism of GLPS on the liver damage is still unknown.Cytochrome P450 (P450) monooxygenase superfamily is the most important phase I metabolic enzyme system in liver. P450 is not only responsible for the oxidative metabolism of numerous exogenous compounds and endogenous hormones, but also plays a critical role involving in the activation of various chemical toxicant and procarcinogen. 8) There are researches which have confirmed that the expressions and activities of some P450 isoenzymes may be down-regulated under the inflammatory or infecting condition, and then resulting in change of the metabolic capability of the enzymes.9) However, whether P450 down-regulation is a homeostatic mechanism or a pathophysiological phenomenon has not been elucidated. On the other hand, because G. lucidum is currently popularly used as self-medication in East Asia, 1) thus, it is needed to be investigated that whether GLPS influences P450 metabolic activity.Bacillus Calmette Guérin (BCG), a live attenuated Mycobacterium bovis, is clinically used as a preventing vaccine for tuberculosis or therapeutic regimens for bladder cancer.10) On the other hand, some cases of disseminated BCG infection have been proven to induce granulomatous hepatitis, sepsis and multiple organ failure in these patients.11) Several animal experiments have confirmed that BCG infection could induce the immune hepatic injury and production of inflammatory cytokines, active free radicals and nitric oxide (NO). 12) Moreover, it was reported that microsomal P450 content and activity were suppressed by NO from inducible nitric oxide synthase (iNOS) during BCG infection in rodent liver.13) Therefore, the pharmacokinetics of P450 metabolized substrates may be changed by BCG in clinical patients, leading to enhancement of the therapeutic or adverse effects of drugs.In our previous experiment, it has been observed that GLPS inhibits iNOS expression or NO production, and mitigates immune liver injury induced by BCG in mice in vivo and in vitro.7) The purpose of the present study was to investigate the effect of GLPS on the metabolic activities of three P450 isoenzymes including CYP2E1, CYP1A2 and CYP3A, which are abundantly expressed in liver, and further to evaluate whether GLPS modulating P450 activity...

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“…The evidence of Mycobacterium bovis by DNArRNA hybridization strengthens the temporal relationship between BCG instillations and kidney-lung impairment despite the unusual delayed onset complications since generally occurring a few weeks after the last instillation [5][6][7]. Some authors stratified into early-and late-presentation disease [10]. The first one (within 3 months) could be result from systemic infection with proliferation of the organisms causing generalized granulomatous response by repeated instillations.…”

Section: Discussionmentioning

confidence: 84%

Late and Reversible Kidney-Lung Failure after Intra-Bladder BCG Therapy

Mat¹,

Kada²,

Philippart³

et al. 2013

OJNeph

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We observed a 76-year-old man who presented "acute kidney-lung failure" 9 months after intravesical Bacillus Calmette-Guérin (BCG) adjuvant treatment for a T1 bladder cancer. He had inflammatory infiltration on chest radiography and required dialysis for acute renal failure. A percutaneous renal biopsy was performed and revealed tubulointerstitial nephritis with a moderate eosinophilic infiltrate without granulomatous lesion. After a few days, an open lung biopsy was also done due to respiratory deterioration. The anatomopathologic specimen demonstrated moderate fibrosis with lympho-neutrophilic infiltration and few aspecific granulomatous lesions without caseous necrosis. Sarcoïdosis was suspected and high dose oral methylprednisolone was started. Three weeks later, Mycobacterium bovis was identified by Polymerase Chain Reaction on open lung biopsy. He responded well to steroids and tuberculostatic tri-therapy. After one month of immunosuppressive treatment, renal function was resolved and hemodialysis could be discontinued. Despite the frequent use of adjuvant BCG immunotherapy, systemic complications such as hepatitis, pneumonitis, spondylodiscitis or multiorgan failure are rare (<1%). Hematogenous dissemination which occurs a few weeks after traumatic instillations is usually suspected but not demonstrated because of absence of mycobacterium in histological specimen. Our case differs from those previously reported by the simultaneous presence of acid-fast bacilli highlighted on lung samples. We discuss the pathophysiology of BCG complications, the use of prophylactic or therapeutic treatment and recommend guidelines to prevent such complications.

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Spectrum of Bacille Calmette‐Guerin (BCG) Infection after Intravesical BCG Immunotherapy

Cited by 181 publications

References 45 publications

Bone and joint tuberculosis

Bone and joint tuberculosis

Effects of Ganoderma lucidum Polysaccharide on CYP2E1, CYP1A2 and CYP3A Activities in BCG-Immune Hepatic Injury in Rats

Late and Reversible Kidney-Lung Failure after Intra-Bladder BCG Therapy

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