Epidemiologic characteristics differ from those of pulmonary tuberculosis, clinical manifestations are variable, and diagnosis may be challenging. Bacillus calmetteguerin vaccine related lymphadenitis in children. The incidence of lymphadenitis due to bcg vaccination has been reported as 0. Bcg lymphadenitis 4 toxoplasma lymphadenitis piringerkuchinka lymphadenopathy 5 lepra. Although bcg lymphadenitis is a well recognised condition, it is not commonly seen in uk district general hospitals. We report here a series of children with bcg adenitis with a view to recognise and manage this condition. The treatment of suppurative bcg adenitis is needle aspiration.
Children with ntm lymphadenitis usually present with painless unilateral cervical or facial preauricular or cheek swelling. Two forms of bcg lymphadenitis can be recognised in its natural coursesimple or nonsuppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative bcg lymphadenitis distinguished by the development of fluctuations in the swelling, with erythema and. On a prolonged culture, bacille calmetteguerin was grown that was resistant to isoniazid but sensitive to ciprofloxacin, ethambutol, and rifampicin. Post vaccination bacille calmetteguerin infection occurs in 1% of infants, although swelling usually subsides braz j med biol res 2004. Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis tb. Two forms of bcg lymphadenitis can be recognised in its natural coursesimple or nonsuppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative. The flowing features are in favor of regional bcg related lymphadenitis rather than other pathology 14, 15, 16. Treatment of bcg lymphadenitis remains controversial. Bcg lymphadenitis with thanks to dr mujahid hassan.
Suppurative lymphadenitis may also develop abruptly within 24 months of immunization. Management of bacillus calmetteguerin lymphadenitis. Bcg vaccination can cause a false positive mantoux test, although a very highgrade reading is usually due to active disease. We report here a series of children with bcg adenitis with a. Bcg lymphadenitis is the most common complication of bcg vaccination. Bcg vaccine can be administered after birth intradermally. Abstract without culture, differentiation of bacille calmette. The relevance of this case is the youngest case report with this reaction. Lymph nodes are small, ovoid nodules normally ranging in size from a few millimeters to 2 cm. It cannot be differentiated from tubercular lymphadenitis on histopathology. Although the vaccine is safe, its administration can result in complications such as bcg adenitis.
Although earlier resolution is achieved and parents. Lymphadenitis is the most common complication of bcg vaccination, and is of two types suppurative and nonsuppurative. Caseating regional lymphadenitis complicating bcg vaccination. Upon failure of aspiration, surgical excision is indicated 2. Suppurative supraclavicular bacille calmetteguerine lymphadenitis a case report, awareness and management options us udgaonkar 1, ss patil 1, vb rekha 2, s shah 1 1 department of microbiology,bharati vidyapeeth deemed university, medical college and hospital, sangli, maharashtra, india 2 department of public health and veterinary public health and epidemiology, rajiv gandhi institute of. The term bcg lymphadenitis applies when lymph nodes have become large enough to be easily palpable and a cause of concern for the parents, likely with a diameter greater than or equal to 1 cm. Two forms of bcg lymphadenitis can be recognised in its natural coursesimple or nonsuppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative bcg lymphadenitis distinguished by the development of fluctuations in the swelling, with. Suppurative supraclavicular bacille calmetteguerine lymphadenitis. Kualu lumpur abstract fiftynine cases of tuberculous cervical lymphadenitis were analysed histologically. In this situation, needle aspiration is recommended. In our study, the most common region of pathology was the left.
Intradermal injection local multiplication of vaccine transport to lymphatics via lymph glands haematogenous dissemination of bcg. Current diagnosis and management of peripheral tuberculous. Bcg adenitisneed for increased awareness europe pmc. The risk of caseating regional lymphadenitis complicating bcg vaccination has not received much attention recently.
Ntm adenitis is determined by clinical presentation, tuberculin skin test purified protein derivative, mycobacterial culture and, to a lesser extent, histology and imaging. Immunocompromised individuals may develop disseminated bcg infection, with a poor prognosis. Lymphadenitis is the most common complication of the bcg vaccine. Follicular hyperplasia, prominence of postcapillary venules, increased number of immunoblasts, plasma cells and histiocytes and fibrosis.
Experience at kfh hospital albaha, ksa muhammad sharif, esamelaminel siddig. The primary function of lymph nodes is to filter out microorganisms and abnormal cells. Histopathology of the abscess walls and lymph nodes of all 6 infants showed the presence of tubercles with caseous necrosis, epithe lioid cells, and langhans. The most controversial aspect of bcg is the variable efficacy found in different clinical trials, which appears to. Characterization of the soviet bcg vaccine and the. The characteristic morphological element is the tuberculous granuloma caseating tubercule. This prospective study was done in rafha central hospital, over 1.
We present a case series of 11 infants with suppurative bcg lymphadenitis. Effect of bcg vaccination on childhood tuberculous meningitis and. Suppurative or non suppurative bcg regional lymphadenitis is present in basis of strain, dosage, age at immunization and technique in application of the vaccine. Bacille calmetteguerin bcg lymphadenitis is the most common complication of bcg vaccination. In situations where epidemiological studies are carried out and this possibility specifically looked for,3 there is little difficulty in recognising the condition. The incidence of disseminated bcg disease has previously been reported to be 0. Bcg adenitis may present at varied time interval after the vaccine administration. Pathologic findings for bacille calmetteguerin infections in. Bcg lymphadenitis is the most common complication associated with the bcg vaccine.
B global vaccine safety, immunization, vaccines and biologicals 20, avenue appia, ch1211 geneva 27 the vaccines the original strain of mycobacterium bovis bcg strain was developed in 1921 at the pasteur institute with attenuation through serial passage. Assistant professor, department of pathology, anjarakandy kannur medical. We report here a series of children with bcg adenitis with a view to recognise. On a prolonged culture, bacille calmette guerin was grown that was resistant to isoniazid but sensitive to ciprofloxacin, ethambutol, and rifampicin. There should be a positive history of bcg administration on the ipsilateral arm, 24 months prior, though this duration can range from 2 weeks to 24 months. It is a cause of concern to the parents and treatment dilemma for the treating doctor. They are distributed in clusters along the course of lymphatic vessels located throughout the body. Bacille calmetteguerin bcg vaccination for protection against tuberculosis has been in use for long. Reported rates of adenitis among bcg recipients vary widely, ranging from 0% to 17. Tuberculous lymphadenitis is a chronic specific granulomatous inflammation with caseation necrosis. Histopathology of lymph nodal tuberculosis university.
However, in the more usual circumstances when the attending. Some patients may develop scrofuloderma, which can persist for 612 months 1,2. Medical treatment with antituberculous drugs is not effective to treat bcg lymphadenitis, when the involved lymph nodes are around 3. It has incidence of 100 to cases per million vaccinations1. Histopathology of lymph nodes in the early phase, follicular hyperplasia and. Granulomatous lymphangitis masquerading as relapsed. Tuberculous lymphadenitis in the cervical region is known as scrofula. Pdf bcg adenitisneed for increased awareness researchgate. Pdf bacille calmetteguerin bcg vaccination for protection against. Department of pathology, seth gsmc and kemh, mumbai, maharashtra, india. Bcg vaccine ssi 1 new zealand data sheet bcg vaccine ssi. It involves multiple organs, including pulmonary hilar lymph nodes, lungs, eyes, and skin 4. A limited number of untoward reactions in children after bcg vaccination in the soviet union are described.
Lymphadenitis is the inflammation or enlargement of a lymph node. Thirty two patients were enrolled after informed consent. Benign regional adenitis is the most common complication, especially in the younger age group. The term regional lymphadenitis may apply when there is a bcg vaccine at one arm with ipsilateral regional. Bcg lymphadenitis archives of disease in childhood. Fineneedle aspiration is the rapid, safe, and costeffective method for diagnosis as well as the management of bcg lymphadenitis. Distant and disseminated diseases including osteomyelitis, bacteremia, 1 trunz bb, fine p, dye c. Tb is responsible for up to 43 percent of peripheral lymphadenopathy in the developing world. Role of needle aspiration and surgical excision in. In this clinical video we will discuss a case of bcg adenitis. This syndrome can also be caused by nontuberculous mycobacteria. In cases of impaired immunity, vaccination can cause disseminated bcg. We observed an increase in the rate of bcg lymphadenitis that coincided with the introduction of a new strain of bcg vaccine. Bacille calmetteguerin bcg vaccination is part of the expanded program of vaccination in saudi arabia.
Vaccination, bcg vaccine, lymph node, lymphadenitis introduction bacillus calmetteguerin bcg is a live attenuated. Suppurative supraclavicular bacille calmetteguerine lymphadenitis a case report, awareness and management options us udgaonkar 1, ss patil 1, vb rekha 2, s shah 1 1 department of microbiology,bharati vidyapeeth deemed university, medical college and hospital, sangli, maharashtra, india 2 department of public health and veterinary public health and epidemiology, rajiv gandhi. Nonsuppurative lymphadenitis includes tuberculosis and bacille calmetteguerin bcg lymphadenitis 4, 5. Product name bcg vaccine ssi mycobacterium bovis bcg bacillus calmetteguerin, danish strain 31, live attenuated, 28 x 105 cfu powder and solvent for suspension for injection. Journal of biological standardization 1977 5, 149153 characterization of the soviet bcg vaccine and the occurrence of lymphadenitis in primarily vaccinated children1 t.
A total of 145 patients with bcg lymphadenitis presented between. Sarcoidosis is a disease of unknown origin, with a global incidence of cases 8100 000. Bcg adenitis is defined as the development of ipsilateral. Bcg adenitis, the enlargement of regional lymph nodes after bcg vaccination is one of the common complications seen.
199 1029 257 337 1037 1267 630 1270 13 346 711 29 892 803 857 861 1077 1349 294 1038 1195 436 651 905 416 1227 1530 174 674 934 1141 1104 110 170 1092 726 367