Bacille Calmette-Guérin Lymphadenitis Research Articles

Regional Lymphadenitis Related to Bacille Calmette–Guerin Vaccination: A Case Series from a Tertiary Care Childrens’ Hospital

Background: Immunization with Bacille Calmette–Guerin (BCG) vaccine, used worldwide for years, for the prevention of tuberculosis, rarely leads to complications like regional lymphadenitis. There is controversy regarding the management of BCG lymphadenitis. We share our experience regarding the management and course of this rare complication in nine infants. Clinical Description: Over a period of 24 months, 9 infants, who had received BCG vaccination after birth, presented to us between 1 and 3 months of age, with left-sided supraclavicular swellings. The infants were otherwise thriving well, with no constitutional symptoms. On examination, the infants were stable with normal systemic examination. Local examination revealed all the swellings to be supraclavicular lymphadenopathies, two of them being suppurative. Thus, the infants fulfilled the clinical criteria for BCG regional lymphadenitis. Management and Outcome: Fine-needle aspiration cytology from the swellings of all infants was consistent with BCG lymphadenitis. Two of the smears were positive for acid-fast bacilli. Besides percutaneous pus aspiration in two infants, no other intervention was done in any of the infants, and no antibiotics nor antitubercular treatment was administered. With observation and regular follow-up, the lymphadenopathies resolved over time in all the infants. Conclusion: This case series creates awareness regarding the benign, self-resolving nature of BCG regional lymphadenitis, which may be followed conservatively without any medical or surgical intervention.

An overview of the prevalence of BCG lymphadenitis among infants registered in consulter clinic for chest and respiratory diseases, Kirkuk, Iraq

Abstract Background: Bacille Calmette-Guérin (BCG) lymphadenitis is one of the uncommon complications of BCG vaccination among infants, as it may lead to many serious problems as fistula or disseminated infection. Objectives: The study aimed to show the distribution of BCG lymphadenitis among vaccinated infants along the past 5 years who were diagnosed and managed in tuberculosis (TB) center. Materials and Methods: An observational study was carried out including 22 infants of both sexes who had BCG lymphadenitis. The diagnosis was made either clinically or it used polymerase chain reaction to examine the suppression, and biopsy was applied for indicated cases. All cases were managed by anti-TB and no death was reported. Results: The results showed male predominance ratio of 2:1. Regarding the latent period between the time of vaccination and appearance of the symptoms; the highest number was between 1 and 2 months (45.5%) whereas the lowest was in the group of 7–9 months following vaccination (4.5%). The results also found high incidence rate of BCG lymphadenitis (1.5%), among the infants. The high occurrence of TB lymphadenitis in the study may indicate many reasons, the most frequent being the dose of the vaccine and the wrong technique. Conclusion: It was concluded from results of the study that it is necessary to follow-up infants, and check for the appearance of lymphadenitis and to inform parents to present the baby to the TB center as soon as possible if any complications were observed.

Bacille Calmette-Guérin vaccine induced lymphadenitis in infants and children masquerading with tubercular lymphadenitis at tertiary care hospital in North India

Background: Bacille calmette–guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis in 1921. It is a safe vaccine. However, there can be minor adverse reactions such as pain, swelling, and redness at local injection site. The lesser known severe adverse reactions such as lymphadenitis, BCG osteitis, and disseminated BCG infection can be present after BCG vaccination. Aims and Objectives: The aim of the study was to report the cases of BCG lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) after BCG vaccination in infants and children. Materials and Methods: All the infants and children (1 month–2 years) who presented with regional lymphadenopathy for FNAC after BCG vaccination were included in the study. Results: Total 21 patients with BCG lymphadenitis were recruited. In all the cases, the lymphadenitis involved ipsilateral left axillary lymph nodes. In three patient sites of involvement included the left supraclavicular lymph nodes and in other three patients left cervical lymph nodes along with left axillary lymph node. Sixteen patients had suppurative granulomatous lymphadenitis (SGLA) on FNAC and positive for Ziehl–Neelsen (ZN) staining for acid fast bacilli (AFB), while rest nine had non-suppurative granulomatous lymphadenitis (NSGLA) with negative for ZN staining for AFB. Conclusion: Early diagnosis of BCG lymphadenitis can help in proper management. Furthermore, it can prevent unnecessary anti tubercular treatment in children.

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

Bacille Calmette-Guerin (BCG) adenitis is a common complication of post-BCG vaccination. Awareness of this lesser known entity in fine-needle aspiration (FNA) is important to prevent misdiagnosis. This study described the clinical presentation, cytomorphological features and disease pattern in patients with BCG adenitis. We analyzed a series of 15 patients with BCG adenitis seen from July 2017 to July 2019. The detailed clinical and cytomorphology of these cases were studied. Age of presentation ranged from 3 to 12 months. Male to female ratio was 2.75:1. A total of four children were diagnosed with primary immunodeficiency. Three children had acyanotic heart disease. Most of the children had left axillary lymph node enlargement. Cytomorphology showed the presence of polymorphs (66.7%), histiocytic aggregates (80%) and reactive lymphoid population (60%). Epithelioid granulomas (26.7%) and giant cells (6.7%) were present. The necrotic background was present in all but one case. Ziehl-Neelsen stain for acid-fast bacilli was positive in all but two cases. A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for patients who are recently vaccinated. FNA cytology, combined with clinical correlation, is useful for diagnosis and management.

Investigation of adverse events following bacille Calmette-Guérin immunization using immunization safety surveillance system in Korea Centers for Disease Control and Prevention.

PurposeThe report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC.Materials and MethodsWe reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018.ResultsThere were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates.ConclusionThe AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.

Bacille Calmette–Guerin lymphadenitis in infants: A lesser known entity – Report of two cases

Bacille Calmette–Guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis (TB) in 1921. Intradermal BCG vaccine gives rise to classic primary complex that consists of a cutaneous nodule at the site of injection and subclinical involvement of the regional lymph nodes, which is self-limiting and requires no treatment. BCG lymphadenitis is the most common complication of BCG vaccination. Fine-needle aspiration is the rapid, safe, and cost-effective method for diagnosis as well as the management of BCG lymphadenitis. Awareness of this lesser known entity is important to prevent misdiagnosis. We report two cases of 2½ month and 6-month healthy male infants with left axillary lymphadenopathy following BCG vaccination. Fine-needle aspiration from both the cases revealed features of necrotizing granulomatous lymphadenitis with Ziehl-Neelsen stain for acid-fast bacilli being positive in 2nd case. Ipsilateral regional lymph node enlargement following BCG vaccination is considered as the most common complication, some progress to suppuration. Very rarely disseminated BCG infection may develop in immune-compromised individuals, resulting in a devastating outcome. Variable strategies have been applied in treating lymphadenitis related to BCG vaccine in the past decade, ranging from observation, antimycobacterial therapy, aspiration, incision, and drainage to lymph node surgical excision.

BCG lymphadenitis of a healthy infant

This is a case of a 2-month-old infant who had suppurative lymphadenitis at left axilla after Bacille Calmette Guérin (BCG) vaccination. She presented with a non-healing BCG wound and left axillary swelling associated with one-week fever at 2 months of age. Aspiration under general anaesthesia was done and pus sent for mycobacterium culture grew Mycobacterium tuberculosis complex. The patient improved without anti-tuberculosis treatment.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.283-285

Bacille Calmette-Guerin Lymphadenitis: A single center experience

To describe the clinical presentation, course and management of infants that presented with the diagnosis of lymphadenitis after Bacille Calmette-Guerin (BCG) vaccination. This is a descriptive study of 89 patients that were referred to the pediatric infectious disease clinic at King Hussein Medical Center in Jordan with regional lymphadenitis after BCG vaccination. The presentation, course and treatment options of these cases were discussed. The study was conducted between September 2006 and September 2007. Eighty-nine patients (47 males (53%) and 42 females (47%) were studied. All infants received the same type of vaccine used by our Ministry of Health, which is the Danish strain. Unilateral axillary lymph node enlargement was the most commonly seen (47%). Cervical lymph nodes were noted in 22 patients (25%) and supraclavicular lymphadenopathy was seen in 16 (18%). Sinus formation was seen in 16 (18%) patients. 27 cases (30%) had fluctuating lymph nodes. Four infants had disseminated infection. The majority (65%) of patients had their symptoms starting within the first 2 months after BCG vaccination. Forty-two (47%) infants had conservative observational management. Anti-tuberculosis medications were commenced in 27 (30%). Surgical excision was performed in 10 (11.5%) cases. All infants but one had complete recovery by the end of the study period. BCG lymphadenitis is a potential complication that necessitates an early recognition and implementing appropriate treatment protocols. Complete healing of suppurative lymphadenitis after BCG vaccine can be achieved using different treatment protocols.

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

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.

Neonatal hyperimmune T-cell reaction mimicking T-cell non-Hodgkin's lymphoma following BCG and hepatitis B co-vaccination

We describe a case of a 2-week-old male infant who presented with a rapidly enlarging inguinal mass after having received both the bacille Calmette-Guérin (BCG) and hepatitis B vaccines at birth. The clinical picture raised suspicion of a neoplasm, and an excision biopsy was performed. It showed complete effacement of the lymph node architecture by a diffuse proliferation of monomorphic, mitotically active, and medium-sized T-cell blasts with strong expression of CD99. Coalescent necrotizing granulomas were also seen. The lymph node culture was negative for BCG. Upon expert review and additional molecular diagnostics, the initial pathological diagnosis of lymphoblastic T-cell lymphoma was changed to ectopic BCG lymphadenitis and hyperimmune post-vaccinal reaction. The atypical T-cell proliferation was most likely a result of the adjuvant effects of the co-administered vaccines. Post-vaccinal reactions usually involve the injection site or result in localized lymph node enlargements in the areas draining the inoculation site. This case highlights the importance of the clinical context for accurate interpretation of the pathological findings. In the setting of post-vaccinal lymphadenopathy, a biopsy is rarely needed but, when performed, should be interpreted with great caution.

Lymphadenitis in an 18-Month-Old Traveler to Mexico

Lymphadenitis in an 18-Month-Old Traveler to Mexico

Is BCG vaccine innocent?

Four patients admitted to the Hacettepe University Department of Pediatric Surgery between 1987 and 1995, two with Bacille Calmette-Guérin (BCG) lymphadenitis and two with multisystem postvaccination tuberculosis (MPT), are presented. The hospital records and records of the Ministery of Health Tuberculosis Control Department were evaluated to determine the complications of BCG vaccine. The most common complication was lymphadenitis with or without suppuration (0.3 per thousand - 3 per thousand). Surgical intervention was required in two BCG lymphadenitis cases and two cases of MPT. Involved lymph nodes were excised in two lymphadenitis cases. Colostomy and percutaneous nephrostomy was performed in the first case of MPT in addition to triple antituberculous drug therapy. Although BCG lymphadenitis is self limited, chronically discharging nodes and tumor-like lymphadenopathy masses need to be excised. On the other hand, MPT has a silent nature with resistance to antituberculous drug therapy. Surgical intervention may be required, directed to the involved systems.

Regional lymphadenitis following BCG vaccination

A cluster of cases of lymphadenitis occurred in Dublin following vaccination with a newly introduced Copenhagen 1331 strain of Bacille Calmette-Guerin (BCG) vaccine during 1989. All cases of BCG lymphadenitis presenting to paediatric surgical clinics over an 11-year period were reviewed to determine the optimum treatment for this problem. Seventeen patients are included, 16 of whom received vaccine in the newborn period; 1 received BCG at 8 months. Nine were treated by initial operation, 6 with antituberculous drugs, and 2 were observed without specific therapy. All but 1 of the medically treated patients and both patients who received observation only required operation for failure to resolve or progression of disease. The best results were obtained with excision and primary closure. We conclude that although sponteneous resolution occurs in a majority of all cases of BCG lymphadenitis in infants, in those patients with more severe disease who require surgical referral, a short trial of anti-microbial therapy is indicated. Patients who fail to improve or develop complications are then best treated by surgical excision of the involved nodes.