BCG Lymphadenitis Research Articles

The spectrum of cytological findings in patients with BCG lymphadenitis: A series of 13 cases

ContextBacillus Calmette–Guérin (BCG) vaccine has been used to prevent tuberculosis and/or its severe complications for long. BCG lymphadenitis is a common complication of the vaccine, which is sometimes subjected to cytological examination.The aim of the study is to describe the cytological findings of BCG lymphadenitis. SettingsThe study was conducted in a tertiary care hospital in the western part of India from January 2021 to December 2022. DesignThe study was performed on archived material of all patients who were referred to the fine needle aspiration clinic for cytology examination. Clinical and pathological data of cases were retrieved, and cases of BCG lymphadenitis were selected in the study based on these data. Slides of cases were retrieved, and cytological findings were studied. Materials and methodsPapanicolaou, Giemsa, and Hematoxylin & eosin-stained smears, as well as Ziehl-Neelson stain (Z.N. stain) smears of all BCG lymphadenitis cases, were retrieved. Cases were reviewed for individual cytological features and overall cytological diagnostic categories. Z.N. stain smears were evaluated for acid-fast bacilli. Results and conclusionsDiagnostic categories observed in BCG lymphadenitis include suppurative lymphadenitis/abscess (15 %), necrotizing lymphadenitis (23 %), necrotizing granulomatous lymphadenitis (46 %), suppurative granulomatous lymphadenitis (8 %), non-necrotizing granulomatous lymphadenitis (8 %). Acid-fast bacilli were detected by Z.N. stain in 8 cases (62 %).The cytological findings of BCG lymphadenitis closely overlap with those of tuberculous lymphadenitis. So, clinical context is very important while reporting isolated axillary lymphadenopathy, specifically in recently vaccinated infants, to avoid misdiagnosis as tuberculous lymphadenitis.

Demographic, clinical, immunological, and molecular features of iranian national cohort of patients with defect in DCLRE1C gene

BackgroundDCLRE1C gene mutation leads to Artemis deficiency, a severe form of combined immunodeficiency (SCID). Impaired DNA repair and block in early adaptive immunity maturation results in T-B-NK+ immunodeficiency associated with radiosensitivity. Recurrent infections early in life are the main characteristic of Artemis patients.MethodAmong 5373 registered patients, 9 Iranian patients (33.3% female) with confirmed DCLRE1C mutation were identified since 1999–2022. The demographic, clinical, immunological and genetic features were collected through retrospective investigation of medical records and using next generation sequencing.ResultsSeven patients were born in a consanguineous family (77.8%). The median age of onset was 6.0 (5.0–17.0) months. Severe combined immunodeficiency (SCID) was clinically detected at a median (IQR) age of 7.0 (6.0–20.5) months, following a median diagnostic delay of 2.0 (1.0–3.5) months The most typical first presentation was pneumonia (44.4%) and otitis media (3.33%), followed by BCG lymphadenitis (22.2%) and gastroenteritis (11.1%). The most prevalent manifestations were respiratory tract infections (including otitis media) (66.6%) and chronic diarrhea (66.6%). In addition, juvenile idiopathic arthritis (P5) and celiac disease and idiopathic thrombocytopenic purpura (P9) as autoimmune disorders were reported in 2 patients. All patients had reduced B CD19+ and CD4+ cell counts. IgA deficiency occurred in 77.8% of individuals.ConclusionRecurrent infections particulary respiratory tract infection and chronic diarrhea during the first months of life in patients born to consanguineous parents should raise the suspicion for inborn errors of immunity, even in the presence of normal growth and development.

Hematological and biochemical features with tuberculosis and bacterial lymphadenitis in children

Objective — to improve approaches to differential diagnosis of lymphadenitis by identifying features of hematological and biochemical parameters of blood of children with nonspecific bacterial and specific tuberculous lymphadenitis.
 Materials and methods. Under our supervision were 45 children aged 1 to 5 years with an increase in lymph nodes (LN), who were treated in the surgical department of the Odessa Regional Children’s Clinical Hospital for the period from 2017 to 2018. Patients were assessed for general condition and affected lymph node lesions, as well as blood sampling for general and biochemical studies. Additionally, the calculation of integrated hematological indices of immunological tolerance of the organism was performed, namely the index of neutrophils to lymphocytes ratio (NLR); lymphocyte to monocyte ratio (LMR); neutrophil to monocyte ratio (NMR); lymphocyte to eosinophil ratio (LER). For comparison with the norm used the data of these indicators, established in healthy children.
 Results and discussion. All patients were divided into 2 clinical groups. The first group (СG-1) included 25 children with lymphadenitis caused by BCG vaccination, the second (СG-2) — 20 patients with acute purulent lymphadenitis. The study found that the condition of most children (75 %) of the second group was more severe compared with patients with CG-1, which was manifested by more pronounced manifestations of intoxication and local condition of the affected LN.Evaluation of a general blood test showed that the average number of leukocytes with specific lymphadenitis in most (80.8 %) patients was within normal limits, with purulent; on the contrary, in 71.4 % of children there was a tendency to increase. The calculations of hematological indices revealed a decrease in NLR, and, with BCG lymphadenitis, it decreased by half (to 0.96) compared with bacterial lymphade­nit (to 1.88), which indicates an increase in specific immunological reactivity in children of CG-1. ISNM in most patients with lymphadenit remained low throughout the course of the disease. This indicates the timely activation of the macrophage defense system of the body. LMR with tuberculous lymphadenit grew, while with bacterial lymphadenit, on the contrary, it decreased by half, which indicates earlier mobilization of lymphocytes as an effector immunity in children with BCG lymphadenitis. LER in all forms of the disease tended to increase, which indicates the predominance of a delayed-type hypersensitivity reaction in children of both groups.Analysis of blood biochemical parameters in patients of both clinical groups did not reveal clear differences in children with bacterial and tuberculous lymphadenitis.
 Conclusions. At specific defeat of LN unlike nonspecific, the clinical and laboratory picture with lack of expressive leukocytes reaction is noted. Determining the indices of the ratio of blood leukocytes makes it possible to more deeply assess the level of immunological reactivity and the general condition of the child, which increases the informative value of clinical blood tests. Analysis of blood biochemical parameters in patients with specific and nonspecific lymphadenitis, although it has no specific differential diagnostic value, however, is an important component of assessing the quality of treatment and the patient’s condition as a whole.

Cytomorphological spectrum of enlarged lymph nodes

Introduction: Fine Needle Aspiration cytology (FNAC) is a simple, cost effective, rapid and reliable technique which can be used as a routine outpatient department (OPD) procedure and first line of investigation in diagnosing a variety of superficial and deep lesions. Enlarged lymph nodes is one of the common complaint in the surgical OPD’s. Lymphadenopathy is of great clinical significance and the underlying cause may range from a treatable infectious etiology to malignant neoplasms. Any lymph node greater than 1 cm can be aspirated with least complications to arrive at the diagnosis. Objectives of Study: To study the cytomorphology of enlarged lymph nodes to aid in diagnosis and treatment. Materials and Methods: This is a retrospective study with 261 cases of lymph node lesions.Clinical data and FNAC of lymph node cytology reports were obtained from the archives during the period of January 2019-December 2019(1 year study). Results: In this study a total of 261 cases were examined. The age group of patients ranged from 4yrs - 72yrs. Out of 261 cases, 116 cases were reported as Caseating granulomatous lymphadenitis, followed by 99 cases as Reactive lymphadenitis, 25 cases as Suppurative granulomatous lymphadenitis, 15 cases as Suppurative lymphadenitis, 3 cases as Metastatic squamous cell carcinoma, 2 cases as Metastatic adenocarcinoma, 2 cases as Non Hodgkin lymphoma, 1 case as Hodgkin lymphoma, 1 case as Kikuchi lymphadenitis, 1 case as BCG lymphadenitis. Conclusion: FNAC Lymph node emphasizes on diagnosing inflammatory treatable conditions and malignant neoplastic conditions, there by guiding the patients for early intervention. Keywords: Lymph node cytology, Caseating lymphadenitis.

BCG lymphadenitis: a potential complication of immune reconstitution following haematopoietic stem cell transplant

Case reportAn MHC class II deficient 2-year-old boy presented with fever and an enlarging left neck mass 100 days post allogeneic haematopoietic stem cell transplant (HSCT). Fever persisted despite treatment...

Primary immunodeficiency masks: A clinical case of vaccine-associated paralytic poliomyelitis

Human inborn immune-related errors comprise a heterogeneous group of rare genetically determined diseases of the immune system caused by loss or gain of function mutations altering relevant protein functions. The 2019 International Union of Immunological Societies recently proposed the classification for such pathologies now comprising 406 distinct disorders with 430 different gene defects. Predominantly antibody deficiencies represent most common group of human inborn immune-related errors, which diagnostics poses uneasy challenge for general practitioner due to a broad range of their clinical manifestations, such as infection, allergy, autoimmunity and malignancy. In addition, patients with human immune-related inborn errors may develop a vaccine-associated disease after administering live vaccines in accordance with the Russia-wide National Vaccine Schedule. Most common among vaccine-associated diseases are vaccine-associated paralytic poliomyelitis, vaccine-associated encephalitis (1 case per 1 000 000 doses of measles, rubella, varicella vaccine), vaccine-associated meningitis (1 case per 250 000 – 500 000 doses of mumps vaccine) as well as adverse effects related to BCG immunization: local (infiltration, cold abscess – 8.6 case per 100,000 vaccinated patients) and disseminated complications (BCG lymphadenitis – 15.5 case per 100 000 vaccinated patients, BCG osteitis – 3.5 case per 100 000 vaccinated patients). Vaccine-associated paralytic poliomyelitis in vaccinated patients occurs after the first, second and rarely third oral polio vaccine dose inoculation. Incidence rate for vaccineassociated paralytic polio after 1 and 3 oral vaccine inoculation ranges from 1 case per 700 000 vaccine doses to 1 case per 3 500 000, respectively. Vaccine-associated paralytic poliomyelitis mainly emerges due to inborn mutations related to humoral immunity after primary vaccination with oral polio vaccine or close contact of unvaccinated patients with subjects vaccinated with oral polio vaccine. Here, we describe a clinical case of vaccine-associated paralytic poliomyelitis in patient with primary immunodeficiency. Our is aimed at emphasizing importance of immunological alertness with regard to detecting primary immunodeficiencies and timely apply a replacement therapy prior to verifying type of immunodeficiency.

Immune status of children with complications of BCG/BCG-M vaccination

The objective of the study: to analyze certain parameters of immune status in children with complications after BCG/BCG-M vaccination.Subjects and methods. The immune status parameters were tested in 24 children who developed complications after TB vaccination such as BCG-ostitis, BCG-lymphadenitis. Lymphocyte population was assessed using flow cytofluorometry by Cytomics FC 500 (Bekman Coulter).The serum level of immunoglobulins IgG, IgA, IgM was tested by immunodiffusion in Mancini agar. The leukocyte phagocytic activity was tested using flow cytofluorometry (Cytofluorimeter Cytomics FC 500) with FITC-labeled staphylococcus.Results. Of the 24 children with BCG lymphadenitis or BCG ostitis, 22 (92%; 95% CI 73-99%) had abnormality in immune status.Of the 24 children, 7 had low CD3+count, while 9 had an elevated level of CD3+. The level of СD4+was low in 4 children and elevated in 15 pediatric patients. CD8+count was low in 21 children (88%; 95% CI 72-97%). 11 children had low СD16+number, and it was elevated in 2 children. In 10 children, low level of СD16+was combined with low level of CD8+. 10 children had low СD19+number, and it was elevated in 4 children. The leukocyte phagocytic index drastically decreased (down to 37%) only in 1 child, and in 23 children, it varied from 60 to 90%.IgG level was low in 13 (54%), and elevated in 2 (8%) children. IgA level was low in 6 (25%), and it was not detected at all in 8 (33.3%) children. IgM level was elevated in 4/24 (17%) children, while it was low in 1/24 (4%). In 8 children with no IgA detected, the IgG level was low in 5 of them, 3 had a normal level, and IgM level was elevated in 2 children, 6 children had a normal level of IgM. With IgA completely absent, 1 child had the normal level of IgG and IgM.

Children with lymphadenitis associated with Bacillus Calmette-Guérin (BCG) vaccination do not experience more infections when compared with BCG-vaccinated children without lymphadenitis: a three years paired-cohort in Mexico.

Vaccination against tuberculosis with live-attenuated Bacillus Calmette-Guérin (BCG) is widely used even though its effectiveness is controversial. BCG-lymphadenitis (BCG-LA) is its most common complication. Some studies have proposed that BCG-LA can be associated with primary immunodeficiencies (PIs). This study's aim is to see whether patients who developed BCG-LA (named as 'LA') developed more infections than BCG-vaccinated children without BCG-LA (named as 'NON-LA'). From January 2009 to April 2014, 31 LA children were seen at the outpatient clinic of the General Hospital of Tijuana, Mexico. Among them, 22 (70.97%), 5 (16.13%) and 4 (12.9%) had axillary, supraclavicular, or both BCG-LA, respectively. No treatment was given and complications were not seen. Per LA subject, a NON-LA not >1 month of age difference and same gender was paired and followed for 3 years to look for ambulatory infections (AINFs), acute otitis media (AOM) and hospitalizations. Surveillance per patient was performed by phone monthly, and they were seen at the clinic every 4 months. All patients were HIV-negative and had no family history of PI. Statistical analyses used were relative risk (RR) with confidence intervals (CI), t test for independent variables and z test. In total 62 subjects were enrolled: 31 LA paired with 31 NON-LA. Between them, there were no differences in age, day care attendance and breastfeeding. There were no differences in the total number of AINF per patient (LA: 18.61 avg. ± 5.03 SD versus NON-LA: 18.19 avg. ± 4.17 SD, RR = 1.06, 95% CI = 0.33-0.66), AOM total episodes (LA: 30 versus NON-LA: 26, RR = 0.87, 95% CI = 0.31-0.68) and hospitalizations (LA: 5 versus NON-LA: 4, RR = 1, 95% CI = 0.25-0.74). This cohort strongly suggests that BCG-LA in healthy children is not associated with more episodes of AINF and hospitalizations, when paired and compared with children BCG-vaccinated without BCG-LA.

Suppurative BCG Lymphadenitis in an Infant

Suppurative BCG Lymphadenitis in an Infant

BCG-SSI® vaccine-associated lymphadenitis: Incidence and management

Background and objectiveThere is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI® vaccine and to evaluate the treatment results. Material and methodsThe study included 194 patients. All patients had received the BCG-SSI® vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment – the affected lymph node extirpation. ResultsThe mean age of the patients was 5.12±0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11%±0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n=193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71±0.18 days. ConclusionsThe incidence of BCG-SSI® vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.

Surgical management of post BCG vaccine lymphadenitis, comparative retrospective study

Introduction: Adverse reactions following BCG vaccination are uncommon, with an estimated prevalence of 0.4 per 1000 vaccines. The options for surgical management of post BCG vaccine suppurative lymphadenitis are incision and drainage, total excision, or simple needle aspiration. The aim of the study is to compare the outcome of surgical treatment of suppurative post BCG lymphadenitis using simple needle aspiration versus primary excision. Patients and methods: A retrospective file review was done for all children who presented, with a diagnosis of post BCG vaccine suppurative lymphadenitis (axillary and/ or supraclavicular), to the pediatric surgery clinic in two tertiary pediatric surgery centers during the period from January 2007 to January 2013. Results: The study population included 91 patients, 38 in Group 1 versus 53 in Group 2. There were 60 males and 31 females. Two groups were identified in the study, according to the type of management at the initial presentation, Group 1 who were managed with simple needle aspiration and Group 2 who were managed with primary surgical excision. Patients who received antituberculous treatment were excluded from the study. Conclusion: Primary surgical excision for post BCG suppurative lymphadenitis showed better outcomes than needle aspiration in the current study population.

Supraclavicular BCG Lymphadenitis Noted at 21 Months after BCG Vaccination Confirmed by a Molecular Method

Supraclavicular BCG Lymphadenitis Noted at 21 Months after BCG Vaccination Confirmed by a Molecular Method

Post-Bacillus Calmette-Guérin lymphadenitis in Egyptian children

Background / purpose Intradermal vaccinations with Bacillus Calmette-Gue´ rin (BCG) give rise to a classic primary complex that consists of a cutaneous nodule at the site of injection and swelling of the regional lymph nodes. This study was performed to evaluate the clinical course of BCG lymphadenitis in relation to different management strategies and to assess the microbial resistance to an Indian BCG strain causing an Egyptian outbreak. Patients and methods Prospective analytical follow-up of 152 patients with BCG lymphadenitis attending the Mansoura University Children Hospital between March 2010 and May 2011; of these, eight patients who had lymph nodes that were B1 cm in size (group A =5.3%) were managed with regular follow-up, 86 patients who presented with lymph nodes larger than 1–3 cm in size (group B=56.6%) received isoniazid and rifampicin for 6 months, and 58 patients who presented with lymph nodes larger than 3 cm in size or with BCG abscess or sinus (group C=38.1%) were subjected to early surgical excision. Results Of the 152 patients, the male-to-female ratio was 1.7 : 1. The mean age was 5.97 months. The site of the lesions was the left axilla (132 patients, 86.84%), left supraclavicular (10 patients, 6.58%), cervical (four patients, 2.63%), and left axillary and supraclavicular (six patients, 3.95%). BCG lymphadenitis regressed spontaneously in four patients of group A (50%), 24 patients of group B showed an improvement in 6–9 months(27.9%), and progressive enlargement (44 cases, 51.2%) and development of BCG abscesses (18 cases, 20.9%) occurred in the rest of the patients who needed surgical treatment. For group C, surgical excision was performed from the start. Pathological examination was performed for all excised lymph nodes (124 patients, 81.6%) and revealed granulomas with extensive caseation necrosis. Microbiological examination was performed in all cases and revealed acid fast bacilli in 100 samples (80.6%) that were resistant to isoniazid, pyrazinamide, and streptomycin but sensitive to rifampicin only in 25 samples. Conclusion As antituberculous therapy was found to be ineffective in the management of BCG lymphadenitis, we recommend a careful choice of BCG vaccines to avoid multidrug-resistant strains, early surgical excision of lymph nodes larger than 3 cm and lymphadenopathy complicated with abscess or sinus formation, and regular follow-up of smaller lymph nodes. Keywords : Bacillus Calmette-Gue´ rinlymphadenitis, outbreak, tuberculosis, vaccination

Interleukin‐12/‐23 receptor beta 1 deficiency in an infant with draining BCG lymphadenitis

Interleukin‐12/‐23 receptor beta 1 deficiency in an infant with draining BCG lymphadenitis

Anesthetic management in a pediatric patient with infantile phase Prader-Willi Syndrome: A case report.

Prader-Willi syndrome is a genetic disorder characterized by infantile hypotonia, childhood obesity, characteristic facial appearance, mental retardation, hypogonadism and short stature. It is described as a 2-stage disorder with an infantile hypotonic phase, followed by a childhood obese phase. The first phase, during the newborn and infancy period, is characterized by marked hypotonia, poor sucking, swallowing, coughing, crying, and episodes of asphyxia. Since these signs of poor strength cause poor reversal in the postoperative period, muscle relaxants should be used cautiously, especially in patients in the first phase of the syndrome. We experienced the anesthetic management of a 5-month-old female patient with Prader-Willi syndrome under general anesthesia, without muscle relaxant for excision of BCG lymphadenitis and a preauricular mass.

Clinical Features of BCG Lymphadenitis

Clinical Features of BCG Lymphadenitis

Surgical management of BCG vaccine-induced regional axillary lymphadenitis in HIV-infected children.

There are as yet no clear surgical guidelines for the management of BCG vaccine-induced regional axillary lymphadenopathy. The aim of this study was to evaluate the management of the condition and to suggest possible management strategies. A retrospective study was undertaken of 23 cases of suspected ipsilateral BCG adenitis following neonatal BCG inoculation (2001 - 2004). Diagnosis of a BCG infection was confirmed by culture and/or gastric washout. The age of the patient and mode of presentation, imaging findings, and results of tuberculin skin testing (Mantoux test) were documented. Because of a change in management policy the first group of patients treated by primary surgery were compared with those treated by fine-needle aspiration (FNA). The influence of HIV status on outcome was assessed. Surgical complications and outcome were analysed. Twenty-three children under 13 years of age (mean age 8.8 months, male/female ratio 1.9:1) were evaluated. Eighteen patients tested positive for HIV and 5 were HIV-negative. A positive culture for BCG bacillus was identified in 19 cases (83%) - by FNA (N=13, 68%), on pus swab (N=3, 16%), at surgery (N=1, 5%), and by gastric washing (N=2, 11%). Three HIV-negative children had granulomas on histological examination without a positive culture. Forty-five per cent of the 11 patients treated early in the study period by primary surgery (drainage/biopsy) had complications, which included a difficult anaesthetic induction and technical surgical difficulties. The postoperative incidence of wound dehiscence/infection was extremely high in this group and 18.2% developed postoperative cutaneous sinuses. Following a change in management policy, the following 12 patients, with a comparable HIV incidence, treated by initial conservative management, had a much lower incidence of post-procedural complications. This study confirms a high perioperative complication rate associated with the primary surgical treatment of BCG lymphadenitis in both HIV-positive and negative patients. Primary surgical treatment (incisional drainage or biopsy) is therefore not considered an ideal form of management in BCG lymphadenitis because of the high fistulisation and poor wound healing, especially in the HIV-positive patient. It should be avoided as the initial approach, with needle aspiration being preferred. Surgery should therefore be confined to the unusual event of real doubt about the underlying diagnosis and the treatment of suppurative complications.

Surgical Treatment of BCG Lymphadenitis

Surgical Treatment of BCG Lymphadenitis

Lymphadenitis following intradermal BCG vaccination

Purpose:Intradermal BCG vaccine has not well been accepted by pediatric practitioners due to BCG lymphadenitis. Therefore, this study was undertaken to find out the incidence of lymphadenitis following intradermal BCG vaccination and its clinical outcome. Methods:One thousand and fifty infants, who received intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccination in the Well Baby Clinic of Hanyang University Hospital from July 2001 to January 2004, were included in the study. Severe local reactions at the injection site and any mass noted on surrounding areas were reported to, and evaluated by, pediatricians. Surgical procedures, either surgical resection or needle aspiration, were recommended when lymph nodes progressed to suppurate without regression. Results:Twenty infants(1.9 percent) developed lymphadenitis 2 to 8 months following vaccination. The incidence of BCG lymphadenitis was significantly higher in infants born with intrauterine period of

The effect of local rifampicin instillation on the treatment of suppurative BCG lymphadenitis

Purpose:The purpose of this study was to evaluate the types of lymphadenitis after BCG vaccination and the effect of local rifampicin instillation on the treatment of suppurative BCG lymphadenitis. Methods:A total of 32 otherwise healthy infants with suppurative BCG lymphadenitis, who visited the Department of Pediatrics of Chonbuk National University Hospital, from March 2002 through June 2004, were enrolled in this study. They were treated with needle aspiration and local rifampicin instillation. We investigated the time the lymphadenitis took to be suppurative, accompanying clinical manifestations, and the treatment effects. Results:Of the 32 infants, 19 were male and 13 were female. They were full term babies and one preterm baby with a gestational age of 30 weeks. They received intradermal administration, with the BCG vaccine of PasteurⓇ(French) strain mostly on the left deltoid area(96.9 percent). Regional lymphadenitis occurred in 1 to 11 months after BCG vaccination, mostly 1-5 months after vaccination (78.1 percent). Among the infants, 87.5 percent had unilocular lesion but 12.5 percent had more than one enlarged lymph node cares. Most of the lymphadenitis presented in the left axillary area(77.8 percent), and the left supuraclavicular area(11.1 percent). After one to three times of needle aspiration with rifampin instillation, all infants recovered completely without surgical excision or severe complication. Conclusion:The regional lymphadenitis is the most common complication in infants who receive intradermal BCG vaccination. This study supports that in suppurative BCG lymphadenitis the needle aspiration and local rifampicin instillation is very effective and can be a more economical treatment modality.