BCG Vaccination Site Research Articles

Wiskott-Aldrich syndrome diagnosed after cellulitis at the BCG vaccination site.

Wiskott-Aldrich syndrome diagnosed after cellulitis at the BCG vaccination site.

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...

Disseminated cutaneous tuberculosis from BCG vaccination site in an immunocompetent child.

A healthy 4-month-old girl presented with widespread scaly papules and a nodule over the site of BCG immunization. A diagnosis of disseminated cutaneous tuberculosis in an immunocompetent child was confirmed with biopsy. The child was treated with antituberculosis therapy without recurrence.

BCG and Adverse Events in the Context of Leprosy.

Notwithstanding its beneficial immunoprophylactic outcomes regarding leprosy and childhood TB, BCG vaccination may cause adverse events, particularly of the skin. However, this local hyper-immune reactivity cannot be predicted before vaccination, nor is its association with protection against leprosy known. In this study we investigated the occurrence of adverse events after BCG (re)vaccination in contacts of leprosy patients and analyzed whether the concomitant systemic anti-mycobacterial immunity was associated with these skin manifestations. Within a randomized controlled BCG vaccination trial in Bangladesh, 14,828 contacts of newly diagnosed leprosy patients received BCG vaccination between 2012 and 2017 and were examined for adverse events 8 to 12 weeks post-vaccination. From a selection of vaccinated contacts, venous blood was obtained at follow-up examination and stimulated with Mycobacterium leprae (M. leprae) antigens in overnight whole-blood assays (WBA). M. leprae phenolic glycolipid-I-specific antibodies and 32 cytokines were determined in WBAs of 13 individuals with and 13 individuals without adverse events after vaccination. Out of the 14,828 contacts who received BCG vaccination, 50 (0.34%) presented with adverse events, mainly (80%) consisting of skin ulcers. Based on the presence of BCG scars, 30 of these contacts (60%) had received BCG in this study as a booster vaccination. Similar to the pathological T-cell immunity observed for tuberculoid leprosy patients, contacts with adverse events at the site of BCG vaccination showed elevated IFN-γ levels in response to M. leprae-specific proteins in WBA. However, decreased levels of sCD40L in serum and GRO (CXCL1) in response to M. leprae simultaneously indicated less T-cell regulation in these individuals, potentially causing uncontrolled T-cell immunity damaging the skin. Skin complications after BCG vaccination present surrogate markers for protective immunity against leprosy, but also indicate a higher risk of developing tuberculoid leprosy. Netherlands Trial Register: NTR3087.

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

BCG-induced Disseminated Mycobacterial Infection of Skin and Bone in an Otherwise Immunocompetent Child.

One 2-year-old undernourished girl presented to our outpatient with large erythematous scaly plaques in arm along with multiple bony swellings over nose, fingers, left foot, and back for the past 1 year. Apart from skin and bone lesions the girl was also had intermittent fever, pallor, irritability, and malnourishment. Her parents gave a history of incomplete healing at the BCG vaccination site. The case was diagnosed to be case of disseminated mycobacterial infection skin and bone with the help of histopathology, radiological examination, and DNA polymerase chain reaction (PCR). DNA PCR from the skin lesion came positive for mycobacteria tuberculosis complex. The girl was treated with 6 months of standard antitubercular drug treatment with very good improvement not only of her cutaneous and bone changes but also of her general health and growth. We report the case because paucity of similar infection in literature and for greater recognition of potential epidemiological threat.

Effect of simultaneous administration of oral polio vaccine on local reaction of BCG vaccine in term infants.

To study local reaction and to ascertain timing of scar formation in infants after BCG vaccination at birth, with and without simultaneous administration of trivalent OPV. Prospective observational study. Teaching hospital in Lucknow, India. 152 term neonates born in the hospital and given BCG and OPV 0-dose simultaneously before discharge, within 7 days of birth (Group I) , and 122 infants born at home or in private health facility, not given OPV-0 dose, coming for vaccination within 7 days of age (Group 2). Follow up done at 6 week, 10 week, 14 week and 9 months. Local reaction was recorded at the site of BCG vaccination. Scar formed in ≤14 wks in 51.3% and 89.3% babies in Group 1 and Group 2, respectively following BCG vaccination (P<0.001). At 9 months, scar developed in 93.9% infants in Group I and 94.3% babies in Group II. Abortive reaction and non-reactors were similar in both groups (P>0.05). Simultaneous administration of BCG vaccine with trivalent OPV to term infants in early neonatal period prolongs the time of scar formation but sequence of local reaction is not affected.

Tuberculin Positivity in Kawasaki Disease: An Unusual Occurrence

To the Editor:A 3-y-old girl presented with high grade fever, irritability, red eyes, lips and tongue and a pruritic rash. She had conjunctival injection, red, cracked lips, ‘strawberry tongue’, edematous hands and feet, and an erythematous, popular rash on the trunk, face and extremities, sparing the palms and soles with classical periungual desquamation. Mobile, non-tender, cervical lymph nodes were palpable. There was erythema and induration at the site where tuberculin had been administered 4 wk ago (Fig. 1). The BCG scar site was normal. Rest of the examination was unremarkable. She had anemia, leukocytosis, thrombocytosis and high erythrocyte sedimentation rate (57 mm) and C reactive protein (92.95 mg/L). Urine showed 7–8 leucocytes per high power field; culture was sterile. Echocardiogram did not reveal any coronary artery abnormalities. Due to the presence of typical features, a diagnosis of Kawasaki disease (KD) was made. Intravenous immunoglobulin was given followed by aspirin. Tomisaku Kawasaki, first reported reactivation of the BCG vaccination site in children with KD. Erythema at the BCG site is reported in upto 50 % of children with KD [1]. However, it has been an uncommon finding in reports from India. The first child with KD and erythema at both BCG and tuberculin administration sites was reported by Kadowaki et al. [2]. Beretto et al. reported tuberculin skin test to be a highly sensitive and specific diagnostic test for KD [3]. They observed that children with acute KD had swelling at the site of previous BCG vaccination or an erythematous reaction at BCG inoculation sites if given during acute KD. They compared tuberculin skin tests in typical KD patients and patients with other febrile illnesses and found that all KD patients had a positive tuberculin skin test. However, a similar study by Kollmann et al. did not support these findings [4]. Skin lesions at the site of BCG or tuberculin administration have been ascribed to molecular mimicry between a mycobacterial heat shock protein (HSP-65) and human homologue HSP 63. Mice inoculated with BCG followed by a crude extract ofMycobacterium intracellulare (cMI) developed coronary arteritis, whereas control animals inoculated with only cMI or BCG did not, suggesting that the immune response to the mycobacteria probably induced autoimmune damage to the vascular wall [5]. In countries with universal BCG vaccination, skin changes at the site of BCG or tuberculin inoculation can be a valuable aid in diagnosis of KD.

Síndrome de reconstitución inmune por BCG en niños tratados por VIH

The objective of this study is to describe the clinical profile of the immune reconstitution syndrome due to Mycobacterium bovis Bacillus Calmette-Guérin (IRS-BCG) in children with HIV infection who receive highly active antiretroviral treatment (HAART) at Instituto Nacional de Salud del Niño de Lima (National Children’s Health Institute of Lima), Peru. A case study was conducted, including 8 children with IRS-BCG, defined as the presence of regional lymphadenopathy or inflammation on the BCG vaccination site with at least one less logarithm in the viral load or immune improvement. All patients had AIDS (C3). The starting median age in HAART was 7.2 months and the event occurred 3 to 11 weeks after the treatment was started. 7 cases showed axillary adenitis. When compared with the Non IRS-BCG group, a significant association between the age at which HAART was started at one year, severe immunodepression, and increased viral load was found. It is concluded that IRS-BCG was related to a rapid clinical progression of the mother-to-child transmitted HIV/AIDS infection, severe immunosuppression and high viral load when the HAART began.

Tuberculosis and cancer on a BCG vaccination site: an instance of immunocompromised district

Tuberculosis and cancer on a BCG vaccination site: an instance of immunocompromised district

Tufted angioma arising at a site of BCG vaccination

ejd.2012.1887 Auteur(s) : Yue-Ping Zeng, Dong-Lai Ma mdonglai@sohu.com Department of Dermatology , Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing 100730 China Tufted angioma (TA) is a rare, benign, vascular neoplasm of unknown pathogenesis, which has the characteristic histological features of small circumscribed angiomatous tufts and lobules in a “cannonball” distribution pattern in the dermis and subcutis [1-3]. The [...]

Síndrome de reconstitución inmune por BCG en niños tratados por VIH

The objective of this study is to describe the clinical profile of the immune reconstitution syndrome due to Mycobacterium bovis Bacillus Calmette-Guérin (IRS-BCG) in children with HIV infection who receive highly active antiretroviral treatment (HAART) at Instituto Nacional de Salud del Niño de Lima (National Children's Health Institute of Lima), Peru. A case study was conducted, including 8 children with IRS-BCG, defined as the presence of regional lymphadenopathy or inflammation on the BCG vaccination site with at least one less logarithm in the viral load or immune improvement. All patients had AIDS (C3). The starting median age in HAART was 7.2 months and the event occurred 3 to 11 weeks after the treatment was started. 7 cases showed axillary adenitis. When compared with the Non IRS-BCG group, a significant association between the age at which HAART was started at one year, severe immunodepression, and increased viral load was found. It is concluded that IRS-BCG was related to a rapid clinical progression of the mother-to-child transmitted HIV/AIDS infection, severe immunosuppression and high viral load when the HAART began.

Primary paediatric TH1 immunodeficiency with BCG-osis

Introduction: In tuberculosis (TB) endemic regions BCG vaccine is administered at birth in an effort to protect against neonatal tuberculous meningitis. However, this live vaccine facilitates overwhelming systemic infections by otherwise innocuous organisms in infants with cellular primary immunodeficiencies . Case Report: Our case is a seven month old infant who developed abscess at BCG vaccination site followed by disseminated BCG­osis and was diagnosed to have TH1 immunodeficiency. Conclusion: Dissemination following BCG vaccination warrants prompt investigation to diagnose primary immunodeficiency disorders in HIV seronegative individuals.

Psoriasis in a 3-month-old infant with Kawasaki disease

Kawasaki disease (KD) or mucocutaneous lymph node syndrome is a systemic vasculitis of unknown etiology affecting young children. Typical cutaneous manifestations of KD are polymorphous, including maculopapular or morbilliform rash and erythroderma. Occurrence of psoriasis following KD is rare. Herein we report a case of new onset of psoriasis in a 3-month-old that flared after a typical clinical case of KD, manifesting spiking fever, diffuse redness and fissuring of the lips, bilateral conjunctiva injection, injected throat, left cervical lymphadenopathy, erythema and desquamation of the lips, cheeks, hands, feet and perianal area, and a generalized maculopapular eruption. In addition, erythema and induration of the BCG vaccination site and coronary artery dilatation were noted. After fading of the initial rash, the patient developed widespread psoriasiform papules and plaques involving the face and extremities. The cheeks, lips and nail involvement with subunqual hyperkeratosis and pincer nail deformity were particularly striking. The diagnosis of psoriasis was confirmed by skin biopsy. The eruption resolved after one month of topical momentasone furoate treatment. The role of superantigens in KD-associated psoriasis is discussed.

A lesion at BCG vaccination site

A lesion at BCG vaccination site

Lessons in giving vaccines: soft tissue complications of vaccinations

Adverse reactions to vaccines vary from the mild to fatal.1 Systemic reactions can be attributed to the vaccine itself, but local reactions are often due to hypersensitivity to other agents in the vaccine. These include adjuvant (e.g. aluminium hydroxide), stabilizers (e.g. gelatin), antibacterial preservatives (e.g. mercury-based thiomersal) and antibiotics (e.g. neomycin). There are many other causes. Many of these substances are also found in other medicines, including anti toxins, contact lens solutions, allergy extracts, topical antibiotic agents and immunoglobulin.2 It has been suggested that alternative substances should be sought to prevent these problems but this has been difficult to achieve.3 Other reactions reported include urticaria, angiooedema, atopic eczema and granuloma annulare.4 Most of the hypersensitivity reactions settle on conservative treatment. Aluminium hydroxide is the main causative agent in granuloma formation at the site of vaccination.5 This has been previously reported in one case of tetanus toxoid injection, three cases of diphtheria, pertussis and tetanus (DPT) inoculation,6 one case of Q fever vaccination7 and three cases of the quadruple vaccine (tetanus, diphtheria, pertussis, polio).8 The illustrated case (Fig. 1) had each of the three DPT injections in the lateral thigh at the appropriate times. The second and third injections were given in spite of the discharging lesion. Aluminium was confirmed in the granulomata on electron microscopy. These discharging sinuses require surgery. Another significant problem is keloid scar formation at the site of BCG vaccination. This vaccine is traditionally given in the deltoid area (Fig. 2). This anatomical site has a bad reputation for scarring anyway but keloids occur more often if there is secondary bacterial infection or delay in healing. Problems can also arise when the vaccine is wrongly inserted in the superficial dermis. Keloid is also more common in some ethnic groups such as Afro-Caribbean and Chinese. Once a keloid (or even a hypertrophic reaction) has developed, it can be very difficult to treat. Repeat BCG should be given in a less conspicuous site, for example. the upper inner arm.9

BCG revaccination in school children: evolution of the lesion at the vaccination site between 48 hours and 10 weeks

Cutaneous reaction after BCG revaccination has been cause of concerns due its magnitude. Would it be intense enough to discourage its use in school-age children? The objective of this study is to describe the evolution of BCG vaccination site between 48 hours and 10 weeks post-revaccination. A descriptive cohort study was carried out involving 484 children between six and 11 years. The subjects were vaccinated with 0.1 mL of BCG-Moreau. Erythema, induration, pustule, ulcer, crust and final scar were measured within 48 h, 72 h and weekly until the tenth week, evaluated between July and December 1987. Epi Info 6.0 software was utilized to analyze frequencies, means, median and standard deviations. Induration was present in 99.1% and erythema in 91.6% of 438 children evaluated within 48 h. Pustules were observed in the first week in 26.1% of 479 children. The first ulcers were seen during the second week. In the tenth week, 69.8% of 463 children showed crusts but only 29.2% completed the healing process. BCG revaccination in school-age children causes intense and early reaction that can be related to Koch phenomenon, even though it does not present the expected reduction in the healing period. The magnitude of the reaction is not enough to discourage its recommendation for school-age children. On the other hand, it is possible that the rapid inflammatory response is an indication of active immune response from the first vaccination.

Revacinação BCG em escolares: evolução da lesão vacinal entre 48 horas e 10 semanas

Objective: cutaneous reaction after BCG revaccination has been cause of concerns due its magnitude. Would it be intense enough to discourage its use in school-age children? The objective of this study is to describe the evolution of BCG vaccination site between 48 hours and 10 weeks post-revaccination. Methods: a descriptive cohort study was carried out involving 484 children between six and 11 years. The subjects were vaccinated with 0.1 mL of BCG-Moreau. Erythema, induration, pustule, ulcer, crust and final scar were measured within 48h, 72h and weekly until the tenth week, evaluated between July and December 1987. Epi Info 6.0 software was utilized to analyze frequencies, means, median and standard deviations. Results: induration was present in 99.1% and erythema in 91.6% of 438 children evaluated within 48h. Pustules were observed in the first week in 26.1% of 479 children. The first ulcers were seen during the second week. In the tenth week, 69.8% of 463 children showed crusts but only 29.2% completed the healing process. Conclusions: BCG revaccination in school-age children causes intense and early reaction that can be related to Koch phenomenon, even though it does not present the expected reduction in the healing period. The magnitude of the reaction is not enough to discourage its recommendation for school-age children. On the other hand, it is possible that the rapid inflammatory response is an indication of active immune response from the first vaccination.

Administration of the BCG vaccination using the multipuncture method in schoolchildren: a comparison with the intradermal method

BACKGROUNDBCG vaccination using the multipuncture device (the Heaf gun) is recommended in the UK for infants and very small children only. The aim of this study was to investigate the...

Lichen scrofulosorum–like eruption localized to multipuncture BCG vaccination site

Lichen scrofulosorum is a rare complication of BCG vaccine. We describe a patient with an unusual lichen scrofulosorum–like eruption localized to a previous multipuncture BCG vaccination site. (J Am Acad Dermatol 1999;41:262-4.)