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Yu SC, Chan TH, Jou R. Granulomatous lymphadenitis in Taiwan: Unraveling infantile peak and Bacillus Calmette-Guérin lymphadenitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00084-7. [PMID: 38816320 DOI: 10.1016/j.jmii.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/14/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Granulomatous lymphadenitis, a histopathological diagnosis, often indicates infections, such as those caused by mycobacterial and fungal agents. METHODS We conducted an analysis of 1098 granulomatous lymphadenitis cases, examining age distribution, lymph node locations, and laterality. Molecular detection of Bacillus Calmette-Guérin (BCG) was performed on archived formalin-fixed paraffin-embedded tissue specimens. RESULTS Our analysis revealed a bimodal age distribution, notably with a minor peak in infants. These infantile cases predominantly featured axillary involvement, frequently occurring on the left side. Positive rates of BCG identification decreased with age: <1 year, 71%; 1-2 year, 33%; 2-3 year, 13%; 3-4 year, 0%. Remarkably, only one of the 14 cases with molecularly confirmed BCG lymphadenitis had comments regarding BCG in the pathological report. Compared with patients born after 2016 (BCG at 5-8 months), those born before 2016 (BCG at birth) developed BCG lymphadenitis at a wider age range with right skewness (before 2016, 13 ± 11 months [range, 3-33 months] vs. after 2016, 10 ± 2 months [range, 8-13 months]). Four of the 14 BCG-positive cases had congenital heart disease. Seven patients received anti-tuberculosis drugs following surgical excision. No surgical complications were reported. CONCLUSIONS BCG lymphadenitis constitutes a distinctive minor peak within the spectrum of granulomatous lymphadenitis in Taiwan. Pathologists should consider the possibility of BCG infection, especially in cases of infantile axillary, supraclavicular, neck lymphadenopathies on the left side. Moreover, BCG administration at 5-8 months may reduce delayed-onset BCG lymphadenitis.
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Affiliation(s)
- Shan-Chi Yu
- Department of Pathology and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Tai-Hua Chan
- Tuberculosis Research Center, Taiwan Centers for Disease Control, Taipei, Taiwan, ROC; Reference Laboratory of Mycobacteriology, Taiwan Centers for Disease Control, Taipei, Taiwan, ROC
| | - Ruwen Jou
- Tuberculosis Research Center, Taiwan Centers for Disease Control, Taipei, Taiwan, ROC; Reference Laboratory of Mycobacteriology, Taiwan Centers for Disease Control, Taipei, Taiwan, ROC.
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Wang X, Du J, Zhang Y, Zhu T, Mao L, Xu L, Shi Z, Zhang J, Sun Q, Qi Z, Xia L. Construction and expression of Mycobacterium tuberculosis fusion protein AR2 and its immunogenicity in combination with various adjuvants to form vaccine. Tuberculosis (Edinb) 2022; 137:102270. [PMID: 36265370 DOI: 10.1016/j.tube.2022.102270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/10/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
Abstract
Tuberculosis (TB) is recognized as a highly infectious disease worldwide, and Bacille Calmette-Guerin (BCG) remains the only TB vaccine licensed for clinical use. As there is little evidence that BCG is effective in adults, there is an urgent need for a safe and effective vaccine to control TB in adults. In this study, we tested the immunomodulatory efficiency of the fusion protein AR2. whole blood IFN-γ release assay (WBIA) was used to detect antigen specificity. The immunogenicity of the vaccine was tested in C57BL/6 mice, and confirmed by enzyme-linked immunosorbent assay (ELISA), flow cytometry, and qRT-PCR. The fusion protein AR2 was successfully constructed and expressed. The level of IFN-γ in the peripheral blood of subjects stimulated by AR2 was significantly higher than in those induced by all subcomponent proteins. AR2-specific IgG and the Th1 cytokines IFN-γ, TNF-α, and iNOS were significantly increased in the group treated with the fusion protein and compound adjuvant (AR2+DMC). Likewise, the number of IFN-γ+ CD4+, IFN-γ+CD8+, and IL-4+ CD8+ T lymphocytes increased significantly. The combination of the fusion protein and the compound adjuvant (AR2+DMC) may be a suitable candidate for an enhanced TB vaccine. This study provides theoretical and experimental support for future research to enhance the effectiveness of TB vaccines and provides an experimental basis for evaluating the influence of different adjuvants on vaccine efficacy.
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Affiliation(s)
- Xiaochun Wang
- Department of Pathogen Biology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Jianpeng Du
- Department of Pathogen Biology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Yanpeng Zhang
- Department of Cosmetology, College of Medicine, Huainan Union University, Huainan, 232038, China.
| | - Tao Zhu
- Department of Morphology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Lirong Mao
- Department of Immunology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Lifa Xu
- Department of Immunology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Zilun Shi
- Department of Clinical Laboratory, Affiliated Cancer Hospital, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Jingyan Zhang
- Department of Clinical Laboratory, Affiliated Heping Hospital, Changzhi Medical College, Changzhi, 046000, China.
| | - Qishan Sun
- Department of Clinical Laboratory, Huainan Chaoyang Hospital, Huainan, 232001, China.
| | - Zhiyang Qi
- Department of Pathogen Biology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
| | - Lu Xia
- Department of Pathogen Biology, School of Medicine, Anhui University of Science and Technology, Huainan, 232001, China.
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Chest Wall Tuberculosis After Bacillus Calmette-Guérin Vaccination. Pediatr Infect Dis J 2022; 41:e504-e505. [PMID: 36102718 DOI: 10.1097/inf.0000000000003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dash N, Verghese VP, Rose W, Michael JS, Rebekah G, Venkatesan M, Chacko A. Clinical, Microbiological Profile and Treatment Outcomes of Infants with BCG Adenitis: A Retrospective Study. J Trop Pediatr 2022; 68:6825445. [PMID: 36370459 DOI: 10.1093/tropej/fmac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) adenitis is an uncommon complication following BCG vaccination. In rare cases, infants can develop other complications. Controversy exists regarding the diagnosis and management of these cases. Not much information is available in literature regarding their microbiological and immunological characteristics. METHODS Electronic medical records of children presenting to the Pediatric Infectious Diseases clinic in a tertiary care hospital from January 2011-December 2020 with a diagnosis of BCG adenitis were retrospectively reviewed. Their clinical, microbiological, treatment and follow-up data were noted and analyzed. FINDINGS During the study period, 40 infants presented with a probable diagnosis of BCG adenitis with or without disseminated BCG. Median age at symptom onset was 4(2.5-5.9) months. Nine infants had disseminated disease at presentation. Fifteen infants were suspected to have underlying immune deficiency of whom 12 had proven defects in immune function. On multivariable logistic regression analysis, presence of disseminated disease was the only factor predictive of underlying immunodeficiency. Isoniazid monoresistance was seen in seven cases (32%) of the 22 samples sent for TB cultures. CONCLUSIONS Though BCG adenitis runs a benign course, it could rarely be the first manifestation of an underlying immune defect. There is sizable isoniazid monoresistance, hence sending tissue samples for microbiologic evaluation is necessary to guide anti-tubercular therapy.
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Affiliation(s)
- Nabaneeta Dash
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Grace Rebekah
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anila Chacko
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
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Tsujioka Y, Nozaki T, Nishimura G, Miyazaki O, Jinzaki M, Kono T. BCG osteomyelitis: tips for diagnosis. Skeletal Radiol 2022; 51:1571-1584. [PMID: 35043224 DOI: 10.1007/s00256-021-03966-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the clinical and imaging characteristics of BCG-osteomyelitis, and compare them with those of pyogenic osteomyelitis. MATERIALS AND METHODS Clinical and imaging findings were retrospectively evaluated in 14 children with BCG osteomyelitis, including 3 with Mendelian susceptibility to mycobacterial diseases (MSMD), and in 40 children with pyogenic osteomyelitis, using Fisher exact and Mann-Whitney U tests. RESULTS BCG-osteomyelitis was an indolent inflammatory disease of young children (mean age 15.5 months). Immunocompetent patients came to medical attention over months after vaccination, while patients with MSMD much earlier (the average time lapse: 13.7 vs. 5.0 months). The former manifested with a slowly progressive, painless mass with only mildly increased acute-phase reactants, while the latter started with lymphadenitis with significant inflammatory reactions and later developed osteomyelitis. These clinical scenarios contrasted with acute febrile illness in pyogenic osteomyelitis. The imaging findings were identical in both immunocompetent and MSMD groups; however, the former showed monoostotic involvement, while the latter polyostotic affliction. The typical imaging finding of BCG-osteomyelitis comprises a large intraosseous abscess with modest reactive edema commonly associated with transphyseal extension from the metaphysis to the epiphysis, contrasting with the manifestation of pyogenic osteomyelitis; size of abscess (p=0.028), pattern of abscess extension (p<0.001), and extent of surrounding edema (p<0.001). CONCLUSIONS BCG-osteomyelitis should be suspected in children under 2 years of age with insidious osteomyelitis, accompanied with characteristic imaging findings. Polyostotic BCG osteomyelitis is highly suggestive of MSMD. Awareness of the distinctive features of BCG-osteomyelitis enables the early diagnosis and timely therapeutic intervention.
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Affiliation(s)
- Yuko Tsujioka
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. .,Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Gen Nishimura
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Center for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Characteristics and incidence of vaccine adverse events after Bacille Calmette–Guérin vaccination: A national surveillance study in Japan from 2013 to 2017. Vaccine 2022; 40:4922-4928. [DOI: 10.1016/j.vaccine.2022.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liu C, Huang M, Liu F, Xu X, Feng W, Han G, Liu X, Zheng B, Geng L, Fu T. The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center. BMC Infect Dis 2021; 21:801. [PMID: 34380453 PMCID: PMC8359026 DOI: 10.1186/s12879-021-06531-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background The management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma. Methods From January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months. Results Of the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus. Conclusions The present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.
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Affiliation(s)
- Chen Liu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Minxiang Huang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Fang Liu
- Child Health Section, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Xiaoliang Xu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Wenyu Feng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Guoxiu Han
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Xijie Liu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Bufeng Zheng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China.
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Shandong, 256603, China
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Wang J, Zhou F, Jiang MB, Xu ZH, Ni YH, Wu QS. Epidemiological characteristics and trends of Bacillus Calmette-Guérin lymphadenitis in Shanghai, China from 2010 to 2019. Hum Vaccin Immunother 2021; 18:1938922. [PMID: 34156902 PMCID: PMC8920159 DOI: 10.1080/21645515.2021.1938922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the administration of the Bacillus Calmette–Guérin (BCG) vaccine is generally safe, lymphadenitis, the most common complication of BCG vaccination, can occur. Here, we describe the epidemiological characteristics and incidence trends of BCG lymphadenitis in Shanghai, China, among a population with a high burden of tuberculosis. A total of 56 cases of adverse events following immunization (AEFI) after BCG vaccination were reported in Shanghai, including 51 cases of BCG lymphadenitis (91.07%), from 2010 to 2019. The general incidence of BCG lymphadenitis was 173 per 1,000,000 doses in Shanghai from 2010 to 2019. A nonsignificant increase of 58.81% per year was observed between 2010 and 2012 (t = 0.93; p = .40), followed by a significant decline of 28.00% per year from 2012 to 2019 (t = −4.27; p < .01). Seven batches of BCG vaccines triggered three or more BCG lymphadenitis cases, for 27 (52.94%) cases in total. We identified two patients with immunodeficiency of chronic granulomatous disease, one of whom died four years later after BCG vaccination and another of whom was still being treated after two transplants. The average total care cost of the 47 recovered cases was 11,336 RMB (range: 2,637–33,861 RMB). Due to the high burden of BCG lymphadenitis, especially in children with immunodeficiency, it is suggested that government departments should strengthen healthcare provider training, assign specific nurses to perform BCG vaccination, monitor vaccinated individuals actively and timely detect abnormal signals so as to reduce the incidence of BCG lymphadenitis.
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Affiliation(s)
- Jing Wang
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Feng Zhou
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Ming-Bo Jiang
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Zhen-Hui Xu
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Yi-Hong Ni
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Qiang-Song Wu
- Department of Immunization, Xuhui District Center for Disease Control and Prevention, Shanghai, China
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Korppi M. The sixty-year story of Finnish Bacillus Calmette-Guérin (BCG) osteitis. Acta Paediatr 2021; 110:1119-1124. [PMID: 33073891 DOI: 10.1111/apa.15609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022]
Abstract
AIM A review published in 2015 showed that 331 Bacillus Calmette-Guérin (BCG) osteitis cases were globally reported in 1976-2012. The 222 Finnish cases from 1960 to 1988 formed two-thirds of all cases. The present narrative review summarises epidemiological, clinical and immunological findings obtained from this Finnish cohort in relation to data from other countries. METHODS Six reports including 93 BCG osteitis cases, which were not included in the 2015 review, were identified from PubMed. RESULTS In all, 424 BCG osteitis cases have been published. Population-based data were available only from Finland and Taiwan. The BCG osteitis incidence in Finnish infants was 6.4/100 000/year in 1960-1988 compared to 3.4/100 000/year in Taiwanese infants in 1998-2012. The incidence in Finland increased to 36.9/100 000 in 1971-1977, and the vaccinations were temporarily discontinued. Over half of lesions were in lower limbs and nearly all were solitary in both cohorts. The outcomes after surgery and chemotherapy were good. Immunology of BCG osteitis was studied only in the Finnish cohort. There were deviations from population data in polymorphisms of genes regulating Toll-like receptors 1, 2 and 6, mannose-binding lectin and interleukin-17A. CONCLUSION BCG osteitis after vaccination is rare. Preliminary findings in innate immunity raise a question of genetic background.
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Affiliation(s)
- Matti Korppi
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
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Ikeda K, Matsuzaki Y. Local reactions after BCG vaccination in Japan. Pediatr Neonatol 2021; 62:115-116. [PMID: 33191135 DOI: 10.1016/j.pedneo.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Kazushige Ikeda
- Division of Neonatology, Department of Pediatrics, Saitama City Hospital, Saitama, Saitama, Japan.
| | - Yohei Matsuzaki
- Department of Pediatrics, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
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Huang W, Chiu NC, Chi H, Huang FY, Huang CY. Inoculation Age of Bacillus Calmette-Guérin Tokyo-172 Strain and Vaccine-related Adverse Reactions in Taiwan Birth Cohort of 2012–2017. Clin Infect Dis 2020; 73:e1554-e1559. [DOI: 10.1093/cid/ciaa1235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2016 in Taiwan, inoculation with the Bacillus Calmette-Guérin (BCG) Tokyo-172 vaccine was postponed from 24 hours after birth to 5–8 months of age. We reviewed BCG-induced adverse reactions reported to the Vaccine Injury Compensation Program (VICP) to identify differences between early and delayed BCG inoculation.
Methods
Clinical presentations of BCG-related adverse reactions reported to VICP for the 2012–2017 birth cohort were reviewed until the end of 2019. The correlations between inoculation age and complications were evaluated.
Results
We analyzed 233 BCG adverse reactions, including regional lymphadenitis (33.9%), injection site reactions (35.2%), osteitis/osteomyelitis (27.9%), and distant soft tissue infections (3.0%). The incidence of osteitis/osteomyelitis was lower when vaccination was done after 5 months of age (relative risk [RR], 0.32; 95% confidence interval [CI], .16–.64). Injection site reactions (RR, 8.82; 95% CI, 5.04–15.44) and lymphadenitis (RR, 2.24; 95% CI, 1.44–3.45) were significantly more common in vaccinees older than 5 months. Shorter onset durations of mild adverse reactions (lymphadenitis and injection site reactions) were reported in vaccinees older than 5 months, while no statistical significance was found regarding osteitis/osteomyelitis.
Conclusions
Osteomyelitis and distant soft tissue infection may occur less frequently when BCG inoculation occurs after 5 months of age, although mild adverse reactions can be more frequent, symptom onset times can be shortened. As few severe reactions might occur more than 2 years after BCG inoculation and the policy of delayed BCG inoculation was implemented in 2016, a longer observational period is needed to clarify the exact severe complications decrement.
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Affiliation(s)
- Wei Huang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Fu-Yuan Huang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Narvskaya O, Starkova D, Levi D, Alexandrova N, Molchanov V, Chernyaeva E, Vyazovaya A, Mushkin A, Zhuravlev V, Solovieva N, Vishnevskiy B, Mokrousov I. First insight into the whole-genome sequence variations in Mycobacterium bovis BCG-1 (Russia) vaccine seed lots and their progeny clinical isolates from children with BCG-induced adverse events. BMC Genomics 2020; 21:567. [PMID: 32811436 PMCID: PMC7437937 DOI: 10.1186/s12864-020-06973-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background The only licensed live Bacille Calmette-Guérin (BCG) vaccine used to prevent severe childhood tuberculosis comprises genetically divergent strains with variable protective efficacy and rates of BCG-induced adverse events. The whole-genome sequencing (WGS) allowed evaluating the genome stability of BCG strains and the impact of spontaneous heterogeneity in seed and commercial lots on the efficacy of BCG-vaccines in different countries. Our study aimed to assess sequence variations and their putative effects on genes and protein functions in the BCG-1 (Russia) seed lots compared to their progeny isolates available from immunocompetent children with BCG-induced disease (mainly, osteitis). Results Based on the WGS data, we analyzed the links between seed lots 361, 367, and 368 used for vaccine manufacture in Russia in different periods, and their nine progeny isolates recovered from immunocompetent children with BCG-induced disease. The complete catalog of variants in genes relative to the reference genome (GenBank: CP013741) included 4 synonymous and 8 nonsynonymous single nucleotide polymorphisms, and 3 frameshift deletions. Seed lot 361 shared variants with 2 of 6 descendant isolates that had higher proportions of such polymorphisms in several genes, including ppsC, eccD5, and eccA5 involved in metabolism and cell wall processes and reportedly associated with virulence in mycobacteria. One isolate preserved variants of its parent seed lot 361 without gain of further changes in the sequence profile within 14 years. Conclusions The background genomic information allowed us for the first time to follow the BCG diversity starting from the freeze-dried seed lots to descendant clinical isolates. Sequence variations in several genes of seed lot 361 did not alter the genomic stability and viability of the vaccine and appeared accumulated in isolates during the survival in the human organism. The impact of the observed variations in the context of association with the development of BCG-induced disease should be evaluated in parallel with the immune status and host genetics. Comparative genomic studies of BCG seed lots and their descendant clinical isolates represent a beneficial approach to better understand the molecular bases of efficacy and adverse events during the long-term survival of BCG in the host organism.
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Affiliation(s)
- Olga Narvskaya
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, 197101, Russia. .,St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, 191036, Russia.
| | - Daria Starkova
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, 197101, Russia
| | - Diana Levi
- Scientific Center for Expert Evaluation of Medical Products, Moscow, 127051, Russia
| | - Natalia Alexandrova
- Scientific Center for Expert Evaluation of Medical Products, Moscow, 127051, Russia
| | - Vladimir Molchanov
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, 197101, Russia. .,Present address: Van Andel Institute, Grand Rapids, MI, 49503-2518, USA.
| | | | - Anna Vyazovaya
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, 197101, Russia
| | - Alexander Mushkin
- St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, 191036, Russia
| | - Viacheslav Zhuravlev
- St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, 191036, Russia
| | - Natalia Solovieva
- St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, 191036, Russia
| | - Boris Vishnevskiy
- St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, 191036, Russia
| | - Igor Mokrousov
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, 197101, Russia
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Bacillus Calmette–Guérin (BCG) vaccine safety surveillance in the Korea Adverse Event Reporting System using the tree-based scan statistic and conventional disproportionality-based algorithms. Vaccine 2020; 38:3702-3710. [DOI: 10.1016/j.vaccine.2020.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022]
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Rermruay R, Thaveekarn W, Chokephaibulkit K. Clinical features and outcomes of Bacille Calmette-Guérin (BCG)-induced diseases following neonatal BCG Tokyo-172 strain immunization. Vaccine 2019; 37:3384. [DOI: 10.1016/j.vaccine.2019.04.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 11/27/2022]
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Yamamoto S, Nakada N. Comment on: Clinical features and outcomes of Bacille Calmette-Guérin (BCG)-induced diseases following neonatal BCG Tokyo-172 strain immunization. Vaccine 2019; 37:3383. [DOI: 10.1016/j.vaccine.2019.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 04/23/2019] [Indexed: 11/29/2022]
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Huang CY, Chiu NC, Chi H, Huang FY, Chang PH. Clinical Manifestations, Management, and Outcomes of Osteitis/Osteomyelitis Caused by Mycobacterium bovis Bacillus Calmette-Guérin in Children: Comparison by Site(s) of Affected Bones. J Pediatr 2019; 207:97-102. [PMID: 30577978 DOI: 10.1016/j.jpeds.2018.11.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the clinical manifestations, management, and outcomes of Mycobacterium bovis Bacillus Calmette-Guérin (BCG) osteitis/osteomyelitis. STUDY DESIGN We reviewed 71 cases of BCG osteitis/osteomyelitis registered in Taiwan's vaccine injury compensation program (VICP) in 1998-2014. Demographic, clinical, laboratory, treatment, and outcome data were compared according to site(s) of infection. RESULTS Involvement of a long bone of the lower extremity was present in 36.6% of the children, followed by foot bone (23.9%), rib or sternum (15.5%), upper extremity long bone (9.9%), hand bone (7%), multiple bones (4.2%), and vertebrae (2.8%). Children with lower extremity long bone involvement had a longer interval from receipt of BCG vaccine to presentation (median, 16.0 months; P = .02), and those with foot bone infection had higher rates of swelling (94.1%; P = .02) and local tenderness (76.5%; P = .004). Surgical intervention was performed in 70 children, with no significant difference in the number of procedures by site (median, 1.0 procedure per patient). Among the 70 children who received antimicrobial therapy, those with vertebral and multifocal infections had a longer duration of treatment (P < .001) and/or second-line antituberculosis medications (P = .002). Three children with vertebral and multifocal infections had major sequelae with kyphosis or leg length discrepancy. Outcomes were good for children with involvement of the ribs, sternum, and peripheral bones without multifocal involvement. The average time for functional recovery was 6.2 ± 3.9 months. CONCLUSION Children with BCG osteitis/osteomyelitis in different bones had distinct presentations and outcomes. Pediatricians should consider BCG bone infection in young vaccinated children with insidious onset of signs and symptoms, and consider affected site(s) in the management plan.
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Affiliation(s)
- Ching-Ying Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Fu-Yuan Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Pin-Hsuan Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
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Choi YY, Han MS, Lee HJ, Yun KW, Shin CH, Yoo WJ, Cho TJ, Cheon JE, Park KU, Choi EH. Mycobacterium bovis Osteitis Following Immunization with Bacille Calmette-Guérin (BCG) in Korea. J Korean Med Sci 2019; 34:e3. [PMID: 30618511 PMCID: PMC6318445 DOI: 10.3346/jkms.2019.34.e3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mycobacterium bovis Bacille Calmette-Guérin (BCG) osteitis, a rare complication of BCG vaccination, has not been well investigated in Korea. This study aimed to evaluate the clinical characteristics of BCG osteitis during the recent 10 years in Korea. METHODS Children diagnosed with BCG osteitis at the Seoul National University Children's Hospital from January 2007 to March 2018 were included. M. bovis BCG was confirmed by multiplex polymerase chain reaction (PCR) in the affected bone. BCG immunization status and clinical information were reviewed retrospectively. RESULTS Twenty-one patients were diagnosed with BCG osteitis and their median symptom onset from BCG vaccination was 13.8 months (range, 6.0-32.5). Sixteen children (76.2%) received Tokyo-172 vaccine by percutaneous multiple puncture method, while four (19.0%) and one (4.8%) received intradermal Tokyo-172 and Danish strain, respectively. Common presenting symptoms were swelling (76.2%), limited movement of the affected site (63.2%), and pain (61.9%) while fever was only accompanied in 19.0%. Femur (33.3%) and the tarsal bones (23.8%) were the most frequently involved sites; and demarcated osteolytic lesions (63.1%) and cortical breakages (42.1%) were observed on plain radiographs. Surgical drainage was performed in 90.5%, and 33.3% of them required repeated surgical interventions due to persistent symptoms. Antituberculosis medications were administered for a median duration of 12 months (range, 12-31). Most patients recovered without evident sequelae. CONCLUSION Highly suspecting BCG osteitis based on clinical manifestations is important for prompt management. A comprehensive national surveillance system is needed to understand the exact incidence of serious adverse reactions following BCG vaccination and establish safe vaccination policy in Korea.
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Affiliation(s)
- Youn Young Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Korea
| | - Won Joon Yoo
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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