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Spruijt LE, Mosch A, Hoffmann CF, van Nieuwkoop C, Tijsterman JD, Zutt R, van der Gaag NA, Contarino MF. Mycobacterium bovis Infection of a Deep Brain Stimulation System Following Intravesical Bacillus Calmette-Guérin (BCG) Instillation. JOURNAL OF PARKINSON'S DISEASE 2024; 14:1061-1069. [PMID: 38788088 PMCID: PMC11307081 DOI: 10.3233/jpd-230426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/26/2024]
Abstract
Deep brain stimulation (DBS) is an advanced treatment in Parkinson's disease. We describe a 71-year-old patient in whom the DBS got infected with Mycobacterium bovis shortly after intravesical BCG instillations as an adjuvant treatment of bladder cancer. The DBS internal pulse generator and extension wires had to be replaced, and the patient was treated successfully with rifampicin, isoniazid, and ethambutol during three months. This case suggests that physicians need to be aware of the risk of this kind of infection and add a specific Mycobacterial test to the regular cultures.
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Affiliation(s)
- Linda E. Spruijt
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Arne Mosch
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Carel F.E. Hoffmann
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Rodi Zutt
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Niels A. van der Gaag
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- University Neurosurgical Center Holland, The Netherlands
| | - M. Fiorella Contarino
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Arsuffi S, Cambianica A, Di Filippo E, Ripamonti D, Tebaldi A, Arosio MEG, Farina CF, Rizzi M. Vascular graft infections caused by Mycobacterium bovis BCG after BCG immunotherapy for non-muscle-invasive bladder cancer: Case report and review of literature. J Clin Tuberc Other Mycobact Dis 2023; 31:100360. [PMID: 36941969 PMCID: PMC10023866 DOI: 10.1016/j.jctube.2023.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Bacillus Calmette-Guerin (BCG) immunotherapy (i.e., intravesical instillation of live attenuated strain of Mycobacterium bovis) is a standard of care for non-muscle-invasive bladder cancer (NMIBC). The risk of infective adverse events is generally low as studies have reported an incidence of systemic BCG infections between 3% and 7%. In the majority of cases, BCG infections are disseminated (34.4%), genitourinary (23.4%), osteomuscular (19.9%), or vascular (6.7%). Regarding vascular involvement, mycotic aortic aneurysm, aorto-enteric fistula and vascular bypass graft infections have been described. A 73-year-old man with a prosthetic femoral-popliteal bypass was treated with BCG immunotherapy for a relapsed NMIBC. Two months later, the patient developed fever and hyporexia. PET-CT and CT scans of the abdomen showed an abscess surrounding the superficial femoral artery, while blood cultures yielded M. bovis BCG, and antitubercular therapy (with RMP + EMB + INH) was started. The prosthetic graft was removed and its cultures tested positive for M. bovis as well. A total of 14 cases of vascular prosthesis infections caused by M. bovis BCG following BCG instillation are so far reported. All the cases occurred in adult symptomatic men. Abdominal aorta was involved in the majority of cases. CT scan played a pivotal role in the diagnostic process. Mycobacterium bovis BCG was isolated from several different sources. Treatment required surgery and medical therapy, the latter showing wide variability. Previous BCG immunotherapy must be considered in the differential diagnosis in patients with infected vascular grafts. These infectious complications are rare and, while the infected grafts should be removed, there are no definite recommendations regarding the type of regimen and duration of treatment.
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Affiliation(s)
- Stefania Arsuffi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Anna Cambianica
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
- Corresponding author.
| | - Elisa Di Filippo
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Alessandra Tebaldi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | | | | | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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Palmier M, Monnot A, Tenière T, Cohen Q, Plissonnier D. Mycotic arterial aneurysm secondary to BCG intravesical instillation: A review. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:94-105. [PMID: 35691669 DOI: 10.1016/j.jdmv.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Mycotic aortic aneurysm is a rare and life-threatening pathology. The first case of mycotic aneurysm induced by immunotherapy with bacille Calmette-Guérin for malignancy was published in 1988. The main objective of this review is to characterize this rare pathology. MATERIALS AND METHODS Since then, 60 cases of arterial aneurysm following intra vesical BCG instillation have been described in the literature. All cases have been included, and characteristics have been collected retrospectively, with simple statistical analyses of the cases. RESULTS We present a brief review from 1988 to 2022 enhancing the contemporary understanding of this arterial infection. Mycotic aneurysm secondary to BCG instillation has a poor prognosis, up to 50% complication and 15% mortality at 1 month, whether managed by open repair or endovascular means. CONCLUSION BCG mycotic aneurysm is an extremely serious condition, the diagnosis of which must be considered at an early stage in order to adapt diagnostic and therapeutic strategies.
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Affiliation(s)
- M Palmier
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France.
| | - A Monnot
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - T Tenière
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - Q Cohen
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Plissonnier
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
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Dubert M, Abihssira S, Diamantis S, Guenin R, Messaoudi R, Roux AL, Rouis K, Lillo A, Surgers L, Douard R, Julia P, Lebeaux D. Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer. Infection 2020; 49:345-348. [PMID: 32749595 DOI: 10.1007/s15010-020-01495-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare. CASE We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good. DISCUSSION AND CONCLUSIONS Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).
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Affiliation(s)
- Marie Dubert
- Université de Paris, 75006, Paris, France. .,Service de Microbiologie, Unité Mobile D'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Sharon Abihssira
- Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Sylvain Diamantis
- Service de Maladies Infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Remi Guenin
- Service de médecine nucléaire, Centre de Médecine Nucléaire, 77 Santepole, Melun, France
| | - Rabah Messaoudi
- Service d'urologie, Clinique Saint Jean de L'Hermitage, Dammarie-Les-Lys, Melun, France
| | - Anne-Laure Roux
- Service de Microbiologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, Paris, France
| | | | - Agnès Lillo
- Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Laure Surgers
- Service de Maladies Infectieuses, Hôpital Saint Antoine, AP-HP Sorbonne Université, Paris, France.,Sorbonne université, CIMI équipe 13, INSERM U1135, 75005, Paris, France
| | - Richard Douard
- Service de Chirurgie générale, Digestive Et Oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Julia
- Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - David Lebeaux
- Université de Paris, 75006, Paris, France. .,Service de Microbiologie, Unité Mobile D'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
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Mycobacterium bovis infection of a femorofemoral bypass graft following intravesical Bacillus Calmette-Guérin (BCG) immunotherapy. J Clin Tuberc Other Mycobact Dis 2020; 19:100152. [PMID: 32140570 PMCID: PMC7047174 DOI: 10.1016/j.jctube.2020.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vascular bypass graft infection with Mycobacterium bovis following Bacillus Calmette–Guérin (BCG) immunotherapy for bladder cancer is an incredibly rare complication. We present the case of an 85-year-old man with a history of femorofemoral bypass who developed this complication over a year after BCG treatment. He was successfully treated with explantation of the polytetrafluoroethylene (PTFE) graft, redo bypass with vein graft, and antituberculous medical therapy.
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BCGites après immunothérapie pour cancer de vessie, une pathologie hétérogène: physiopathologie, description clinique, prise en charge diagnostique et thérapeutique. Rev Mal Respir 2018; 35:416-429. [DOI: 10.1016/j.rmr.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
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DeSimone DC, Tande AJ. Infection of an axillo-bifemoral bypass graft following intravesical bacillus Calmette-Guerin (BCG) immunotherapy for urothelial cancer due to Mycobacterium bovis and Staphylococcus aureus. J Clin Tuberc Other Mycobact Dis 2016; 5:1-3. [PMID: 31723689 PMCID: PMC6850222 DOI: 10.1016/j.jctube.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022] Open
Abstract
We report a case of occult Mycobacterium bovis left axillary-bifemoral bypass graft infection, with superimposed acute methicillin-susceptible Staphylococcus aureus (MSSA) infection in an 82 year old male following intravesicular bacillus Calmette-Guerin (BCG) for adjuvant therapy of urothelial cancer. The patient underwent partial removal of the bypass graft and treated with antimycobacterial therapy-rifampin and isoniazid for 9 months, and intravenous cefazolin followed by oral cephalexin for chronic suppressive therapy for MSSA. This presentation highlights the need to consider indolent infection masquerading as mechanical erosion, even when an alternate infection is present.
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Affiliation(s)
- Daniel C DeSimone
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Aaron J Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
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Pérez-Jacoiste Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido Á, San Juan R, Arrebola-Pajares A, Lizasoain M, Prieto S, Aguado JM. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine (Baltimore) 2014; 93:236-254. [PMID: 25398060 PMCID: PMC4602419 DOI: 10.1097/md.0000000000000119] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0-9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.
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Affiliation(s)
- María Asunción Pérez-Jacoiste Asín
- Unit of Infectious Diseases (MAPJA, MFR, FLM, CL, RSJ, ML, JMA), Department of Urology (AT, AAP), and Department of Internal Medicine (SP), Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain
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[Unilateral purpura of a limb revealing a periprosthetic abscess in an HIV-infected patient]. Ann Dermatol Venereol 2011; 138:748-52. [PMID: 22078036 DOI: 10.1016/j.annder.2011.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/02/2011] [Accepted: 06/28/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many diagnoses may be evoked in the presence of purpuric lesions of the lower limbs in HIV-positive patients. We report here on a Staphylococcus aureus abscess around a vascular prosthesis revealed by unilateral purpuric lesions. PATIENTS AND METHODS A 43-year-old HIV-positive man was referred to us with febrile purpura of the left lower limb. His past medical history included a crossover iliofemoral arterial bypass. Clinical examination revealed fever and infiltrated purpuric lesions on the left ankle associated with cyanotic left toes. A skin biopsy showed leucocytoclastic vasculitis. A voluminous right iliac abscess was demonstrated by abdominal and pelvic CT scans. S. aureus was isolated from the skin biopsy, two blood cultures and the periprosthetic abscess. The abscess was drained without replacing the prosthesis and antibiotic therapy consisting of oxacillin was given for 6 months, resulting in complete healing. DISCUSSION Vascular prosthetic infections are rare events that can occur early or late after surgery. S. aureus is usually the causative infectious agent. Clinical signs are non-specific and include purpuric lesions, which rarely reveal these infections. The organism may generally be isolated from prosthetic materials and blood cultures. CT scan is the recommended test to visualize prosthetic impairment. Treatment comprises prolonged antibiotic therapy adapted in accordance with the bacterial antibiogram, along with surgical debridement and, preferably, prosthetic replacement. CONCLUSION This case report describes a unilateral purpura revealing a periprosthetic abscess. Dermatologists must be aware of this sign as a potential indicator of prosthetic infection.
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Current world literature. Curr Opin Pediatr 2010; 22:117-26. [PMID: 20068414 DOI: 10.1097/mop.0b013e32833539b5] [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: 11/26/2022]
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