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Brzezińska S, Zabost A, Borkowska-Tatar D, Klatt M, Goździk J, Dłużniewska A, Błasińska K, Augustynowicz-Kopeć E. Molecular Identification of Extrapulmonary Vaccine Adverse Events after BCG in Paraffin-Embedded Specimens. Pathogens 2023; 12:1374. [PMID: 38133259 PMCID: PMC10745674 DOI: 10.3390/pathogens12121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
According to the World Health Organization (WHO), around 1 million children worldwide are diagnosed with tuberculosis each year. The Bacillus Calmette-Guérin (BCG) vaccine has been used around the world for over 100 years. The complications of the BCG vaccination can occur in about 0,06% of children and include local or systemic adverse reactions. Due to the close analogy between the vaccine strain and other species of the Mycobacterium tuberculosis complex (MTBC), molecular methods are recommended for differential diagnosis of Vaccine adverse events (VAE) after BCG. The ability to quickly and specifically identify BCG is important in view of different treatment regimens. The aim of the study was to assess the usefulness of genetic testing for Mycobacterium bovis BCG in the paraffin-embedded specimens' methods. We describe two cases of VAE in immune-compromised children presenting with osteoarticular changes that had been clinically suspected of tuberculosis and led to molecular identification through GeneXpert, GenoType MTBC, and Spoligotyping. Results: Mycobacterium bovis BCG was detected in osteoarticular changes embedded in paraffin block of two patients. Conclusion: Genetic tests using paraffin-embedded materials allow for quick identification and differential diagnosis of patients with Tuberculosis and VAE after BCG. This is an important issue, especially in cases where the tissue has only been submitted for histopathological examination without microbiological diagnostics for tuberculosis.
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Affiliation(s)
- Sylwia Brzezińska
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Anna Zabost
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Dagmara Borkowska-Tatar
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Magdalena Klatt
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Jolanta Goździk
- Department of Clinical Immunology and Transplantation, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | | | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
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Marouli D, Pappas C, Raissaki M, Proklou A, Papadakis E, Kondili E. Disseminated Bacillus Calmette-Guérin (BCG) infection presenting as severe respiratory failure and septic shock. Germs 2023; 13:277-281. [PMID: 38146386 PMCID: PMC10748841 DOI: 10.18683/germs.2023.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 12/27/2023]
Abstract
Introduction Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur. Case report We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to Mycobacterium bovis dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Conclusions Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.
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Affiliation(s)
- Diamantina Marouli
- MD, PhD, Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
| | - Charalampos Pappas
- MD, Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
| | - Maria Raissaki
- MD, PhD, Department of Radiology, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
| | - Athanasia Proklou
- MD, PhD, Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
| | - Eleftherios Papadakis
- MD, Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
| | - Eumorfia Kondili
- MD, PhD, Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, PC: 71110, Heraklion, Crete, Greece
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