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Raíces Francisco N, Suárez Gil R, Ayuso García B, Romay Lema E, Rivas Domínguez OM, Rodríguez Ameijeiras E, Besteiro Balado Y, Pérez López A, Rabuñal Rey R. BCGitis with aortoiliac aneurysm involvement: Report of two cases and review of the literature. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:152-157. [PMID: 37487765 DOI: 10.1016/j.eimce.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 07/26/2023]
Abstract
BCGitis is a rare complication after intravesical administration of Bacillus Calmette-Guérin for high-grade superficial bladder cancer and carcinoma in situ. May cause vascular involvement. We present 2 cases and a review of the literature of the case reports pubished on the 10 years prior to April of 2022, when this proyect was finished, which described a case of aortoiliac mycotic aneurysm after receiving this treatment. Of the 51 cases included (49 revised and 2 original), 100% were men, 82% were older than 65 years. The median latency period was 15 months (IQR 18). The most frequent location was the abdominal aorta, rupture occurred in 45,1% of patients. The most frequent symptom was abdominal or lumbar pain (61%), followed by general syndrome (49%). In 39,2% cases, it was associated with retroperitoneal abscesess. Attributable mortality was 13,6%. BCGitis should be included in the differential diagnosis in patients who have received BCG therapy and present vascular involvement, even years after being treated.
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Affiliation(s)
| | - Roi Suárez Gil
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Blanca Ayuso García
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Eva Romay Lema
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | | | - Antía Pérez López
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain; Grupo de Estudio en Infecciones por Micobacterias. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIM-SEIMC)
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2
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Satchithanantham V, Babiker T, Riding G, Banihani M. A case of mycotic infrarenal abdominal aortic aneurysm after bacillus Calmette-Guérin immunotherapy for bladder cancer and a review of the literature. J Vasc Surg Cases Innov Tech 2023; 9:101213. [PMID: 37388673 PMCID: PMC10300401 DOI: 10.1016/j.jvscit.2023.101213] [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] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 07/01/2023] Open
Abstract
A 69-year-old patient presented with a 9-month history of constitutional symptoms and a 3-week history of increasing abdominal and back pain. He had a history of bacillus Calmette-Guérin immunotherapy for bladder cancer 9 months earlier. An infrarenal mycotic aneurysm was detected by positron emission tomography-computed tomography. His abdominal aorta was reconstructed using a tube graft tailored from a bovine pericardium sheet. We chose this graft because of its acellular nature and reduced risk of postoperative infection. The culture from the aortic wall yielded acid fast bacilli, and he was treated with antituberculosis medication. His postoperative recovery was uneventful, except for chylous ascites.
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Affiliation(s)
- Vinojan Satchithanantham
- Department of Vacular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
- Department of Surgery, Faculty of Medicine, University of Jaffna, Jaffna, Srilanka
| | - Thamer Babiker
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
| | - Graham Riding
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
| | - Mohamed Banihani
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
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3
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Nishizawa M, Kudo T, Kijima T, Fujii Y. Failed endovascular abdominal aortic aneurysm repair due to Mycobacterium bovis infection following intravesical bacillus Calmette-Guérin therapy. J Vasc Surg Cases Innov Tech 2022; 8:807-812. [PMID: 36507086 PMCID: PMC9729924 DOI: 10.1016/j.jvscit.2022.10.020] [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] [Received: 06/17/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
A mycotic aneurysm after intravesical instillation of bacillus Calmette-Guérin (BCG) for early-stage bladder cancer is a rare, but life-threatening, complication. In the present report, we have described the case of a patient who had undergone endovascular aneurysm repair for a rapidly growing saccular abdominal aortic aneurysm after BCG therapy. Three months after endovascular aneurysm repair, the patient had developed an abscess that required open surgery. Cultures from a blood sample and the abscess revealed Mycobacterium bovis BCG. A mycotic aneurysm due to BCG therapy should be suspected in patients with a history of BCG treatment. Such patients should immediately start antitubercular therapy.
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Affiliation(s)
- Masato Nishizawa
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan,Correspondence: Toshifumi Kudo, MD, PhD, Department of Vascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan 113-8519
| | - Toshiki Kijima
- Department of Urology, Dokkyo Medical University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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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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Xu J, Pu Y, Lin R, Xiao S, Fu Y, Wang T. PEAC: An Ultrasensitive and Cost-Effective MRD Detection System in Non-small Cell Lung Cancer Using Plasma Specimen. Front Med (Lausanne) 2022; 9:822200. [PMID: 35308511 PMCID: PMC8928926 DOI: 10.3389/fmed.2022.822200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/14/2022] [Indexed: 12/25/2022] Open
Abstract
Circulating tumor DNA (ctDNA), a tumor-derived fraction of cell-free DNA (cfDNA), has emerged as a promising marker in targeted therapy, immunotherapy, and minimal residual disease (MRD) monitoring in postsurgical patients. However, ctDNA level in early-stage cancers and postsurgical patients is very low, which posed many technical challenges to improve the detection rate and sensitivity, especially in the clinical practice of MRD detection. These challenges usually include insufficient DNA input amount, limit of detection (LOD), and high experimental costs. To resolve these challenges, we developed an ultrasensitive ctDNA MRD detection system in this study, namely PErsonalized Analysis of Cancer (PEAC), to simultaneously detect up to 37 mutations, which account for 70–80% non-small cell lung cancer (NSCLC) driver mutations from low plasma sample volume and enables LOD of 0.01% at a single-site level. We demonstrated the high performance achieved by PEAC on both cfDNA reference standards and clinical plasma samples from three NSCLC patient cohorts. For cfDNA reference standards, PEAC achieved a specificity of 99% and a sensitivity of 87% for the mutations at 0.01% allele fraction. In the second cohort, PEAC showed 100% concordance rate between ddPCR and Next-generation sequencing (NGS) among 29 samples. In the third cohort, 22 of 59 patients received EGFR TKI treatment. Among them, three in four patients identified low level actionable gene mutations only by PEAC had partial responses after targeted therapy, demonstrating high ctDNA detection ability of PEAC. Overall, the developed PEAC system can detect the majority of NSCLC driver mutations using 8–10 ml plasma samples, and has the advantages of high detection sensitivity and lower costs compared with the existing technologies such as ddPCR and NGS. These advantages make the PEAC system quite appropriate for ctDNA and MRD detection in early-stage NSCLC and postsurgical recurrence monitoring.
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Affiliation(s)
- Jianping Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing, China
- *Correspondence: Jianping Xu
| | - Yue Pu
- Department of Research and Development, Hangzhou Repugene Technology Co., Ltd., Hangzhou, China
| | - Rui Lin
- Department of Research and Development, Hangzhou Repugene Technology Co., Ltd., Hangzhou, China
| | - Shanshan Xiao
- Department of Research and Development, Hangzhou Repugene Technology Co., Ltd., Hangzhou, China
| | - Yingxue Fu
- Department of Research and Development, Hangzhou Repugene Technology Co., Ltd., Hangzhou, China
| | - Tao Wang
- Department of Research and Development, Hangzhou Repugene Technology Co., Ltd., Hangzhou, China
- Tao Wang
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Systematic review of case reports of Bacillus Calmette-Guerin (BCG) vascular infections. Ann Vasc Surg 2022; 83:369-377. [DOI: 10.1016/j.avsg.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 12/24/2022]
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7
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Buerger M, Kapahnke S, Omran S, Müller V, Hinterseher I, Greiner A, Frese JP. [Aortic Complications Related to Mycobacterium bovis after Intravesical Bacille Calmette-Guérin Therapy - a Systematic Review]. Zentralbl Chir 2021; 146:506-520. [PMID: 34666364 DOI: 10.1055/a-1592-1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aortic complications after intravesical Bacillus Calmette-Guérin (BCG) application are a rare complication of the treatment of non-muscle invasive bladder cancer. The aim of this systematic review was to perform a descriptive analysis of previously published studies and to discuss the particular challenges of diagnosis and treatment of this rare complication. MATERIAL AND METHODS A literature search was performed in PubMed (1949-2021) and Web of Science (1900-2021) using the search terms "mycobacterium" OR "bovis" OR "BCG" AND "aorta" OR "aneurysm". In a staged review process, publications with the following inclusion criteria were included in data analysis: original paper, full-text availability in English or German and aortic complication after intravesical BCG instillation. We focused on the analysis of BCG-specific medical history data as well as treatment strategies in relation to patient outcome and the occurrence of graft infections during follow-up. RESULTS A total of 60 individual cases were described in 55 published articles. BCG-induced mycotic aortic aneurysms can occur in all segments of the thoracoabdominal aorta, but the infrarenal aortic segment was most commonly affected (65% of cases). The most common configuration was saccular outpouchings (65%). Concomitant infections in other tissues were typical (65%). Patients with mycotic aneurysm presented with or without consecutive aortic rupture in 28% and 63%, respectively. Diagnosis was based on a combination of pathological and microbiological examinations. A common treatment algorithm was surgical infection treatment (85%) and antitubercular therapy (83%). Performed simultaneously, they resulted in a long-term survival of 81%. Graft infection after initial aortic repair with alloplastic material (n = 40) developed in ten patients (25%) during follow-up. DISCUSSION Diagnosis of mycotic aneurysms or vascular complications after intravesical BCG application is exceptionally challenging and a high level of suspicion is required. Diagnosis is based on obtaining sample material of affected regions and the combination of patient's history, clinical presentation and pathological or microbiological examinations. Currently, no consensus guideline for optimal medical treatment options of aortic complications secondary to BCG instillation exists. The combination of surgical treatment and supportive antitubercular therapy seems to achieve the best results. Since the risk of prosthetic infection after the use of alloplastic materials remains high (25%), we strongly suggest evaluating autologous or allogenic aortic replacement during initial aortic repair.
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Affiliation(s)
- Matthias Buerger
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kapahnke
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Safwan Omran
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Müller
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Hinterseher
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Greiner
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Paul Frese
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
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Buerger M, Kapahnke S, Omran S, Schomaker M, Rief M, Greiner A, Frese JP. Aortic aneurysm and aortic graft infection related to Mycobacterium bovis after intravesical Bacille Calmette-Guérin therapy-a case series. BMC Surg 2021; 21:138. [PMID: 33731071 PMCID: PMC7972206 DOI: 10.1186/s12893-021-01142-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background So called “mycotic” aortic aneurysms account for only 0.7 to 1.3% of all aortic aneurysms and are commonly caused by Staphylococcus aureus and Salmonella species. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is part of the therapy of non-muscle-invasive bladder cancer (NMIBC). Case presentation We report a case series of three patients with a mycobacterial graft infection related to BCG after surgical treatment of a presumed mycotic aortic aneurysm as an extremely rare complication after NMIBC treatment. All three patients developed aortic aneurysm after BCG instillation and subsequent mycobacterial graft infection. Conclusion Diagnosis requires a high degree of suspicion because of its nonspecific symptoms and imaging. The pathogen is not detected by standard microbiological testing. Treatment includes triple antimycobacterial therapy and radical surgical interventions. Graft preservation may be considered if no anastomosis is involved. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01142-1.
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Affiliation(s)
- M Buerger
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - S Kapahnke
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - S Omran
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Schomaker
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Rief
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstraße 10, 10117, Berlin, Germany
| | - A Greiner
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J P Frese
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Minakata T, Nakano Y, Tamura S, Kazuki Y, Hayakawa K, Hayakawa T, Oota T, Fuzimoto T, Yamano Y, Takii T. Tuberculous Spondylitis Caused by Intravesical Bacillus Calmette-Guerin Therapy. Intern Med 2020; 59:733-737. [PMID: 32115520 PMCID: PMC7086334 DOI: 10.2169/internalmedicine.3288-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old man underwent intravesical bacillus Calmette-Guerin (BCG) therapy for bladder cancer and later presented with lower left back pain. Magnetic resonance imaging of the spine showed high signal intensity, diagnosed as a cystic lesion in the epidural and bilateral intestinal psoas muscle. A computed tomography-guided needle biopsy and histological examination revealed bacteria from the family Mycobacteriaceae, and Mycobacterium bovis was identified using multiplex polymerase chain reaction. If lower back pain appears in a patient who has undergone BCG therapy, it is necessary to test for tuberculous spondylitis. In addition, QuantiFERON is useful for the differential diagnosis of M. bovis BCG infection.
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Affiliation(s)
| | - Yoshio Nakano
- Department of Internal Medicine, Kinan Hospital, Japan
| | - Shinobu Tamura
- Division of Hematology, Department of Internal Medicine, Wakayama Medical University, Japan
| | | | - Kana Hayakawa
- Department of Internal Medicine, Kinan Hospital, Japan
| | | | - Takayuki Oota
- Department of Internal Medicine, Kinan Hospital, Japan
| | | | | | - Takemasa Takii
- Department of Mycobacteriology, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Japan
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Cadiou S, Al Tabaa O, Nguyen CD, Faccin M, Guillin R, Revest M, Guggenbuhl P, Houvenagel E, Pertuiset E, Coiffier G. Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases. Clin Rheumatol 2019; 38:1773-1783. [PMID: 30868320 DOI: 10.1007/s10067-019-04500-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France.
| | - Omar Al Tabaa
- Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France
| | - Chi-Duc Nguyen
- Department of Rheumatology, Hôpital St Philibert GHICL, 249 Rue du grand but, 59462, Lomme, France
| | - Marine Faccin
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France
| | - Raphaël Guillin
- Department of Medical Imaging, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, CHU Univ Rennes, Inserm U 1230, F-35000, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France.,CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France.,UMR INSERM U 1241, University of Rennes 1, 35000, Rennes, France
| | - Eric Houvenagel
- Department of Rheumatology, Hôpital St Philibert GHICL, 249 Rue du grand but, 59462, Lomme, France
| | - Edouard Pertuiset
- Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France
| | - Guillaume Coiffier
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France.,UMR INSERM U 1241, University of Rennes 1, 35000, Rennes, France
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11
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Ikeda S, Shih M, Likourezos A, Flom P, Rhee RY, Youdelman BA. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33:840-852. [DOI: 10.1111/jocs.13952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shinichiro Ikeda
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
| | - Michael Shih
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Antonios Likourezos
- Department of Emergency Medicine, Research manager/Statistical Analysis Consultant; Maimonides Medical Center; Brooklyn New York
| | - Peter Flom
- Peter Flom Consulting; New York New York
| | - Robert Y. Rhee
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Benjamin A. Youdelman
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
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Ruptured Iliac Pseudoaneurysm after Intravesical Bacillus Calmette-Guérin: Urgent Endovascular Treatment. Case Report and Literature Review. Ann Vasc Surg 2018; 53:269.e1-269.e9. [DOI: 10.1016/j.avsg.2018.05.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 12/29/2022]
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13
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Darriet F, Bernioles P, Loukil A, Saidani N, Eldin C, Drancourt M. Fluorescence in situ hybridization microscopic detection of Bacilli Calmette Guérin mycobacteria in aortic lesions: A case report. Medicine (Baltimore) 2018; 97:e11321. [PMID: 30045257 PMCID: PMC6078740 DOI: 10.1097/md.0000000000011321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE To improve the diagnosis of life-threatening Bacilli Calmette Guérin (BCG) arterial aneurysm in patients treated by intravesical instillation of BCG vaccine as adjunctive therapy for non-muscular bladder carcinoma, is a life-threatening condition. Its diagnosis remains cumbersome. PATIENT CONCERNS One patient with a history of intravesical BCG installation presented with aortic aneurysm with routine microscopic examination after Ziehl-Neelsen staining remaining negative. DIAGNOSES We used fluorescence in situ hybridization (FISH) to target the Mycobacterium tuberculosis complex rpob gene in a fresh aortic specimen. FISH yielded fluorescent mycobacteria in aortic lesions; mycobacteria were further confirmed as Mycobacterium bovis BCG mycobacteria by polymerase chain reaction (PCR) sequencing. INTERVENTIONS The patient benefited from an antituberculous treatment combining rifampicin, isoniazid, and ethambunol. OUTCOME A 9-month follow-up indicated a favorable outcome. LESSONS This case report teaches that FISH targeting the M tuberculosis complex rpoB gene should be incorporated in the laboratory investigation of aortic aneurysm in patients with a history of bladder carcinoma.
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Affiliation(s)
| | - Paola Bernioles
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Ahmed Loukil
- Aix-Marseille University, Institut de Recherche pour le Développement, Microbes, Evolution, Phylogénie, Infections, Institut Hospitalier Universitaire Méditerranée-Infection, Marseille, France
| | - Nadia Saidani
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Carole Eldin
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Michel Drancourt
- Microbiology Laboratory
- Aix-Marseille University, Institut de Recherche pour le Développement, Microbes, Evolution, Phylogénie, Infections, Institut Hospitalier Universitaire Méditerranée-Infection, Marseille, France
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14
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Higashi Y, Nakamura S, Kidani K, Matumoto K, Kawago K, Isobe J, Kanatani J, Kawagishi Y, Sakamaki I, Yamamoto Y. Mycobacterium bovis-induced Aneurysm after Intravesical Bacillus Calmette-Guérin Therapy: A Case Study and Literature Review. Intern Med 2018; 57:429-435. [PMID: 29093394 PMCID: PMC5827329 DOI: 10.2169/internalmedicine.9102-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium bovis infection after intravesical Bacillus Calmette-Guérin (BCG) therapy is rare. A 65-year-old Japanese man with history of bladder cancer and intravesical BCG therapy, presented with low-grade fever. An aneurysm with perianeurysmal fluid was suspected and endovascular aortic repair was performed. After 160 days, he developed blood-streaked sputum and computed tomography images revealed that the perianeurysmal fluid area was increasing in size. A multiplex polymerase chain reaction using sputum identified M. bovis. Treatment with anti-tuberculosis drugs reduced the size of the perianeurysmal fluid area. After intravesical BCG therapy, the possibility of M. bovis infection should be considered, thus further investigations are required.
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Affiliation(s)
- Yoshitsugu Higashi
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
| | - Shigeki Nakamura
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Japan
| | - Kento Kidani
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
| | - Kaoru Matumoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
| | - Koyomi Kawago
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
| | - Junko Isobe
- Department of Bacteology, Toyama Institute of Health, Japan
| | | | - Yukio Kawagishi
- Division of Respiratory Medicine, Kurobe City Hospital, Japan
| | - Ippei Sakamaki
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Japan
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15
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Simar J, Belkhir L, Tombal B, André E. Ruptured aortic aneurysm due to Mycobacterium bovis BCG with a delayed bacteriological diagnosis due to false negative result of the MPB 64 immunochromatographic assay. BMC Res Notes 2017; 10:64. [PMID: 28126017 PMCID: PMC5270368 DOI: 10.1186/s13104-017-2382-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023] Open
Abstract
Background Adjuvant therapy with bacillus Calmette–Guerin (BCG), a live attenuated strain of Mycobacterium bovis, has become the treatment of choice for low-risk superficial bladder carcinoma following transurethral resection of the bladder. Complications following vesical BCG instillations are uncommon but, in some cases, severe side-effects can occur such as sepsis or mycotic aneurysm. Besides usual laboratory techniques used for the diagnosis of Mycobacterium tuberculosis complex (MTBC) infections (smear microscopy and cultures), commercial immunochromatographic assays detecting MBP64, a 24 kDa M. tuberculosis complex-specific secretory protein, can rapidly distinguish MTBC and non-tuberculosis mycobacteria (NTM). MPB64 is found in M. tuberculosis, M. bovis and some but not all substrains of M.bovis BCG. Therefore, these immunochromatographic tests can lead to false negative results and delayed bacteriological diagnosis depending on the presence or absence of MPB64 protein in BCG substrains used for intravesical therapy. Case presentation We report the case of a 78-year-old male patient who was admitted to the hospital because of a 1-month history of unexplained fever, thrill, weight-loss and general malaise. His past medical history was marked by a non-muscle-invasive bladder carcinoma treated by transurethral resection followed by BCG instillations (Oncotice, Merck, USA). The patient was initially treated for a urinary tract infection but as fever persists after 72 h of antibiotherapy, urinary tract ultrasound was performed and revealed a large abdominal aortic aneurysm confirmed by computed tomography. Surgery was performed after multidisciplinary discussion. Direct smear of perioperative samples revealed acid-fast bacilli and both solid and liquid cultures were massively positive. Rapid identification of the positive mycobacterial culture was performed using an immunochromatographic assay based on the detection of the Mycobacterium tuberculosis MPB 64 antigen. The result was negative for Mycobacterium tuberculosis complex. After review of the medical record, a polymerase chain reaction (PCR) was performed and gave a positive result for M. tuberculosis complex. Anti-tuberculosis therapy was started immediately and the patient evolved favorably. Conclusions Through this case, we showed how the utilisation of MPB64 immunochromatographic assays can provide misleading information due to the variable presence of this protein among the different BCG strains. This case further illustrates the utility of rapid TB complex-specific PCR assays which provide a more reliable identification of all MTBC species.
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Affiliation(s)
- J Simar
- Microbiology Unit, Laboratory Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - L Belkhir
- Infectious Diseases Unit, Department of Internal Medicine, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - B Tombal
- Urology Unit, Department of Surgery, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - E André
- Microbiology Unit, Laboratory Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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16
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Colomba C, Di Carlo P, Guadagnino G, Siracusa L, Trizzino M, Gioè C, Cascio A. A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection. Infect Agent Cancer 2016; 11:25. [PMID: 27257433 PMCID: PMC4890504 DOI: 10.1186/s13027-016-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intravesical instillation of bacille Calmette-Guérin (BCG) has been established as efficient therapy for superficial bladder carcinoma. Overall, intravesical BCG is well tolerated and results in complications of less than 5 %. However, adverse effects such as granulomatous prostatitis, pneumonitis, hepatitis, sepsis, and hypersensitivity reactions may occur. The reported rate for tuberculous orchitis after BCG intravesical therapy is 0.4 %. Findings We report a case of monolateral tuberculous orchitis occurring one month after the second course of intravescical instillation of bacille Calmette-Guérin in a patient with proven superficial bladder carcinoma and latent tuberculosis infection. Conclusions In our opinion intravesical instillation of BCG should be considered on an individual patient basis, with full patient disclosure of the potentially significant risks. A screening with an intradermal Mantoux before starting the first cycle of BCG instillation should be recommended and isoniazid would be indicated as the treatment for latent tuberculosis infection.
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Affiliation(s)
- C Colomba
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - P Di Carlo
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - G Guadagnino
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - L Siracusa
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - M Trizzino
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - C Gioè
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - A Cascio
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
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