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Lyra PT, Souza E, Moura ACA, Matta MC, Torres LC, Coelho AVC, Rocha MÂW, Arraes L, Oliveira JB. Inborn Errors of Immunity in Patients with Adverse Events Following BCG Vaccination in Brazil. J Clin Immunol 2022; 42:1708-1720. [PMID: 35907101 DOI: 10.1007/s10875-022-01302-9] [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: 08/07/2020] [Accepted: 05/28/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The Bacille Calmette-Guérin (BCG) vaccine is routinely applied in Brazil. Adverse events (AE) may occur in patients with inborn or acquired immunodeficiencies, varying between local (BCGitis) or disseminated (BCGosis) reactions. We evaluated 53 individuals with local or disseminated adverse events to BCG vaccination to assess if they had inborn errors of immunity (IEI). METHODS Patients diagnosed with an adverse event following BCG vaccination between 2014 and 2017 were included in the study. We collected clinical data, immunophenotyped T and B lymphocytes, and natural killer cells (NK), assessed oxidative function of neutrophils through dihydrorhodamine (DHR) 123 testing, and genotyped 361 genes related to IEI through targeted (panel) sequencing. RESULTS The median age of the 53 individuals was four months (IQ 1.5-12), and 52.8% were male. Forty-eight (90.6%) individuals presented only locoregional AE and five (9.4%) presented both locoregional and disseminated AE. Nine (16.9%) patients were diagnosed with an IEI. Four of them presented BCGitis and five presented BCGosis after BCG vaccination. Clinically, four presented chronic granulomatous disease (CGD), three Mendelian susceptibility to mycobacterial disease (MSMD), and two severe combined immunodeficiency (SCID). Patients with IEI had a higher frequency of systemic symptomatology (p = 0.002), history of other infections (p < 0.001), parental consanguinity (p = 0.01), familial history of sick siblings (p < 0.001), or early deaths in the family (p < 0.01). CONCLUSION There is a high frequency of IEI in patients with locoregional and disseminated adverse events to BCG vaccination, revealing the need for the investigation of IEI accompanied by clinical and familial inquiry.
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Affiliation(s)
- Paula T Lyra
- Department of Clinical Immunology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil. .,Children's Department of Infectious Disease, Oswaldo Cruz University Hospital (HUOC), Universidade de Pernambuco (UPE), Recife, PA, Brazil.
| | - Edvaldo Souza
- Department of Clinical Immunology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Faculdade Pernambucana de Saúde (FPS), Recife, PA, Brazil
| | - Ana Carla A Moura
- Department of Clinical Immunology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Children's Department of Infectious Disease, Oswaldo Cruz University Hospital (HUOC), Universidade de Pernambuco (UPE), Recife, PA, Brazil
| | - Marina C Matta
- Translational Research Laboratory Prof. C. A. Hart, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Leuridan C Torres
- Translational Research Laboratory Prof. C. A. Hart, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | | | - Maria Ângela W Rocha
- Children's Department of Infectious Disease, Oswaldo Cruz University Hospital (HUOC), Universidade de Pernambuco (UPE), Recife, PA, Brazil
| | - Luiz Arraes
- Department of Clinical Immunology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco (UFPE), Recife, PA, Brazil
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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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Troch RL, Kochis S, Milstone AM, Jain S, Lederman H, Sick-Samuels AC. Fever and an Abdominal Mass in an 18-month-old Boy. Pediatr Rev 2020; 41:S94-S97. [PMID: 33004595 PMCID: PMC7670867 DOI: 10.1542/pir.2018-0312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Suzanne Kochis
- Department of Pediatrics.,Division of Pediatric Allergy and Immunology
| | - Aaron M Milstone
- Department of Pediatrics.,Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sanjay Jain
- Department of Pediatrics.,Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Howard Lederman
- Department of Pediatrics.,Division of Pediatric Allergy and Immunology
| | - Anna C Sick-Samuels
- Department of Pediatrics.,Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
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Roh EJ, Lee YK, Lee MH, Kim MK, Kim TE, Lee SG, Chung EH. Investigation of adverse events following bacille Calmette-Guérin immunization using immunization safety surveillance system in Korea Centers for Disease Control and Prevention. Clin Exp Vaccine Res 2020; 9:133-145. [PMID: 32864370 PMCID: PMC7445325 DOI: 10.7774/cevr.2020.9.2.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose The report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC. Materials and Methods We reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018. Results There were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates. Conclusion The AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.
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Affiliation(s)
- Eui Jeong Roh
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Youn-Kyung Lee
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea, Centers for Disease Control and Prevention, Cheongju, Korea.,Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Korea
| | - Min-Kyoung Kim
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea, Centers for Disease Control and Prevention, Cheongju, Korea
| | - Tae Eun Kim
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea, Centers for Disease Control and Prevention, Cheongju, Korea
| | - Sok Goo Lee
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
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Engelis A, Kakar M, Meikšāns R, Petersons A. BCG-SSI(®) vaccine-associated lymphadenitis: Incidence and management. MEDICINA-LITHUANIA 2016; 52:187-91. [PMID: 27496189 DOI: 10.1016/j.medici.2016.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 02/29/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI(®) vaccine and to evaluate the treatment results. MATERIAL AND METHODS The study included 194 patients. All patients had received the BCG-SSI(®) vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment - the affected lymph node extirpation. RESULTS The mean age of the patients was 5.12±0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11%±0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n=193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71±0.18 days. CONCLUSIONS The incidence of BCG-SSI(®) vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.
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Affiliation(s)
- Arnis Engelis
- Department of Pediatric Surgery, Riga Stradins University, Riga, Latvia; Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia.
| | - Mohit Kakar
- Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
| | - Roberts Meikšāns
- Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
| | - Aigars Petersons
- Department of Pediatric Surgery, Riga Stradins University, Riga, Latvia; Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
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Kuchukhidze G, Kasradze A, Dolakidze T, Baliashvili D, Merabishvili T, Blumberg HM, Kempker RR. Increase in Lymphadenitis Cases after Shift in BCG Vaccine Strain. Emerg Infect Dis 2016; 21:1677-9. [PMID: 26291303 PMCID: PMC4550156 DOI: 10.3201/2109.150289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Adverse reactions to the Bacillus Calmette–Guérin (BCG) vaccine in new-born infants—an evaluation of the Danish strain 1331 SSI in a randomized clinical trial. Vaccine 2016; 34:2477-82. [DOI: 10.1016/j.vaccine.2016.03.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/22/2022]
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A study of the incidence of BCG vaccine complications in infants of Babol, Mazandaran (2011-2013). CASPIAN JOURNAL OF INTERNAL MEDICINE 2016; 7:48-51. [PMID: 26958333 PMCID: PMC4761123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND BCG vaccination which is administered to prevent tuberculosis is sometimes associated with serious complications. This study aimed to determine the incidence of complications of BCG vaccination in Babol. METHODS All infants who received BCG vaccination between 2011-2013 in health centers of Babol entered the study. Data regarding complications of vaccine were extracted according to the National Inventory of babies. All complicated cases were confirmed by the Academic Committee to review the adverse consequences of the vaccine. RESULTS Among the 15984 vaccinated neonates, 150 (0.93%) cases presented lymphadenitis. 46.5% were females and 53.5% were males; 43% were rural residents and 57% were urban residents. No cases of lymphadenitis including 1% of lymphadenitis with abscess formation were recovered without treatment. Disseminated infection occurred in 3 cases of immune deficient patients who responded to the treatment. Most complications occurred during 4 months after vaccination. CONCLUSION According to the results of this study, the prevalence of lymphadenitis in Babol was higher than the standard of WHO. This may be attributed to type and vaccine storage and injection technique. These findings justify further training of health-center workers.
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Lechiche C, Charpille M, Saissi G, Sotto A. [Assessment of BCG vaccine practices]. Arch Pediatr 2015; 23:34-8. [PMID: 26552631 DOI: 10.1016/j.arcped.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
Tuberculosis is a major public health problem. In France, the vaccine against tuberculosis (Bacillus Calmette-Guerin, BCG) is in decline. This decline is firstly due to changes in BGG administration that were implemented in 2006 and secondly because of new recommandations in 2007 that ended compulsory vaccination. To determine their position on this vaccine, in 2013-2014 we asked general practitioners, pediatricians, and Maternal and Infantile Protection Center physicians in the Gard and Herault departments (in Southern France) why this vaccine was not administered and their suggestions for improvement. Most of these doctors (73.9%) stated that they did not oppose this vaccination for children. They expressed concern about potential side effects, technical problems (intradermic injection, multi-dose bottles) and parents' refusal. One quarter of these physicians would have preferred that this vaccine remains compulsory and one third that this vaccine be administered in the maternity hospital. They also requested simplified criteria for patient eligibility, technical improvements (training for intradermal injection, single-dose vaccine) and more information for the public concerning this vaccination.
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Affiliation(s)
- C Lechiche
- Service des maladies infectieuses et tropicales, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - M Charpille
- Service des maladies infectieuses et tropicales, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - G Saissi
- Réanimation chirurgicale, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - A Sotto
- Réanimation chirurgicale, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
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Primary Immunodeficiency Diseases in Saudi Arabia: a Tertiary Care Hospital Experience over a Period of Three Years (2010-2013). J Clin Immunol 2015; 35:651-60. [PMID: 26395454 DOI: 10.1007/s10875-015-0197-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Primary immunodeficiencies (PID) are a group of heterogeneous diseases. Epidemiological studies from databases worldwide show geographical variation. In this study the objective is to determine the spectrum of PID in Saudi Arabia by analyzing the database in a referral tertiary hospital. METHODS This is a prospective data collection by interviews and medical chart review for all PID patients followed at the King Faisal Specialist Hospital & Research Center (KFSH&RC) from May 2010 to April 2013. RESULTS A total of 502 patients presented (53 % male and 47 % female). Combined immunodeficiencies were the most common (59.7 %), followed by predominantly antibody deficiencies (12.3 %), congenital defects of phagocyte (9.4 %), combined immunodeficiencies with associated or syndromic features (6.2 %), disease of immune dysregulation (6 %), complement deficiencies (5.8), and defects in innate immunity (0.6 %). The most common combined immunodeficiencies phenotype was T-B-SCID (17 %). The patients' ages ranged from less than 1 year old to 78 years, and 394 patients (78.2 %) are in the paediatrics age group (<14 years). The overall mean age of symptoms onset was 17 months and the overall mean delay in diagnosis was 21.6 months. Recurrent infections were the most common occurring clinical presentation (66 %), followed by family history (26 %). Consanguinity was found in 75 % of the patients. A total of 308 (61 %) patients had undergone stem cell transplantation (SCT). CONCLUSION The study revealed that combined immunodeficiencies are not uncommon and are the most frequent occurring diagnosis in our patient population. This study is a prerequisite to establish a national registry of primary immunodeficiency in Saudi Arabia.
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Varghese B, Al-Hajoj S. Mapping the epidemiology and trends of extra-pulmonary tuberculosis in Saudi Arabia. Int J Mycobacteriol 2015; 4:261-9. [PMID: 26964806 DOI: 10.1016/j.ijmyco.2015.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/18/2022] Open
Abstract
An extra-pulmonary tuberculosis (EPTB) infection rate of 30% in Saudi Arabia remains above the global rate. A variable rate of infection in each province has been reported and the involvement of most organs has been cited. Nationwide collective data on the current trends of infection are scarce and the factors behind the increased rate of EPTB are perplexing. This review endeavors to shed light into the epidemiology of EPTB, various types of infections sites, geographical differences in the infection rate, known risk factors, and challenges in the diagnosis and management of EPTB in Saudi Arabia.
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Affiliation(s)
- Bright Varghese
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahal Al-Hajoj
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Elsidig N, Alshahrani D, Alshehri M, Alzahrani M, Alhajjar S, Aljummah S, Bin Hussain I, Alshaalan M, Alzamil F, Alodyani A, Aljobair F. Bacillus Calmette-Guérin vaccine related lymphadenitis in children: Management guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2015; 2:89-95. [PMID: 30805444 PMCID: PMC6372430 DOI: 10.1016/j.ijpam.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
Abstract
The Bacillus Calmette–Guérin (BCG) vaccine contains live attenuated Mycobacterium bovis; was first used in humans to prevent tuberculosis (TB) in 1921. The World Health Organization (WHO) established the Expanded Program on Immunization in 1974 to ensure that all children have access to routinely recommended vaccines including BCG. Each year 120 million doses of BCG vaccine are administered worldwide. Intradermal BCG vaccine gives rise to a classic primary complex that consists of a cutaneous nodule at the site of injection and subclinical involvement of the regional lymph nodes, which is self-limiting and requires no treatment. However, ipsilateral regional lymph node enlargement may follow BCG vaccine and is considered as the most common complication, some progress to suppuration. Rarely a disseminated BCG infection may develop in immunocompromised individuals resulting in a devastating outcome. Within the last decades, variable strategies have been applied in treating lymphadenitis related to BCG vaccine, ranging from observation, anti-mycobacterial therapy, aspiration, incision and drainage to lymph node surgical excision. We are presenting these guidelines that intended to optimize and standardize management of various types of BCG related lymph adenitis in children. They are based upon the best available evidence in literature beside our experience in this field.
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Affiliation(s)
- Nagi Elsidig
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dayel Alshahrani
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alshehri
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alzahrani
- Pediatric Infectious Diseases, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sami Alhajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suliman Aljummah
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ibrahim Bin Hussain
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammad Alshaalan
- Pediatric Infectious Diseases, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Fahad Alzamil
- Pediatric Infectious Diseases, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Abdularahman Alodyani
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fahad Aljobair
- Pedantic Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
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13
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Indumathi CK, Kowtal PM, Poornima RN, Lewin S. Clinical profile and outcome of clinical BCG disease in infants. Indian Pediatr 2015; 51:730-2. [PMID: 25228607 DOI: 10.1007/s13312-014-0491-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the clinical profile, immunological status and outcome of BCG disease in infants. METHODS All infants with a diagnosis of BCG disease in a period of 17 months were followed up. RESULTS Among 25 infants with BCG disease; 19 had local/regional involvement and 6 had suspected or confirmed distant/disseminated disease, Mean (range) age of presentation was 3.6 (1.5-9) months. Two of 6 infants with disseminated disease required second-line anti-tubercular treatment. One infant with confirmed disseminated disease had INFg R1 receptor deficiency. There was no mortality. CONCLUSION Most infants with BCG- related disease have local or regional disease.
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Affiliation(s)
- C K Indumathi
- Department of Pediatrics, St. John's Medical College Hospital, Bangalore, India. Correspondence to: Dr CK Indumathi, Associate Professor, Department of Pediatrics, St John's Medical College Hospital, Sarjapur Road, Bangalore 560 034, Karnataka, India.
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Biering-Sørensen S, Jensen KJ, Aamand SH, Blok B, Andersen A, Monteiro I, Netea MG, Aaby P, Benn CS, Hasløv KR. Variation of growth in the production of the BCG vaccine and the association with the immune response. An observational study within a randomised trial. Vaccine 2015; 33:2056-65. [DOI: 10.1016/j.vaccine.2015.02.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/20/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Suliman OM, Ahmed MJ, Bilal JA. Clinical characteristics and needle aspiration management of Bacillus Calmette-Guérin lymphadenitis in children. Saudi Med J 2015; 36:280-5. [PMID: 25737168 PMCID: PMC4381010 DOI: 10.15537/smj.2015.3.10294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/19/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment. METHODS Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration. RESULTS The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary lesions; with a mean lymph node size of 3.2 cm. Abscesses were detected by ultrasound in 8 (80%). Non-suppurative lymphadenitis was conservatively managed, while suppurative was aspirated. The mean duration for resolution was 3.25 months. Lymph nodes aspirate were positive for acid and alcohol fast bacilli in 10 patients (66.6%), and 3 of them grew Staphylococcus aureus. CONCLUSION Bacillus Calmette-Guérin adenitis occurs in young children, mainly as unilocular suppurative left axillary group with a mean size of 3.2 cm. Needle aspiration is safe in treatment of suppurative lymphadenitis. Mycobacteria stained positive in most of the suppurative lesions. Excision is not needed.
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Affiliation(s)
- Omer M Suliman
- Department of Pediatrics, Al-Rass General Hospital, Al-Rass, Kingdom of Saudi Arabia. E-mail.
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Al-Hajoj S, Shoukri M, Memish Z, AlHakeem R, AlRabiah F, Varghese B. Exploring the sociodemographic and clinical features of extrapulmonary tuberculosis in Saudi Arabia. PLoS One 2015; 10:e0101667. [PMID: 25647300 PMCID: PMC4315397 DOI: 10.1371/journal.pone.0101667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/10/2014] [Indexed: 12/23/2022] Open
Abstract
Background Saudi Arabia annually reports a relatively higher proportion (28–32%) of extrapulmonary tuberculosis (EPTB) cases in comparison to other global regions. However, there were few studies conducted so far to determine the sociodemographic factors and clinical manifestations associated with EPTB at a nationwide level. Methodology A retrospective analysis on culture positive EPTB isolates collected from all the provinces of the country were conducted for a period of 12 months to determine the spectrum of diversity in EPTB infection sites and the confounding factors. A detailed clinical and demographical data analysis was carried out along with first line drug susceptibility testing. Principal Findings Intra-thoracic and extra-thoracic lymph nodes (44.6%) were the most common sites of infection followed by gastrointestinal (17.3%) and central nervous systems (11.8%). Male patients were mostly infected (58.8%), in contrary to the global trend. Any drug resistance was observed in 23.1% isolates with a 2.1% of multi-drug resistance. HIV reactivity was found only in 2.2% cases. A higher proportion of Saudi nationals (58.8%) were infected compared to the immigrants, descending mostly from South Asia (34.4%) and South East Asia (31.2%). The Saudi population predominated with all forms of EPTB while immigrants showed no significant variations. Conclusions Saudi Arabia faces a serious threat from EPTB, particularly to the central nervous system and gastrointestinal systems. More effective diagnostic strategies and control measures must be implemented to reduce the high rate of EPTB in the country. In addition, these findings warrant further detailed research to explore all related comorbid conditions of EPTB development, particularly the host-related factors.
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Affiliation(s)
- Sahal Al-Hajoj
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- * E-mail:
| | - Mohammed Shoukri
- National Biotechnology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ziad Memish
- Preventive Medicine Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - Raafat AlHakeem
- Preventive Medicine Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - Fahad AlRabiah
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bright Varghese
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Molecular confirmation of Bacillus Calmette Guerin vaccine related adverse events among Saudi Arabian children. PLoS One 2014; 9:e113472. [PMID: 25409184 PMCID: PMC4237431 DOI: 10.1371/journal.pone.0113472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bacillus Calmette Guerin (BCG) is the only available vaccine for tuberculosis (TB). Low grade complications in healthy recipients and disseminated vaccine associated complications among immuno-suppressed individuals were noticed globally after administration. Recently a series of clinically suspected BCG associated suppurative and non-suppurative lymphadenitis cases were reported from different regions of Saudi Arabia. However a molecular confirmative analysis was lacking to prove these claims. METHODOLOGY During 2009-2010, 42 Mycobacterium bovis BCG suspected clinical isolates from children diagnosed with suppurative lymphadenitis from different provinces of the country were collected and subjected to 24 loci based MIRU-VNTR typing, spoligotyping and first line anti-TB drugs susceptibility testing. PRINCIPAL FINDINGS Of the total 42 cases, 41 (97.6%) were Saudi nationals and particularly male (64.3%). Majority of the cases were aged below 6 months (83.3%) with a median of age 4 months. All the enrolled subjects showed left axillary mass which suppurated in a median of 4 months after vaccination. Among the study subjects, 1 (2.4%) case was reactive to HIV antigen and 2 (4.8%) case had severe combined immunodeficiency. Genotyping results showed that, 41 (97.6%) isolates were identical to the vaccine strain Danish 1331 and one to Tokyo 172-1. Phylogenetic analysis revealed all the Danish 1331 isolates in a single cluster. CONCLUSION Elevated proportion of suppurative lymphadenitis caused by M. bovis BCG reported in the country recently is majorly related to the vaccine strain Danish 1331. However lack of nationwide data on real magnitude of BCG related adverse events warrants population centric, long term future studies.
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Soh SBL, Han PY, Tam KT, Yung CF, Liew WK, Tan NWH, Chong CY, Thoon KC. Investigations into an outbreak of suppurative lymphadenitis with BCG vaccine SSI® in Singapore. Vaccine 2014; 32:5809-15. [DOI: 10.1016/j.vaccine.2014.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/06/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
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Al-Hajoj S, Varghese B, Al-Habobe F, Shoukri MM, Mulder A, van Soolingen D. Current trends of Mycobacterium tuberculosis molecular epidemiology in Saudi Arabia and associated demographical factors. INFECTION GENETICS AND EVOLUTION 2013; 16:362-8. [PMID: 23523599 DOI: 10.1016/j.meegid.2013.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 12/11/2022]
Abstract
Data are scarce on demographical factors related to the population structure of Mycobacterium tuberculosis in Saudi Arabia. A study was conducted on 902 clinical isolates to explore current trends in the phylogeography and associated demographical factors of tuberculosis by using spoligotyping and 24 loci based MIRU-VNTR typing. Young male patients (aged 16-29 and 30-44) were predominant in this cohort. The phylogenetic diversity among M. tuberculosis isolates was found high, as almost all known genetic lineages were identified. Delhi/CAS (26.4%), EAI (13.7%) and Haarlem (11.3%) were the most common lineages observed, particularly among the low age groups (16-29 and 30-44 years), whereas elderly patients (>60 years) showed a predominance in the lineages S, Ghana, TUR and Uganda-I. A statistically significant association was observed between gender of the patients and lineages of EAI (p value 0.026) and LAM (p value 0.005). Overall, molecular strain cluster rate was 34.4% with an elevated rate among patients aged below 15 years (43.1%), while cases among the elderly (>60 years) showed the lowest degree of clustering (12.5%). The largest level of clustering was noticed among cases caused by strains of the lineages Haarlem (59.8%), Beijing (55.8%) and LAM (42.8%). The current population structure of M. tuberculosis in Saudi Arabia is highly diverse with significant associations to demography, transmission dynamics and origin of the patients. The difference in genotype distributions among low and high aged patients reflects the ongoing change in the strain population structure in the country.
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Affiliation(s)
- Sahal Al-Hajoj
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
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Varghese B, Supply P, Allix-Béguec C, Shoukri M, Al-Omari R, Herbawi M, Al-Hajoj S. Admixed phylogenetic distribution of drug resistant Mycobacterium tuberculosis in Saudi Arabia. PLoS One 2013; 8:e55598. [PMID: 23383340 PMCID: PMC3562184 DOI: 10.1371/journal.pone.0055598] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 12/27/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The phylogeographical structure of Mycobacterium tuberculosis is generally bimodal in low tuberculosis (TB) incidence countries, where genetic lineages of the isolates generally differ with little strain clustering between autochthonous and foreign-born TB patients. However, less is known on this structure in Saudi Arabia-the most important hub of human migration as it hosts a total population of expatriates and pilgrims from all over the world which is equal to that of its citizens. METHODOLOGY We explored the mycobacterial phylogenetic structure and strain molecular clustering in Saudi Arabia by genotyping 322 drug-resistant clinical isolates collected over a 12-month period in a national drug surveillance survey, using 24 locus-based MIRU-VNTR typing and spoligotyping. PRINCIPAL FINDINGS In contrast to the cosmopolitan population of the country, almost all the known phylogeographic lineages of M. tuberculosis complex (with noticeable exception of Mycobacterium africanum/West-African 1 and 2) were detected, with Delhi/CAS (21.1%), EAI (11.2%), Beijing (11.2%) and main branches of the Euro-American super-lineage such as Ghana (14.9%), Haarlem (10.6%) and Cameroon (7.8%) being represented. Statistically significant associations of strain lineages were observed with poly-drug resistance and multi drug resistance especially among previously treated cases (p value of < = 0.001 for both types of resistance), with relative over-representation of Beijing strains in the latter category. However, there was no significant difference among Saudi and non-Saudi TB patients regarding distribution of phylogenetic lineages (p = 0.311). Moreover, 59.5% (22/37) of the strain molecular clusters were shared between the Saudi born and immigrant TB patients. CONCLUSIONS Specific distribution of M. tuberculosis phylogeographic lineages is not observed between the autochthonous and foreign-born populations. These observations might reflect both socially favored ongoing TB transmission between the two population groups, and historically deep-rooted, prolonged contacts and trade relations of the peninsula with other world regions. More vigorous surveillance and strict adherence to tuberculosis control policies are urgently needed in the country.
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Affiliation(s)
- Bright Varghese
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Philip Supply
- Genoscreen, Lille, France
- INSERM, U1019, Lille, France
- CNRS UMR 8204, Lille, France
- Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
- Univ Lille Nord de France, Lille, France
| | | | - Mohammed Shoukri
- National Biotechnology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ruba Al-Omari
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mais Herbawi
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahal Al-Hajoj
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- * E-mail:
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Al Jumaah S, Al Hajjar S, Al Mousa H. Bacille Calmette-Guérin vaccination in Saudi Arabia: benefits versus risks. Ann Saudi Med 2012; 32:1-3. [PMID: 22156632 PMCID: PMC6087653 DOI: 10.5144/0256-4947.2012.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Suliman Al Jumaah
- Section of Infectious Diseases, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sami Al Hajjar
- Section of Infectious Diseases, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hamoud Al Mousa
- Section of Allergy Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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