BCG osteomyelitis: experience in the Stockholm region over the years 1961-1974

Abstract

Eighteen cases of bone and joint tuberculosis in children were diagnosed in the Stockholm region (about 1,500,000 population) over the period 1961-1974. BCG infection was verified by culture and identification of bacterial type in seven, all after 1968. The same origin can be presumed in most of the remaining eleven cases, in spite of the absence of bacterial verification. The increased frequency of complications after BCG vaccination may necessitate a revision of the vaccination programme. We recommend operative treatment, which has not led to any growth disturbances or impairment of joint function, although the lesions were invariably localised close to growth zones and joints.

Nonresponding osteomyelitis in a two-year-old boy

“…The "typical" radiographic picture of BCG osteomyelitis includes a well-demarcated destruction, usually located eccentrically in the metaphysis (sometimes in the epiphysis), a breakthrough of the cortex and no or slight spread of the lesion along the shaft, with scarce periosteal reaction. 13 In seven published case series, surgical biopsy was performed in all but 1 of the 287 pa tients (Appendix 1). Substantial variability in investigations done to confirm the diagnosis occurred.…”

“…Surgical intervention allows for removal of necrotic tissue and drainage of abscess material, which improves antibiotic penetration. 13 …”

Complications rhumatologiques de la BCG-thérapie

“…Les complications générales sont liées soit à une dissé-mination à un organe (os, articulation, foie, méninges) par voie lymphatique ou hématogène, soit une bécégite miliaire généralisée, tout à fait exceptionnelle, qui ne s'observe que chez des patients immunodéprimés. Les infections ostéoarti-culaires à M. bovis [2][3][4][5][6][7][8][9][10][11][12] surviennent en général chez des enfants immunocompétents. La prévalence est variable en fonction des pays, plus importante dans les pays scandinaves que dans le reste de l'Europe.…”

“…Elles surviennent en moyenne 20 mois (de 3 mois à 5 ans) après la vaccination [2,3]. Elles touchent les épiphyses et les métaphyses des os longs, et prédominent aux membres infé-rieurs (genoux).…”

Clinical Features of BCG Lymphadenitis

“…. 국소적 이상반응으로 주사 부위에 궤 양, 림프절염 등이 있고, 심한 경우 파종성 BCG 감염, 골염 등도 생길 수 있다 [13][14][15] . 이 중 BCG 림프절염은 비교적 흔한 이상반응으로 발생 빈도는 다양하게 보고되고 있다 3,[16][17][18] .…”