Disseminated Bacille Calmette-Guérin Infection at a Glance: A Mini Review of the Literature

Hassanzad, Maryam; Valinejadi, Ali; Darougar, Sepideh; Hashemitari, Seyed Karen; Velayati, Ali Akbar

doi:10.5603/arm.2019.0040

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…Although the usual treatment duration for BCGitis is 6 months, no treatment recommendations exist regarding immunocom-promised patients, since most data come from children with primary immunodeficiency syndromes for which regimens with various durations were used [ 60 – 62 ]. In a case report presented by Winger et al [ 63 ], a 16-year-old patient with systemic lupus erythematosus, diagnosed with intestinal M. bovis infection was treated for a total of 9 months, with symptoms resolution.…”

Section: Discussionmentioning

confidence: 99%

Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

et al. 2021

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Patient: Male, 62-year-old Final Diagnosis: BCGitis Symptoms: Fever • general fatigue Medication: — Clinical Procedure: Bone marrow biopsy • liver biopsy Specialty: Infectious Diseases • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Bladder cancer (BC) is the second most common cancer involving the urinary system. In non-muscle-invading BC, transurethral resection of a bladder tumor followed by intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) is the usual treatment. Disseminated (or systemic) BCG infection (BCGitis) represents the most severe adverse effect of intravesical BCG therapy, presenting with high-grade fever, with or without symptoms in the urinary tract, leading to severe sepsis and death if left untreated. The treatment of choice consists of isoniazid, rifampicin, and ethambutol (with or without corticosteroids) for 6 months, and the recovery rate is extremely high. Given the fact that these drugs are hepatotoxic, treating a patient with liver cirrhosis is challenging. Case Report: We present a patient with a medical history of BC treated with transurethral resection and intravesical BCG therapy, presenting with fever, transaminasemia, and generalized weakness. Liver and bone marrow biopsies revealed liver cirrhosis and granulomas in both organs. A diagnose of BCGitis was made and the patient was treated with isoniazid, rifampicin, and ethambutol; rifampicin was substituted with moxifloxacin after 1 month due to worsening of liver laboratory results, and moxifloxacin was substituted with levofloxacin later on due to tonic-clonic seizures. The patient was treated for 4 more months with levofloxacin and for 7 more months with isoniazid and ethambutol, with no other adverse effects, preserving liver function and achieving cure of BCGitis. Conclusions: We present the case of a cirrhotic patient presenting with fever and deterioration of liver laboratory results, found to have BCGitis, and discuss possible difficulties in diagnosing and treating such patients.

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Section: Discussionmentioning

confidence: 99%

Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

et al. 2021

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“… 6 , 7 Bacille Calmette-Guérin (BCG) infection may manifest as regional (BCGitis) or systemic disease (BCGosis) following BCG vaccination. 8 In addition, BCGitis may occur after commencement of antiretroviral therapy (ART) as part of immune reconstitution. This should be borne in mind, especially when children present with lymphadenitis involving axillary or supraclavicular nodes and granulomatous inflammation is noted on histological examination.…”

Section: Bacterial Infectionsmentioning

confidence: 99%

“…This should be borne in mind, especially when children present with lymphadenitis involving axillary or supraclavicular nodes and granulomatous inflammation is noted on histological examination. 8 , 9 Testing for Mycobacterium bovis is indicated in this setting. 8 Tuberculids such as erythema induratum are hypersensitivity reactions to mycobacterial antigens and no acid-fast bacilli are demonstrated in tissue biopsies from these lesions.…”

Section: Bacterial Infectionsmentioning

confidence: 99%

“… 8 , 9 Testing for Mycobacterium bovis is indicated in this setting. 8 Tuberculids such as erythema induratum are hypersensitivity reactions to mycobacterial antigens and no acid-fast bacilli are demonstrated in tissue biopsies from these lesions. 10 Although definitive mycobacterial species identification is not possible on histological examination, the finding of sheets of foamy histiocytes containing ZN and PAS-positive bacilli are suggestive of Mycobacterium avium complex as noted in case 3 (see Figure 3 ).…”

Section: Bacterial Infectionsmentioning

confidence: 99%

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Spectrum of HIV-associated infectious diseases: A case series through the eyes of the histopathologist

Mohanlal

Reddy

2020

Southern African Journal of HIV Medicine

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Background: Human immunodeficiency virus (HIV) infection increases the risk of infection by a host of other opportunistic pathogens. The clinical presentations of these co-infections in immunocompromised patients are often atypical; therefore diagnosis is delayed in the absence of investigations such as tissue biopsy. Infection may involve sites that are difficult to access for biopsy and, as a consequence, there is limited diagnostic tissue available for analysis. The histopathologist, aided by ancillary tests, is relied upon to make a timeous and accurate diagnosis.Objectives: To illustrate key histological features of HIV-associated infectious diseases encountered in a histopathology laboratory and to highlight, with the aid of literature, the relevance of histopathology in diagnosis.Method: A retrospective descriptive case series of biopsies histologically diagnosed with HIV-associated infectious diseases over four years (2015–2019) was performed at the Chris Hani Baragwanath Academic Hospital National Health Laboratory Services Histopathology department. These cases have been photographed to illustrate microscopic aspects and will be accompanied by a literature review of opportunistic infections in the context of HIV infection.Results: This article highlights aspects of fungal, parasitic, viral and selected bacterial infections of people living with HIV for whom the histopathological examination of tissue was an essential component of the clinical diagnosis. Histological features are noted on routine slides and accompanied by diagnostic features revealed with histochemical and immunohistochemical stains.Conclusion: Medical practitioners working in areas of high HIV endemicity should be familiar with the variety of infectious diseases that are encountered and with the diagnostic importance of the histopathologist in clinical management.

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“…The report focuses on the pressing need to define diagnostic and therapeutic pathways for the management of complications resulting from the BCG vaccine. Indeed, to date there is no unanimous consensus on the regimen of drugs to be used and on the duration of such treatments [6,7].…”

Section: Introductionmentioning

confidence: 99%

A case of disseminated BCG infection in a daughter of Italian immigrants in Switzerland

Colomba

Rubino

Tolomeo

et al. 2022

J Infect Dev Ctries

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Bacillus Calmette-Guérin (BCG) is a vaccine against tuberculosis and contains a live, attenuated strain of Mycobacterium bovis as its essential constituent. Being a live, attenuated strain with potential pathogenicity, BCG can cause different complications, both near the inoculation site and through blood dissemination, especially in patients with immunodeficiency. IFN-γR1 deficiency is an autosomal recessively inherited immunodeficiency characterized by predisposition to infections with intracellular pathogens, in particular mycobacteria. We report a rare case of chronic osteomyelitis lasting 30 years due to BCG in a woman with IFN-γR1 deficiency who had previous clinical history of multi-organ BCGitis. Diagnosis of chronic osteomyelitis was confirmed by an 18-fluorine fluorodeoxyglucose positron emission tomography combined with CT scan (18F-FDG PET/CT). In children with a history of BCG vaccination and chronic unexplained infections, a clinical suspicion of BCG-related disease must arise, and a reason of immunodeficiency should be sought.

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Disseminated Bacille Calmette-Guérin Infection at a Glance: A Mini Review of the Literature

Cited by 15 publications

References 28 publications

Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

Spectrum of HIV-associated infectious diseases: A case series through the eyes of the histopathologist

A case of disseminated BCG infection in a daughter of Italian immigrants in Switzerland

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