Emergence of Nontuberculous Mycobacterial Lymphadenitis in Children After the Discontinuation of Mandatory Bacillus Calmette and GuÉrin Immunization in France

Lacroix, Adèle; Piau, Caroline; Lanotte, Philippe; Carricajo, Anne; Guillouzouic, A.; Peuchant, Olivia; Cady, Anne; Dupin, Clarisse; Fangous, Marie-Sarah; Martin, C.; Cariou, Marie-Estelle; Gall, Florence Le; Bémer, Pascale; Tattevin, Pierre

doi:10.1097/inf.0000000000001977

Cited by 13 publications

(16 citation statements)

References 10 publications

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“…This observation led the authors to conclude that calmetization had a protective effect against NTM infections in children. The French authors Lacroix et al 13 presented the same conclusion, describing an increase of Mycobacterium avium bacteriosis in children under 5 years of age in France from 0.57/100 000 to 3.7/100 000 during an interval of 6 years after the ending of the country's vaccination program in 2007. The Dutch authors Haverkamp, et al 14 reviewed the results of a two-year national study, the results of which correspond with our observations.…”

Section: Discussionmentioning

confidence: 77%

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Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003-2018

Doležalová¹,

Malý²,

Wallenfels³

et al. 2021

BIOMED PAP

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Aim. Comparision of the incidence of cervical lymphadenitis caused by nontuberculous mycobacteria in two equal time periods before and after the ending of widespread calmetization (tuberculosis vaccination). Backgroung. From 2011 to 2018, 89 children were registered in the Tuberculosis Register with cervical lymphadenitis caused by nontuberculous mycobacteria, as confirmed by cultivation. In the majority of cases, the infection was caused by a mycobacterium belonging to the Mycobacterium avium complex. Only 7 cases of cervical lymphadenitis of the same etiology were registered during the same time interval between 2003 and 2010. The authors consider the ending of widespread calmetization (tuberculosis vaccination) in 2010 to be the main cause of the growing incidence. Method. A comparison of data for the period 2003-2018 about cases of the illness caused by atypical mycobacteria as reported in the Tuberculosis Register. Results. The average incidence per year in the first interval was 0.04/100 000 children and in the second interval 0.53/100 000 children. During the second time interval, there was an increase from 0.14/100 000 children in 2011 to 1.40/100 000 children in 2018. While the incidence during the first time interval did not show any time trend (P=0.885), the year 2010 marks a significant turning point, with growth during the second interval being highly statistically significant (P<0.001).

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Section: Discussionmentioning

confidence: 77%

“…The protective effect of the BCG vaccine against nontuberculous mycobacterial infections has been demonstrated on mouse models 8 . The increase in incidence of lymphadenitis caused by nontuberculous mycobacteria in those countries that withdrew the widespread vaccination program has been repeatedly documented [9][10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003-2018

Doležalová¹,

Malý²,

Wallenfels³

et al. 2021

BIOMED PAP

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“…Cervical lymphadenitis is mostly caused by M. avium intracellulare complex (MAC). This NTM disease has increased significantly since the discontinuation of routine BCG vaccination in France [21], Sweden [22], the Czech Republic [23] and Finland [24].…”

Section: Bcg and Non-tuberculous Mycobacteriamentioning

confidence: 99%

Proposing BCG Vaccination for Mycobacterium avium ss. paratuberculosis (MAP) Associated Autoimmune Diseases

Dow

2020

Microorganisms

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Bacille Calmette–Guerin (BCG) vaccination is widely practiced around the world to protect against the mycobacterial infection tuberculosis. BCG is also effective against the pathogenic mycobacteria that cause leprosy and Buruli’s ulcer. BCG is part of the standard of care for bladder cancer where, when given as an intravesicular irrigant, BCG acts as an immunomodulating agent and lessens the risk of recurrence. Mycobacterium avium ss. paratuberculosis (MAP) causes a fatal enteritis of ruminant animals and is the putative cause of Crohn’s disease of humans. MAP has been associated with an increasingly long list of inflammatory/autoimmune diseases: Crohn's, sarcoidosis, Blau syndrome, Hashimoto’s thyroiditis, autoimmune diabetes (T1D), multiple sclerosis (MS), rheumatoid arthritis, lupus and Parkinson’s disease. Epidemiologic evidence points to BCG providing a “heterologous” protective effect on assorted autoimmune diseases; studies using BCG vaccination for T1D and MS have shown benefit in these diseases. This article proposes that the positive response to BCG in T1D and MS is due to a mitigating action of BCG upon MAP. Other autoimmune diseases, having a concomitant genetic risk for mycobacterial infection as well as cross-reacting antibodies against mycobacterial heat shock protein 65 (HSP65), could reasonably be considered to respond to BCG vaccination. The rare autoimmune disease, relapsing polychondritis, is one such disease and is offered as an example. Recent studies suggesting a protective role for BCG in Alzheimer’s disease are also explored. BCG-induced energy shift from oxidative phosphorylation to aerobic glycolysis provides the immunomodulating boost to the immune response and also mitigates mycobacterial infection—this cellular mechanism unifies the impact of BCG on the disparate diseases of this article.

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“…Histopathological findings suggestive of TB may support the EPTB diagnosis, but these are also present in other diseases including sarcoidosis and non-tuberculosis mycobacteria (NTM) infections. The incidence of NTM infections is also increasing in western countries [19][20][21][22]. Due to these diagnostic challenges, a definite diagnosis of EPTB is often difficult to obtain.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of extrapulmonary tuberculosis using the MPT64 antigen detection test in a high-income low tuberculosis prevalence setting

et al. 2020

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Background: Extrapulmonary tuberculosis (EPTB) poses diagnostic challenges due to the paucibacillary nature of the disease. The immunochemistry-based MPT64 antigen detection test (MPT64 test) has shown promising results for diagnosing EPTB in previous studies performed in low-resource settings, with higher sensitivity than microscopy and culture. The aim of this study was to investigate the performance of the MPT64 test in a routine clinical setting in a high-income low TB prevalence country. Methods: Extrapulmonary samples sent for TB diagnostics to microbiology and pathology laboratories at three regional tertiary care hospitals in Norway in a one-year period were included and subjected to the MPT64 test in parallel to the routine TB diagnostic tests. Results: Samples from 288 patients were included and categorised as confirmed TB cases (n = 26), clinically diagnosed TB cases (n = 5), non-TB cases (n = 243) and uncategorised (n = 14), using a composite reference standard (CRS). In formalin-fixed biopsies, the sensitivity (95% CI) of the MPT64 test, microscopy, PCR-based tests pooled, and culture was 37% (16-62), 20% (4-48), 37% (16-62) and 50% (23-77), respectively, against the CRS. The MPT64 test showed a good positive predictive value (88%) and an excellent specificity (99, 95% CI 92-100) in formalin-fixed biopsies. In fine-needle aspirates, pus and fluid samples, the test performance was lower. Conclusions: The MPT64 test was implementable in pathology laboratories as part of routine diagnostics, and although the sensitivity of the MPT64 test was not better than culture in this setting, the test supplements other rapid diagnostic methods, including microscopy and PCR-based tests, and can contribute to strengthen the diagnosis of EPTB in formalin-fixed biopsies in the absence of culture confirmation.

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Emergence of Nontuberculous Mycobacterial Lymphadenitis in Children After the Discontinuation of Mandatory Bacillus Calmette and GuÉrin Immunization in France

Cited by 13 publications

References 10 publications

Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003-2018

Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003-2018

Proposing BCG Vaccination for Mycobacterium avium ss. paratuberculosis (MAP) Associated Autoimmune Diseases

Diagnosis of extrapulmonary tuberculosis using the MPT64 antigen detection test in a high-income low tuberculosis prevalence setting

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