Fatal Disseminated BCG Infection

Bacillus Calmette Guérin (BCG) is an attenuated strain of Mycobacterium bovis that is currently used as a live vaccine for human tuberculosis. Disseminated BCG infection may rarely occur following vaccination of children. In half of the cases, regarded as idiopathic, no well‐defined immunodeficiency condition can account for the infection. However, the high rates of parental consanguinity and familial forms and the associated opportunistic infections with Salmonella suggest that these idiopathic BCG infections result from one or several new type(s) of inherited immune disorder(s). As an approach to the description and understanding of this newly described condition, the associated lesions were examined. Samples from 14 patients collected from a French national retrospective study were analysed. Pathological data from 22 cases reported in the world literature were also reviewed. Two types of granuloma were found. The first type (type I, tuberculoid) consisted of well‐circumscribed and well‐differentiated granulomas, with epithelioid and multinucleated giant cells containing very few acid‐fast rods, surrounded by lymphocytes and fibrosis and occasionally with central caseous necrosis. The second type (type II, lepromatous‐like) consisted of ill‐defined and poorly differentiated granulomas, with few if any giant cells and lymphocytes but widespread macrophages loaded with acid‐fast bacilli. Most children displayed a single type of granuloma. One half displayed type I lesions and the other half displayed type II lesions. There was a strong correlation between the type of granuloma and the clinical outcome. Tuberculoid lesions were associated with survival, whilst lepromatous‐like lesions correlated with death. Correlation of granuloma structure with clinical outcome defines two types of idiopathic disseminated BCG infection. The phenotypic heterogeneity of the course of BCG infection reflects distinct pathogenic mechanisms and probably results from a genotypic heterogeneity of the underlying inherited immune disorder. © 1997 by John Wiley & Sons, Ltd.

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Correlation of Granuloma Structure With Clinical Outcome Defines Two Types of Idiopathic Disseminated BCG Infection

Émile

et al. 1997

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Disseminated bcg disease associated with immunotherapy by scarification in acute leukemia

Ritch

McCredie

Gutterman

et al. 1978

Cancer

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Disseminated BCG infection developed in a patient with acute leukemia receiving BCG immunotherapy by scarification. Predisposing factors included the underlying malignancy, intensive chemotherapy, and continuous high-dose corticosteroids. The scarification technique is safe; however, physicians should be alert to this syndrome as a cause of fever of unknown origin in cancer patients receiving BCG immunotherapy.

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BCG immunotherapy: Effects of dose and route of administration on survival of mice bearing established tumors

Codish¹,

Monaco²

1978

Journal of Surgical Oncology

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Bacillus Calmette-Guérin (BCG) was administered in various doses by four different routes to C3H/HeJ mice bearing well-established syngeneic MC-42 fibrosarcomas. Injections of BCG into established primary tumors decreased survival of tumor-bearing mice as compared to saline-injected controls. Of the three dosage groups, high-dose (10(8) viable organisms) intralesional BCG was most detrimental. The injection of low-dose BCG (10(4) organisms) into established tumors or subcutaneously at a distant site also shortened host survival times. Other subcutaneous injections and injections of BCG into the peritoneal or pleural cavities had no significant effect on survival, regardless of dosage. The dose-dependent effects of BCG immunotherapy which may prolong or shorten survival are discussed.

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Fatal Disseminated BCG Infection

Cited by 18 publications

References 17 publications

Correlation of Granuloma Structure With Clinical Outcome Defines Two Types of Idiopathic Disseminated BCG Infection

Correlation of Granuloma Structure With Clinical Outcome Defines Two Types of Idiopathic Disseminated BCG Infection

Disseminated bcg disease associated with immunotherapy by scarification in acute leukemia

BCG immunotherapy: Effects of dose and route of administration on survival of mice bearing established tumors

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