Generalized BCG Infection with Fatal Course in an Infant

Abstract

SUMMARY A fatal case of generalized BCG infection following vaccination is reported. The patient, a girl BCG‐vaccinated at the age of six weeks, developed septic fever and leucocytosis at 5 1/2 months of age and died at 7 months of age in a poor condition with extensive edemas, icterus and severe attacks of general convulsions. Autopsy revealed disseminated tuberculosis. The histological picture showed little tendency to tuberculoid structure, marked caseous necrosis and myriads of acid‐fast bacilli in the affected areas. By bacteriological examination the acid‐fast bacilli were indistinguishable from BCG. Increased virulence or other changes in the BCG vaccine which might explain the fatal complication has not been found. Two of the patient's three siblings had previously shown definite signs of reduced resistance to infection, and both died at an early age from infections. Adding this to the patient's case history, one feels justified in concluding that a familial resistance impairment to infection is present. The cause of this deficiency is discussed. There are at present five known cases of fatal BCG infection following vaccination in Scandinavia, and the number of persons vaccinated is estimated to be between 6 and 7 millions. The probable incidence of fatal complications can thus be put at less than one case per million vaccinated. As the protective effect of BCG vaccination is beyond doubt and the serious complications extremely rare, there seems to be no ground at present for objecting to continued BCG vaccination.

Congenital Agammaglobulinaemia in the Brother of a Boy who Died of Generalized BCG Infection

“…To date 9 cases of fatal generalized BCG infection have been published [9, 16, 171. In none of these were complete serological investigation or determination of immunoglobulins carried out. It is stated with regard to the most recent of them [9] that using an unspecified electrophorctic technique gammaglobulin estimation gave widely varying results (1.0 and 0.2 g/ 100 ml). These findings would fit in with a defect in the gammaglobulin fraction.…”

Fatal BCG Infection in an Immunocompetent Girl

“…Confirmed deficiency of cellular immunity, either as part of a severe combined immunodeficiency syndrome (3,9,11,20) or as an isolated cellular immunodeficiency (14,17), was present in seven cases. In all of these patients the histological findings in the affected organs differed from those seen as a response to BCG vaccination in immunocompetent individuals (10).…”

Generalized BCG Tuberculosis With Fatal Course in Two Sisters

“…A completely different immunological view must be taken of the I 1 published cases of BCG infection (4,5,7,8,18). I n all these cases, the clinical picture and evolution of generalized BCG infection differed from those in our patients and the cases described by Meyer and Thrap-Meyer (13,17).…”