Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Obaid, Sami; Weil, Alexander G.; Rahme, Ralph; Gendron, Cathy; Shédid, Daniel

doi:10.4103/2152-7806.89879

Cited by 24 publications

(21 citation statements)

References 31 publications

(67 reference statements)

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“… 157 The spread of the mycobacteria from the lower urinary tract to the spine via the Batson venous plexus may be the pathogenic mechanism underlying this association. 147 The precocity in the onset of intravesical instillations after the immediately preceding TUR would in theory favor that the bacilli gain access to lymphatics and bloodstream through the disruption of the urothelial integrity. 106 Nevertheless, in our institutional cohort there were no differences in the time interval between those procedures according to the subsequent development of complications.…”

Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0–9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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“…Since 1976, BCG has been administered intravesically to treat transitional cell carcinoma of the bladder, and has previously been proven to be a safe and effective therapy [1] , [2] . Mycobacterium bovis was first isolated by Nocard from the milk of a heifer with tuberculosis mastitis, this strain was called ‘lait Nocard’ [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Since 1976, BCG has been administered intravesically to treat transitional cell carcinoma of the bladder, and has proven to be a safe and effective therapy for various carcinomas in situ [1] , [2] . It comes with potential side effects [3] , where serious reactions may occur in less than 5% of patients [2] . One of the most worrisome is a systemic granulomatous infection with the BCG strain [2] .…”

Section: Introductionmentioning

confidence: 99%

“…It comes with potential side effects [3] , where serious reactions may occur in less than 5% of patients [2] . One of the most worrisome is a systemic granulomatous infection with the BCG strain [2] . Osteitis is rare following BCG immunization, occurring in less than 37 per 100,000 cases [2] .…”

Section: Introductionmentioning

confidence: 99%

“…One of the most worrisome is a systemic granulomatous infection with the BCG strain [2] . Osteitis is rare following BCG immunization, occurring in less than 37 per 100,000 cases [2] . As of 2016 there were only 16 cases of vertebral osteomyelitis secondary to intravesical BCG reported in the English literature [1] .…”

Section: Introductionmentioning

confidence: 99%

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Mycobacteria Bovis osteomyelitis following intravesical BCG for bladder cancer

Seegobin

Maharaj

Baldeo

et al. 2017

IDCases

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Mycobacteria Bovis osteomyelitis is a rare adverse effect after Bacillus Calmette-Guerin (BCG) intravesical therapy. A 62-year-old male presented with acute spinal cord compression three months after completing his second course of therapy for bladder cancer. The first course with intravesical BCG was complicated with an episode of hematuria. He reported intermittent subjective fever for 3 weeks thereafter which resolved with Tylenol. Interferon-α2 B was added to the second cycle of intravesical BCG with the indication here being residual tumor, and was tolerated well. His complete blood count and liver function tests were unremarkable on admission. MRI showed features of osteomyelitis with cord compression at T4/T5. Biopsy of the affected bone showed caseating granuloma which was positive for acid fact bacilli, later confirmed to be Mycobacterium Bovis by PCR and pyrazinamide resistance. He was started on intravenous steroids and underwent spinal cord decompression. Rifampin, Isoniazid, and Ethambutol were then commenced. His weakness improved and after two months of therapy he was asymptomatic and back to his baseline function. Osteomyelitis is a rare but serious complication. Early diagnosis and treatment is important as the outcomes are good.

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Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

et al. 2019

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Introduction: Mycobacterium bovis BCG instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. Methods: We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added 3 new French cases. Review: Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 year-old. Median time between diagnosis and first and last instillation was 22.5 months and 14 months respectively. Half of vertebral osteomyelitis was thoracic, and lumbar in the other half. Sensitivomotor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. Conclusion: M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.

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Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Cited by 24 publications

References 31 publications

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Mycobacteria Bovis osteomyelitis following intravesical BCG for bladder cancer

Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

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