Osteitis Caused by Bacille Calmette-Guerin Vaccination: A Retrospective Analysis of 222 Cases

Abstract

To evaluate the frequency, clinical features, and prognosis of patients with osteitis caused by bacille Calmette-Guérin (BCG) vaccination, medical records from Finnish children based on nationwide registration from 1960 to 1988 were retrospectively analyzed. During the study period, three different BCG vaccine preparations were used. In 222 children, diagnostic criteria of BCG osteitis were fulfilled. The age at onset of BCG osteitis varied from 0.25 to 5.7 years. The most common sites of osteitis were metaphyses of the long bones. The lower extremity (58%) was affected more often than the upper (14%). Osteitis was situated in the sternum in 36 patients (15%) and in the ribs in 27 (11%). The frequency of BCG osteitis, but not the clinical parameters, was closely associated with the vaccine preparation used. Only 6 children were left with some sequelae. With adequate treatment, the prognosis for children vaccinated with BCG is good.

Osteíte por BCG Moreau em uma menina vacinada ao nascer

“…(6) In Finland, the incidence of osteitis has also been reported to vary according to the BCG strain. (7) We found no reports of osteitis caused by BCG Moreau. However, it should be noted that BCG Moreau is not as widely used as are other strains, particularly BCG Glaxo and BCG Pasteur-Paris.…”

Bacille Calmette-Guérin Vaccine-Induced Tuberculous Hip Osteomyelitis in an Infant: Case report

“…18 In a retrospective study, Kröger et al found that the age of onset of children with BCG-induced osteomyelitis varied from 0.25-5.7 years and that the most common sites affected were the metaphyses of the long bones, with the lower extremities more commonly affected than the upper. 19 A systematic review similarly revealed involvement of the lower limbs to be most common (55.6%), followed by involvement of the axial skeleton (26.0%), the upper limbs (15.4%) and multiple bones (3%). 16 An association with immunosuppression has also been documented.…”

Osteíte por BCG

“…(5) Osteitis after BCG vaccination is a rare condition, with an incidence of approximately 0.39/1,000,000, depending on the bacillus used. (6,7) Various cases as well as pain upon palpation and upon movement, of the proximal third of the right upper limb, without signs of inflammation.…”

“…present, fever is low and does not affect the general status of the individual. (4,7) On X-rays, lytic lesions with a sclerotic halo can be seen, as can periosteal reaction and periarticular osteoporosis. (4,(9)(10)(11) Histopathological studies show granulomatous inflammation with epithelioid cells, with or without caseous necrosis.…”