Practical Approaches to the
Prevention and Treatment of
Adverse Reactions to BCG

Meijden, A.P.M. van der

doi:10.1159/000475205

Cited by 44 publications

(23 citation statements)

References 8 publications

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“…Zugang der Mykobakterien zur Blutbahn und Immunsuppression sind die Hauptrisikofaktoren für die Entwicklung schwerer, systemischer Komplikationen. Somit sind traumatische Katheterisierungen, gleichzeitige Zystitis und ein kurzes Intervall zwischen chirurgischem Eingriff und Instillation stets mit einem höheren Risiko verbunden [19]. In dem vorliegenden Fall verliefen die Katheterisierungen und Zystoskopien jedoch nicht traumatisch.…”

Section: Schwere Systemische Komplikationenunclassified

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

et al. 2004

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Local Bacillus Calmette-Guérin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer. A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma. 4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal liver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed noncaseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.

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Section: Schwere Systemische Komplikationenunclassified

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

et al. 2004

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“…However, serious and even life-threatening reactions can occur. This topic is reviewed elsewhere by van der Meijden [33] but it is worth restating that acute septic reac tions to BCG appear, for the most part, to be hypersensi tive in nature. Animal model evidence from our laborato ry now confirms that optimal survival, as suggested by Steg et al [34], can be achieved with isoniazid, rifampicin and prednisone treatment [35], Conclusion Improving BCG Immunotherapy Current efforts at improving the results of BCG immu notherapy are directed at reducing the toxicity and in creasing the efficacy.…”

Section: Disease Progression and Survivalmentioning

confidence: 99%

BCG in Perspective: Advances in the Treatment of Superficial Bladder Cancer

1995

Eur Urol

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“…The combination of isoniazid and rifampin is generally used for the treatment of M. bovis-BCG infection, based on small case series that have reported favourable outcomes. 5,11 Patients usually receive treatment for 6-12 months, although the optimal duration of therapy is not known. 4 Canadian guidelines recommend a minimum of nine months of therapy with isoniazid and rifampin for instances of pyrazinamide-resistant M. tuberculosis infection, although the treatment of M. bovis-BCG infection is not specifically addressed.…”

Section: Infections Complicating Intravesical Bcg Therapymentioning

confidence: 99%

Attenuated but live: a pelvic abscess caused by bacille Calmette-Guerin

Leis¹,

Ricciuto²,

Gold³

2011

Canadian Medical Association Journal

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A 64-year-old man presented with a three-week history of a tender suprapubic mass. His medical history included superficial (stage T1) transitional cell carcinoma of the bladder for which he had undergone transurethral resection of the tumour 10 months earlier. At the time of surgery, he had received one dose of intravesical mitomycin followed by six intravesical instillations of bacille Calmette-Guérin (BCG), without complication. Follow-up cystoscopy performed three months before his current presentation had shown an ulcerative lesion that was suspicious for recurrence of cancer, and his BCG therapy had been resumed. Following his third weekly instillation of BCG, he had developed fever, chills and scrotal pain. His treatment had been discontinued; however, his pain had worsened over a three-week period to the point where he was no longer able to walk.On examination, the patient was grimacing in pain. His blood pressure was 110/74 mm Hg, heart rate was 100 beats/min and temperature was 38.4°C. A firm, tender, nonmobile suprapubic mass was palpated that extended into the scrotum. Inguinal lymph nodes were not enlarged.The results of laboratory investigations showed a hemoglobin concentration of 93 (normal 140-180) g/L, a leukocyte count of 7.0 (normal 4.0-11.0) × 10 9 /L with a normal differential, and a platelet count of 357 (normal 150-400) × 10 9 /L. The creatinine level was 83 (normal < 109) µmol/L, and results of urine and blood cultures for bacteria were negative. Magnetic resonance imaging (MRI) of the pelvis showed a small area of nodular enhancement on the anterior aspect of the bladder neck that was contiguous with the pubic symphysis. In addition, there was a large collection in the soft tissue anterior to the pubic symphysis with extension into the left adductor muscles (Figure 1).The timing of the patient's symptoms in relation to his BCG therapy raised the possibility of a complication from the treatment; specifically, infection with Mycobacterium bovis-BCG. Specimens of first morning urine were taken for mycobacterial culture. An ultrasound-guided biopsy and drainage of the collection in the soft tissue was performed and the sample submitted for pathologic examination and culture. The patient was given isoniazid and rifampin, empirically, for the treatment of presumed infection with M. bovis-BCG. Three specimens of morning urine subsequently grew an organism belonging to the Mycobacterium tuberculosis complex that was later confirmed to be M. bovis-BCG. Results of acid-fast staining of the ultrasound-guided aspirate were positive. In addition, culture of the aspirate grew M. bovis-BCG, which was susceptible to isoniazid and rifampin, but resistant to pyrazinamide. Tissue biopsy showed focal fat necrosis and chronic inflammation, without evidence of malignancy. The patient completed a one-year course of therapy with isoniazid and rifampin, and follow-up MRI of the pelvis showed complete resolution of the collection. There was no recurrence of infection more than four years after the completion of ...

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Practical Approaches to the Prevention and Treatment of Adverse Reactions to BCG

Cited by 44 publications

References 8 publications

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

BCG in Perspective: Advances in the Treatment of Superficial Bladder Cancer

Attenuated but live: a pelvic abscess caused by bacille Calmette-Guerin

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