Regionale suppurative Lymphadenitis nach BCG-Impfung

Abstract

In the first half of 1975 there occurred in the Federal Republic of Germany an unusual rise in the incidence of suppurative inguinal lymphadenitis after BCG vaccination of newborns, in immediate time relation with change of the vaccine by its manufacturers, Behringwerke. The attenuated daughter strain Göteborg had been replaced by the effective but also rather aggressive strain Copenhagen 1331. The complication rate was 1.5% in West Berlin. Clinical course, operative technique as well as microbiological and histomorphological features of these cases were analyzed in a joint study. Since it is likely that, after re-admission of the Copenhagen vaccine, such complications may again occur despite reduced micro-organism count, vaccination of newborns should in future be restricted to those at risk.

Surgical Treatment of Bacillus Calmette Guérin Lymphadenitis

“…Although all tubercle bacilli were isoniazid-sensitive, conservative measures failed in the presence of advanced adenitis. Surgery was the treatment of choice for these fluctuant, enlarged lymph nodes, where the inflammatory process had even infiltrated or perforated the skin [11,15,16]. With a relapse rate of 14% and the risk of fistulation, needle aspiration of pus was not an alternative to surgery [11,17].…”

“…Surgery was the treatment of choice for these fluctuant, enlarged lymph nodes, where the inflammatory process had even infiltrated or perforated the skin [11,15,16]. With a relapse rate of 14% and the risk of fistulation, needle aspiration of pus was not an alternative to surgery [11,17]. Wound healing after excision is of significantly shorter duration compared to all other groups [16].…”

“…Complications with BCG vaccines, such as suppurative lymphadenitis, arthritis, osteomyelitis, pustular vasculitis, or even generalized tuberculosis were reported in 0.01% to 3.80% of cases [1,4,5,11,12]. Changes of strain have led to outbreaks of BCG complications, mainly lymphadenitis, in up to 10% of cases [4,13,14].…”

“…Few reports have dealt with recommendations for therapy in cases with lymphadenitis, and no prospective study has been conducted on this topic [11,[15][16][17][18]. Although regression and healing without therapy ultimately occurs in nearly all cases, suppuration and perforation require prolonged wound care.…”