The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center

Abstract

Background The management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma. Methods From January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months. Results Of the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus. Conclusions The present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.

Mycobacterium bovis Wild-Type BCG or Recombinant BCG Secreting Murine IL-18 (rBCG/IL-18) Strains in Driving Immune Responses in Immunocompetent or Immunosuppressed Mice

“…Our previous study (data not published) revealed that the immunization of mice with the wild-type BCG resulted in an enlargement of the cortical zone accompanied by an increase in the number of lymphocytes and plasma cells in the medulla of draining lymph nodes. This could be due to the migration of lymphocytes to the antigen presentation sites within the lymph nodes [35]. On the contrary, the mice who were inoculated with the wild-type mycobacteria and then with CTX showed a reduction in the cortical zone and an increase in the number of macrophages in the medulla as well as pigmented macrophages and granulocytes in the paracortical area.…”

Clinical Characteristics and Outcomes of Adverse Reactions to Chinese Bacille Calmette- Guérin (BCG) Vaccine: A Single-Center Retrospective Study

“…From our results, both the oral isoniazid group and the observation group had only 2 cases that developed into suppurative lymphadenitis, while the majority of patients recovered, which seems to support the previous notion that oral anti-tuberculosis drugs cannot reduce the occurrence of suppurative lymphadenitis. Various treatment strategies have been reported for suppurative lymphadenitis, including observation, antitubercular treatment, needle aspiration, incision and drainage, and surgical excision of involved lymph nodes [6,18,19,21,23,24]. Solely relying on observation is not recommended because only a minority of patients can spontaneously recover, and it may take up to a year [20].…”

Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report

“…While no trials have determined the exact dose recommended for prednisolone in treatment of IRIS, common practice is to use prednisolone 1-2 mg/kg or equivalent corticosteroid for 1–2 weeks, followed by an individualized taper for the treatment of severe forms of IRIS [ 16 ]. Silver nanoparticles have been shown to have antimycobacterial effects, and when administered alongside anti-TB drugs, including INH, they may have improved extracellular and intracellular antimycobacterial activity [ 9 , 10 , 15 , 17 , 18 ]. We found no literature on the efficacy of crushed INH tablets as a topical treatment, but a review did report on the rapid resolution of symptoms when para-aminosalicylic acid (PAS) is applied externally on draining TB sinuses [ 19 ].…”

“…However, the patient in this case did not have a fluctuant abscess amenable to drainage. Additionally, research has shown that surgical excision is a possible treatment approach in immunocompetent infants with BCG reactions but often requires general anesthesia in young infants [ 9 , 14 ]. Access to surgical care is often limited in the sub-Saharan African countries where most at risk for BCG-IRIS live, and it is noteworthy that the severe localized disease in this case was successfully treated with a non-operative approach.…”

“…There is currently no widely accepted standard-of-care treatment for BCG-IRIS. While some studies have reported that spontaneous resolution without specific treatment is common in mild cases, other studies have reported on aspiration, local instillation of isoniazid (INH), silver nitrate, and surgical excision as possible treatment approaches [ 9 , 10 ].…”