Therapy of regional lymphadenitis following BCG vaccination

Abstract

In this study we presented 92 cases with regional lymphadenitis (over 1 cm in diameter) which was caused by BCG vaccination generally performed a few days after birth. The patients were divided into four therapy groups. In group I, the lymphadenitis in 26 cases was excised totally by a surgical operation and they improved in a median period of four weeks (average: 4.4). No therapy was applied in 33 patients constituting group II and their periods of improvement were 28 weeks (average: 29.1). Sixteen cases in group III were given isoniazid (INH) 10 mg/kg for six months in addition to total surgical excision and their healing period was 4.5 weeks (average: 4). Seventeen cases in group IV were administered only INH for six months and the median improvement period was found to be 27 weeks (average: 28.2). The statistical differences in terms of the improvement periods between groups I and III, and groups II and IV were found to be insignificant (p greater than 0.05) but these differences were significant between groups I and II, groups I and IV, groups II and III, and groups III and IV (p less than 0.05). These results show that spontaneous healing is possible. Total excision is the best therapy for BCG lymphadenitis in suppurative forms and INH has no effect in shortening the therapy period.

Surgical Treatment of Bacillus Calmette Guérin Lymphadenitis

“…Studies have clearly demonstrated that there is no difference between various conservative treatments and with no treatment at all [15,16]: Spontaneous regression occurs in 62% and 67%, respectively. The inflammatory process, however, proceeds when the attacked lymph node has reached a certain size, and perforation and fistulation occur in at least 40%.…”

“…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].…”

“…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.…”

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

“…Surgical indications for the management of BCG vaccine-induced regional suppurative lymphadenitis need to be defined so far [ 17 , 23 ]. Based on the literature review and our experience, hereby, we propose the indications for surgical management as follows: the enlarged lymph node greater than 1 cm in size [ 9 ] and ultrasonography revealing liquefaction and capsule penetration of the lymph node(s); rapidly enlarging or infiltrating nodes [ 22 ]; infiltrating overlying skin [ 10 , 21 , 22 ]; spontaneously perforated or sinus formation [ 10 , 19 , 21 ]; fixation of regional lymph node(s) [ 14 ]; lymph nodes larger than 1.5–3 cm [ 10 , 19 , 21 ]; mass lasting for 3 to 6 months without regression [ 15 , 19 ]; or repeated collections after needle aspiration, especially with matted and multilocular nodes [ 17 , 24 ].…”

“…Although the surgical management of BCG vaccine-induced suppurative lymphadenitis has been reported with good results [ 9 , 18 , 25 ], the disadvantages are the exposure of sedation or general anesthesia, potential intra- and post-operative complications [ 3 , 17 ], and reoccurrence due to residual adenopathy with sinus formation requiring more than one procedure [ 26 ]. Nevertheless, surgical excision, as an invasive technique, still needs to balance the risks of general anesthesia and potential surgical complications.…”