Tuberculosis parotídea secundaria a instilación vesical con bcg: a propósito de un caso

Díaz, C Diego; Baldo, Cristiani; Martín, Ángela Hernández; Fernández, M.; Muñoz, Miriam Estébanez; Rodríguez, Laura Rodríguez; Tudó, Griselda; González, Julià; Pérez, Julio C.; Palacios, Juan José

doi:10.1016/s0001-6519(03)78395-2

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Disseminated BCG infection, in the form of miliary tuberculosis, sepsis, or fever associated with organ involvement, constituted the most commonly reported form of BCG infection in the literature, accounting for one-third of cases. However, it is noteworthy the wide range of clinical manifestations that emerged from our review, including anecdotal reports of prosthetic joint infection, 23 , 69 , 75 , 164 , 184 parotid gland tuberculosis, 49 endogenous endophthalmitis with infiltrative retinitis, 111 or lymphocytic meningitis (present Case 1). Of note, BCG infection had been missed from the initial differential diagnosis in most of these cases until microbiologic documentation of M. bovis was obtained by culture or PCR assay, thus emphasizing the need of maintaining a high index of clinical suspicion based on a previous history of BCG exposure.…”

Section: Discussionmentioning

confidence: 91%

“…Therefore, we included a total of 201 articles comprising 271 cases of BCG infection after intravesical instillation published since 1975. 1 – 14 , 17 – 19 , 21 – 31 , 33 – 39 , 41 – 49 , 51 – 71 , 73 – 80 , 82 – 84 , 87 – 97 , 99 , 101 , 102 , 104 , 105 , 107 – 119 , 121 – 138 , 140 – 151 , 153 – 168 , 170 , 171 , 173 – 180 , 182 – 189 , 192 , 193 , 195 – 202 , 205 – 208 , 210 – 214 , 218 , 219 , 221 – 223 , 225 – 232 Of these, 170 were individually detailed cases, and 31 were summarized in reports containing 2–13 cases. All data shown here were extracted from these case reports and case series, but occasionally articles lacked relevant clinical or microbiologic data.…”

Section: Methodsmentioning

confidence: 99%

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Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0–9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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“…There are still cases in which they were found as acid-fast bacilli within granulomas of lung biopsy (15) or a positive culture (47) or cases in which the acid-fast bacilli have been discovered within the granulomas of liver biopsy as in the case presented by Leebeek et al (48). DNA of mycobacteria after BCG instillation has also been demonstrated in tissues of the parotid (49) and bone marrow (50). However, the direct demonstration of positive staining of mycobacteria Ziehen Nielsen, blood culture, or the culture of the lesions (liver or lung tissue) is very rare and appears to be positive in only 10% of cases of hepatic tuberculosis (16).…”

Section: Discussionmentioning

confidence: 99%

Intravesical BCG Therapy as Cause of Miliary Pulmonary Tuberculosis

et al. 2015

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Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is considered the most effective adjuvant to endoscopic resection of bladder urothelial carcinoma in the therapeutic management of non-muscle invasive (NMIBC) at intermediate and high risk of recurrence and progression (pTa - pT1 and high-grade carcinoma in situ, CIS). Despite its proven efficacy, this type of treatment can determine local and systemic side effects of moderate or severe gravity, with the histological diagnosis of epithelioid granulomas in different organs, even in the absence of microbiological positivity of BCG. The immunotherapy with BCG is usually well tolerated and the virulence of the attenuated BCG is very low in immuno-competent patients, although only 16% of patients are able to receive all the instillations of the maintenance period (3 years) of treatment provided by the protocols, precisely because of side effects. Minor side effects usually resolve within a few hours or days. They develop in 3-5% of patients and usually consist of local infectious complications. Manifestations of BCG dissemination, such as vascular and ocular complications, are much less common, while BCG-disseminated infections, with granulomatous pneumonia or hepatitis present, are quite rare, representing 0.5-2% of the complications recorded. We present the clinical case of granulomatous lung and possibly liver infection caused by BCG in a patient aged 56 years being treated for several weeks with intravesical BCG for NIMBC pT1 high grade associated with CIS.

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Bilateral parotid glands infection caused by Calmette-Guerin Bacillus after intravesical therapy for recurrent bladder cancer: a case report

Friedlander

Pascual

Mora

et al. 2017

Brazilian Journal of Otorhinolaryngology

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Tuberculosis parotídea secundaria a instilación vesical con bcg: a propósito de un caso

Cited by 6 publications

References 17 publications

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Intravesical BCG Therapy as Cause of Miliary Pulmonary Tuberculosis

Bilateral parotid glands infection caused by Calmette-Guerin Bacillus after intravesical therapy for recurrent bladder cancer: a case report

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