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Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran

BACKGROUND: Disseminated bacillus calmette guerin (BCG) infection is a rare but life threatening complication of BCG vaccination. It has been mainly seen in severe immune deficiency. A precise and rapid diagnosis is crucial for prompt initiation of an aggressive anti-mycobacterial treatment. Polymer...

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Autores principales: Aelami, Mohammad Hasan, Alborzi, Abdolvahab, Pouladfar, Gholamreza, Geramizadeh, Bita, Pourabbas, Bahman, Mardaneh, Jalal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kowsar 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740899/
https://www.ncbi.nlm.nih.gov/pubmed/26862381
http://dx.doi.org/10.5812/jjm.25663
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author Aelami, Mohammad Hasan
Alborzi, Abdolvahab
Pouladfar, Gholamreza
Geramizadeh, Bita
Pourabbas, Bahman
Mardaneh, Jalal
author_facet Aelami, Mohammad Hasan
Alborzi, Abdolvahab
Pouladfar, Gholamreza
Geramizadeh, Bita
Pourabbas, Bahman
Mardaneh, Jalal
author_sort Aelami, Mohammad Hasan
collection PubMed
description BACKGROUND: Disseminated bacillus calmette guerin (BCG) infection is a rare but life threatening complication of BCG vaccination. It has been mainly seen in severe immune deficiency. A precise and rapid diagnosis is crucial for prompt initiation of an aggressive anti-mycobacterial treatment. Polymerase chain reaction (PCR) is directly applicable to smear-positive clinical specimens, proven to be a rapid and specific diagnostic test. OBJECTIVES: The aim of this study was to investigate disseminated BCG infection among 34 children in southern Iran, mainly confirmed by PCR. PATIENTS AND METHODS: We included all the patients hospitalized with disseminated BCG infection at a referral teaching hospital in southern Iran between years 1990 and 2007. The clinical and laboratory data including the immunological workups were obtained through a review of the medical files. We recalled all pathology samples from pathology specimen banks and used an in-house PCR specific for Mycobacterium bovis BCG substrain to confirm the diagnosis. RESULTS: From the total of 34 children hospitalized with disseminated BCG infection, 21 were categorized as definite and 13 probable. Thirty-one patients (91%) were under two years of age and 41% were male. The most common clinical findings were fever in 31 (91.2%), axillary’s lymphadenopathy in 26 (76.5%), hepatosplenomegaly in 25 (73.5%), stunted growth in 21 (61.8%), and distant lymphadenopathy in 16 (47.1%). Polymerase Chain Reaction positivity rate was 100% (9 of 9) in bone marrow smear slides and 84.2% (16 of 19) for formalin-fixed and paraffin-embedded tissue specimens. Immunodeficiency state was detected in 50% and the overall mortality rate was 58.8% (20 of 34). CONCLUSIONS: Disseminated BCG infection should be considered in the differential diagnosis of infants and young children with fever, hepatosplenomegaly, lymphadenopathy, and history of BCG vaccination. The PCR method has a high positivity rate and can serve as a useful tool for the rapid and specific identification of M. bovis BCG substrain infection.
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spelling pubmed-47408992016-02-09 Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran Aelami, Mohammad Hasan Alborzi, Abdolvahab Pouladfar, Gholamreza Geramizadeh, Bita Pourabbas, Bahman Mardaneh, Jalal Jundishapur J Microbiol Research Article BACKGROUND: Disseminated bacillus calmette guerin (BCG) infection is a rare but life threatening complication of BCG vaccination. It has been mainly seen in severe immune deficiency. A precise and rapid diagnosis is crucial for prompt initiation of an aggressive anti-mycobacterial treatment. Polymerase chain reaction (PCR) is directly applicable to smear-positive clinical specimens, proven to be a rapid and specific diagnostic test. OBJECTIVES: The aim of this study was to investigate disseminated BCG infection among 34 children in southern Iran, mainly confirmed by PCR. PATIENTS AND METHODS: We included all the patients hospitalized with disseminated BCG infection at a referral teaching hospital in southern Iran between years 1990 and 2007. The clinical and laboratory data including the immunological workups were obtained through a review of the medical files. We recalled all pathology samples from pathology specimen banks and used an in-house PCR specific for Mycobacterium bovis BCG substrain to confirm the diagnosis. RESULTS: From the total of 34 children hospitalized with disseminated BCG infection, 21 were categorized as definite and 13 probable. Thirty-one patients (91%) were under two years of age and 41% were male. The most common clinical findings were fever in 31 (91.2%), axillary’s lymphadenopathy in 26 (76.5%), hepatosplenomegaly in 25 (73.5%), stunted growth in 21 (61.8%), and distant lymphadenopathy in 16 (47.1%). Polymerase Chain Reaction positivity rate was 100% (9 of 9) in bone marrow smear slides and 84.2% (16 of 19) for formalin-fixed and paraffin-embedded tissue specimens. Immunodeficiency state was detected in 50% and the overall mortality rate was 58.8% (20 of 34). CONCLUSIONS: Disseminated BCG infection should be considered in the differential diagnosis of infants and young children with fever, hepatosplenomegaly, lymphadenopathy, and history of BCG vaccination. The PCR method has a high positivity rate and can serve as a useful tool for the rapid and specific identification of M. bovis BCG substrain infection. Kowsar 2015-11-21 /pmc/articles/PMC4740899/ /pubmed/26862381 http://dx.doi.org/10.5812/jjm.25663 Text en Copyright © 2015, Ahvaz Jundishapur University of Medical Sciences. http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
spellingShingle Research Article
Aelami, Mohammad Hasan
Alborzi, Abdolvahab
Pouladfar, Gholamreza
Geramizadeh, Bita
Pourabbas, Bahman
Mardaneh, Jalal
Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title_full Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title_fullStr Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title_full_unstemmed Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title_short Post-Vaccination Disseminated Bacillus Calmette Guerin Infection Among Children in Southern Iran
title_sort post-vaccination disseminated bacillus calmette guerin infection among children in southern iran
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740899/
https://www.ncbi.nlm.nih.gov/pubmed/26862381
http://dx.doi.org/10.5812/jjm.25663
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