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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Kowsar
2015
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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. |
format | Online Article Text |
id | pubmed-4740899 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Kowsar |
record_format | MEDLINE/PubMed |
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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