Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

The most common complication of post BCG vaccination is lymphadenopathy or lymphadenitis usually in the axilliary region. Disseminated TB (DTB) infection has been reported rarely after BCG vaccination, principally in children with immune compromised state.
Two serious cases with DTB after BCG vaccination were treated in our clinic during last 10 years. We wish to discuss the following cases of DTB. Both babies were born healthy and they were not immune compromised. The disease manifested for these patients in the 5-6 month age by enlargement of the regional-axilliary lymph glands. The wheezing, fever, respiratory distress appeared after 14–30 days. Both patients were treated as ill with bronchitis but it had no success. On the x-ray examination and CT showed diffused shadows in lungs and enlarged mediastinal lymphnodes, also enlarged lymphnode in left axilliary side (1,8 cm). Mycobacterium tuberculosis was not found in the gastric washes, Ig E was in normal level, but the level of anti TB antibodies Ig were enlarged. The tuberculin test was positive (+15 and +10mm) for both babies. The patients‘ parents and all family members were examined for TB, they all were healthy. TB granulioma was found in the biopsy from afilliary lymphnode. The diagnosis of TB was confirmed only by suggestion of BCG dissemination. Under treatment their chest x-ray was normal. The specific treatment with 4 drugs was successful and confirmed our diagnosis.
Conclusion: The antituberculous chemoprophylaxis is indicated when there are enlarged regionally lymphnodes (more then 1,5cm) after BCG vaccination, because it can provoke disseminated BCG infection. Rarely DTB after BCG can happen in babies with normal immunity.

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Citations should be made in the following way:
D. Steponaviciene, E. Tamulaitiene (Kaunas, Lithuania). The cases of disseminated tuberculosis post BCG vaccination. Eur Respir J 2006; 28: Suppl. 50, 1793

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