Takashi Ishikawa, Japan
National Center for Child Health and Development Division of ImmunologyPresenter of 1 Presentation
BACILLUS CALMETTE-GUÉRIN INFECTION IN PATIENTS WITH CHRONIC GRANULOMATOUS DISEASE
Abstract
Background and Aims
In Japan, children under age 1 year are routinely vaccinated against Bacillus-Calmette Guérin (BCG). BCG vaccination is contraindicated in children with a primary immunodeficiency disease such as chronic granulomatous disease (CGD), which is characterized by a defect in the ability of phagocytes to form reactive oxygen species against bacteria, fungi, and BCG. Herein, we examined the frequency of BCG infection following a BCG vaccination and the therapeutic effect of antitubercular drugs in patients with CGD.
Methods
The present analysis was based on a retrospective medical record review of 42 CGD patients over the last 16 years. All treatments were given after obtaining the patients’ informed consent.
Results
Twenty-nine patients with CGD received their BCG vaccination at a clinic or hospital. Three of nine patients with a family history of CGD received a BCG vaccination inadvertently. Following vaccination, they experienced a BCG infection, including lymphadenitis (62%), skin ulcers (14%), pneumonia (10%), disseminated disease (6.8%), and dermatitis (3.4%). Of 21 patients with CGD who experienced a BCG infection, 15 patients received antitubercular drugs, including isoniazid, rifampicin, streptomycin, and clarithromycin. None of the patients experienced a life-threatening BCG infection in this study.
Conclusions
Although antitubercular drugs were effective even in CGD patients with a BCG infection, the lesions caused by the infection did not completely resolve in all the patients. To avoid administering a BCG vaccination to patients with CGD, educating both the patients and their family on the topic, detailed history-taking prior to vaccination, and newborn screening to find suspicious patients with CGD are required.