Korean J Pediatr Infect Dis.  2011 Jun;18(1):91-96.

A Case of Disseminated Mycobacterium bovis Infection after BCG Vaccination (Tokyo strain) in an Apparently Immunocompetent Infant

• Paik JY
• Choi JH
• Kim MK
• Choi EH
• Lee HJ
• Park KU

Abstract

Bacille Calmette-Guerin (BCG) vaccine is a live attenuated vaccine derived from Mycobacterium bovis. Frequent complications after BCG vaccination are localized ulcer formation and regional lymphadenitis, but there could be rarely severe systemic reactions to BCG vaccine such as osteomyelitis and disseminated BCG infection. Although disseminated BCG infection can be complicated in infants with underlying immunodeficiency after BCG vaccination, it is very unlikely to develop in immunocompetent infants or children. We report a 13-month-old infant who presented with fever, skin nodules, and multiple enlarged lymph nodes 5 months following BCG vaccination. She was diagnosed with disseminated BCG infection by PCR-confirmed M. bovis BCG infection at > or =2 anatomical sites beyond the region of vaccination. The patient showed no obvious evidence of immunodeficiency as judged on the basis of previous disease history, plasma immunoglobulin levels, B and T lymphocytes counts in peripheral blood, DHR (dihydrorhodamine 123 fluorescence) test and HIV test. She started antituberculous treatment with isoniazid and rifampin, and now, apparently her symptoms have been improved.

Keyword

Disseminated BCG Infection; Mycobacterium bovis Infection; Immunocompetent patient

MeSH Terms

BCG Vaccine
Child
Fever
HIV
Humans
Immunoglobulins
Infant
Isoniazid
Lymph Nodes
Lymphadenitis
Mycobacterium
Mycobacterium bovis
Osteomyelitis
Plasma
Rifampin
Skin
T-Lymphocytes
Ulcer
Vaccination
BCG Vaccine
Immunoglobulins
Isoniazid
Rifampin

Reference

1. Ministry of Health and Welfare. The Korean Insitute of Tuberculosis. The 7th national tuberculosis prevalence survey in 1995 in Korea. 1995. 8–12.

2. The Korean Pediatric Society. Lee HJ, editor. [General recommendations on immunizations]. Immunization guideline. 2008. 6th ed. Seoul: The Korean Pediatric Society;14–26.

3. Trevenen CL, Pagtakhan RD. Disseminated tuberculoid lesions in infants following BCG vaccination. Can Med Assoc J. 1982. 127:502–504.

4. World Health Organization. BCG Vaccine. WHO Position Paper. Wkly Epidemiol Rec. 2004. 79:27–38.

5. Baek HS, Chang JY, Moon SJ, Oh SH. Lymphadenitis following intradermal BCG vaccination. Korean J Pediatr. 2006. 49:46–50.

6. Casanova JL, Blanche S, Emile JF, Jouanguy E, Lamhamedi S, Altare F, et al. Idiopathic disseminated bacillus Calmette-Guérin infection: a French national retrospective study. Pediatrics. 1996. 98:774–778.

7. Levin M, Newport MJ, D'Souza S, Kalabalikis P, Brown IN, Lenicker HM, et al. Familial disseminated atypical mycobacterial infection in childhood: a human mycobacterial susceptibility gene? Lancet. 1995. 345:79–83.

8. Farhoudi A, Bazargan N, Arshi S, Pourpak Z. BCG dissemination in 40 patients and review of leukocyte mycobactericidal defect in one patient. Iran J Allergy Asthma Immunol. 2000. 1:63–67.

9. Ferguson RG, Simes AB. BCG vaccination of Indian infants in Saskatchewan. Tubercle. 1949. 30:5–11.

10. Pedersen FK, Engbaek HC, Hertz H, Vergmann B. Fatal BCG infection in an immunocompetent girl. Acta Paediatr Scand. 1978. 67:519–523.

11. Kim SH, Kim SY, Eun BW, Yoo WJ, Park KU, Choi EH, et al. BCG osteomyelitis caused by the BCG Tokyo strain and confirmed by molecular method. Vaccine. 2008. 26:4379–4381.

12. Fine PE. Variation in protection by BCG: implications of and for heterologous immunity. Lancet. 1995. 346:1339–1345.

13. Kim KH, Lee SJ, Lee K. PPD conversion rate and complications according to the different time of BCG vaccination. J Korean Pediatr Soc. 1987. 30:487–490.

14. Hesseling AC, Rabie H, Marais BJ, Manders M, Lips M, Schaaf HS, et al. Bacille Calmette-Guérin vaccine-induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis. 2006. 42:548–558.

15. Deeks SL, Clark M, Scheifele DW, Law BJ, Dawar M, Ahmadipour N, et al. Serious adverse events associated with bacille Calmette-Guérin vaccine in Canada. Pediatr Infect Dis J. 2005. 24:538–541.