Fatal BCG vaccination

Area of Science:

• Immunology
• Pediatrics
• Infectious Diseases

Background:

• Bacille Calmette-Guérin (BCG) vaccination is a standard preventive measure against tuberculosis.
• Infants with primary immunodeficiencies are at increased risk of disseminated BCG disease.
• Swiss type agammaglobulinaemia is a severe combined immunodeficiency affecting T-cell and B-cell function.

Purpose of the Study:

• To report a fatal case of disseminated tuberculosis following BCG vaccination in an infant with Swiss type agammaglobulinaemia.
• To highlight the potential risks of BCG vaccination in infants with undiagnosed severe combined immunodeficiencies.
• To underscore the importance of early diagnosis of primary immunodeficiencies.

Main Methods:

• Case report of a 7-week-old female infant.
• Clinical presentation, treatment, and post-mortem examination findings.
• Histopathological analysis of tissues for tuberculous foci and immune system evaluation.

Main Results:

• The infant presented with severe infections including oral thrush, pneumonitis, and chronic enteritis.
• Post-mortem examination revealed aplasia of the thymus and hypoplasia of the lymph system.
• Miliary tuberculous foci were identified in lymph nodes, liver, and spleen, confirming disseminated tuberculosis.

Conclusions:

• BCG vaccination can lead to fatal disseminated tuberculosis in infants with undiagnosed Swiss type agammaglobulinaemia.
• Severe combined immunodeficiencies represent a contraindication for live attenuated vaccines like BCG.
• Prompt recognition and management of primary immunodeficiencies are crucial to prevent vaccine-associated complications.