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Immunity status in children with Bacille Calmette-Guerin adenitis. A prospective study in Tehran, Iran
Noorbakhsh Samileh1, Siadati Ahmad, Ashtiani Farzaneh
1Department of Pediatrics, Iran University of Medical Sciences, Research Center of Pediatric Infectious Diseases, Hazrat Rasool Hospital, Niayesh Ave, Satarkhan Street, Tehran 14455, Republic of Iran. Samileh_noorbakhsh@yahoo.com/Saminoor@hbi.dmr.or.ir
Insights
This study assessed immune status in children with Bacille Calmette-Guerin (BCG) lymphadenitis, finding mild immune deficiencies in some cases. Many responded well to standard treatments, suggesting targeted interventions for BCG infection complications.
Area of Science:
- Immunology
- Pediatrics
- Infectious Diseases
Background:
- Bacille Calmette-Guerin (BCG) lymphadenitis is a common complication of BCG vaccination in children.
- Understanding the immune status of affected children is crucial for effective management and preventing complications.
Purpose of the Study:
- To compare the immune status of children with BCG lymphadenitis to that of healthy controls.
- To identify potential immune deficiencies associated with BCG lymphadenitis and disseminated BCG infection.
Main Methods:
- A longitudinal case-control study was conducted on 75 children diagnosed with BCG lymphadenitis and 100 healthy controls.
- Immunological parameters including immunoglobulin levels, nitro blue tetrazolium test, and lymphocyte subsets (CD3, CD4, CD8, CD19, CD16/CD56) were assessed.
Main Results:
- Children with BCG lymphadenitis showed significant differences in lymphocyte subsets (CD3, CD8, CD19, CD16/CD56, NK cells) compared to controls.
- Mild immune deficiencies, including lymphopenia and deficiencies in CD4, CD3, CD19, and NK cells, were observed in some patients.
- Idiopathic disseminated BCG infection was identified in 3 (22%) patients, with some cases responding well to antimycobacterial drugs and immunomodulators like interferon-gamma.
Conclusions:
- Complete immunological evaluation is recommended for children with recurrent BCG lymphadenitis.
- Mild immune deficiencies in BCG lymphadenitis cases often respond to needle aspiration and/or antimycobacterial drugs.
- Interferon-gamma combined with chemotherapy can effectively manage idiopathic disseminated BCG infections.
Objective:
To determine the immunity status of children with Bacille Calmette-Guerin (BCG) lymphadenitis (patient group) and unaffected children (control group) in Iran.
Methods:
We performed this longitudinal case-control study on 75 children between 2 months to 14 years old in Rasool Akram and Markaz Tebbi Hospital, Tehran, Iran during the period of 2 years (2000-2002).
Results:
Ninety percent of patients had normal immunoglobulin, 10% had low level, 96.1% had normal nitro blue tetrazolium test and 3.9% had lower activity. There was a significant difference in the total lymphocyte CD3, CD8, CD19, CD16/CD56 and natural killers (NK) cell but no significant difference in the CD4/CD8 ratio and CD4 between case (n=75) and control (n=100) groups. Thirty-eight cases with mild lymphopenia, isolated CD4, CD3, CD19, NK cells (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients were observed. Thirty-eight cases were diagnosed as mild immune deficient without any previous recurrent infections (mild lymphopenia; Isolated CD4; CD3 or CD19 deficiency. Natural killers (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients. The natural killers (CD16/CD56) deficient cases responded well to 3 antimycobacterial drugs without immunomodulator. Natural killers cell deficiency not yet reported as a risk factor for progression and complication of BCG infection. All cases of idiopathic disseminated BCG infection (unknown immunodeficiency type) with nonlethal and indulgent BCG infections responded well to needle aspiration and antimycobacterial drugs with immunomodulator (gamma interferon).
Conclusion:
In cases with multiple and recurrent BCG lymphadenitis without any previous recurrent infection complete immunological studies should be carried out. Most cases with mild immune deficiency usually response well to needle aspiration alone or combine with antimycobacterial drugs. The combination of IFN-gamma and chemotherapy in cases of idiopathic disseminated infections caused by BCG and without previous recurrent other infection except mycobacterium species, can limit the disease.
