Regional lymphadenitis following BCG vaccination.

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Vaccinology

Background:

• A cluster of Bacille Calmette-Guerin (BCG) lymphadenitis cases emerged in Dublin post-vaccination with the Copenhagen 1331 strain in 1989.
• BCG lymphadenitis is a known complication of BCG vaccination, particularly in infants.

Purpose of the Study:

• To determine the optimal treatment strategy for Bacille Calmette-Guerin (BCG) lymphadenitis.
• To evaluate treatment outcomes for BCG lymphadenitis presenting to pediatric surgical clinics.

Main Methods:

• Retrospective review of all BCG lymphadenitis cases presenting to pediatric surgical clinics over an 11-year period.
• Analysis of treatment approaches including initial operation, antituberculous drugs, and observation.
• Comparison of outcomes based on treatment modality.

Main Results:

• Seventeen patients were included; 16 received BCG vaccine neonatally.
• Initial surgical treatment, antituberculous drugs, and observation were employed.
• Most medically treated or observed patients eventually required surgery due to disease progression or lack of resolution.
• Excision and primary closure yielded the best surgical outcomes.

Conclusions:

• Spontaneous resolution is common in most infant BCG lymphadenitis cases.
• For severe cases requiring surgical referral, a short trial of antimicrobial therapy is recommended.
• Patients not improving or developing complications are best managed with surgical excision of involved lymph nodes.