Related Experiment Videos
Surgical treatment of bacillus Calmette Guérin lymphadenitis
P Hengster1, B Sölder, M Fille
1Department of Pediatric Surgery, Innsbruck University Hospital, Austria.
Insights
BCG vaccination complications like lymphadenitis can occur. Surgery is recommended for larger lymph nodes (over 1.0-1.5 cm) to prevent skin issues and speed healing, while isoniazid therapy is less effective.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Bacillus Calmette-Guérin (BCG) vaccination is widely administered despite debated efficacy and low tuberculosis risk.
- Changes in BCG vaccine strains have been linked to increased complication rates.
- Post-vaccination lymphadenitis is a notable BCG complication.
Purpose of the Study:
- To evaluate treatment outcomes for BCG-induced lymphadenitis in infants.
- To determine the efficacy of isoniazid therapy versus surgical intervention.
- To identify factors influencing treatment success and complication development.
Main Methods:
- Retrospective analysis of 3386 infants vaccinated with BCG (Strain Pasteur) between 1990-1991 in Austria.
- Observation of 116 cases of lymphadenitis developing 3-28 weeks post-vaccination.
- Comparison of outcomes for treatments including observation, isoniazid, surgery, and surgery with isoniazid.
Main Results:
- Surgical intervention was required in 96 cases.
- BCG bacilli were cultured up to 20 weeks post-vaccination; all isolates were isoniazid-sensitive.
- Isoniazid therapy was ineffective for lymph nodes exceeding 1.0-1.5 cm, which were prone to skin infiltration or perforation.
Conclusions:
- Surgical treatment is crucial for suppurative lymphadenitis larger than 1.0-1.5 cm to prevent skin complications and shorten recovery.
- Adjuvant isoniazid therapy is not generally recommended for localized BCG lymphadenitis.
- Isoniazid may be considered only for generalized BCG tuberculosis.
Abstract:
Although its protective effect is contested and the risk of contracting tuberculosis is rather low nowadays, BCG vaccination is frequently performed. Changes of strain repeatedly led to an increased complication rate. In Austria between 1990 and 1991, of 3386 newborn babies (Strain Pasteur) 116 developed lymphadenitis 3 to 28 weeks after vaccination. The affected children received four types of treatment: nothing specific, isoniazid, or surgery with and without isoniazid. Surgical treatment was found to be necessary in 96 cases. Bacilli were successfully grown in culture in 46% of cases up to week 20 after vaccination; but later than 20 weeks no culture became positive. All cultured bacteria were isoniazid-sensitive. From our data we drew the following conclusions: isoniazid therapy did not prove successful when inflamed lymph nodes exceeded a certain size. Suppurative lymphadenitis in lymph nodes exceeding 1.0 to 1.5 cm usually led to infiltration or even perforation of the skin. Surgery prevents these complications and significantly reduces healing time. Adjuvant isoniazid therapy cannot be recommended, except for generalized BCG tuberculosis.