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Disseminated infection with Bacillus Calmette-Guerin in a child with advanced HIV disease
V Rosenfeldt1, A Paerregaard, N H Valerius
1University Clinic of Paediatrics, Hvidovre Hospital, Denmark.
Insights
Disseminated BCG infection can occur in infants with vertically acquired HIV, even with normal CD-4 counts. Early consideration is vital for symptomatic infants in BCG-immunized regions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Vertical transmission of Human Immunodeficiency Virus (HIV) can lead to severe opportunistic infections in infants.
- Bacillus Calmette-Guérin (BCG) vaccination is a standard immunization in many countries, including those with high HIV prevalence.
Observation:
- An 8-month-old infant with vertically acquired HIV presented with disseminated BCG infection despite a normal CD-4 lymphocyte count.
- Symptoms included fever, anemia, and failure to thrive.
- BCG was identified in cerebrospinal fluid, bone marrow, and peripheral blood.
Findings:
- Disseminated BCG infection was confirmed in an HIV-infected infant.
- The infant experienced severe symptoms despite initial anti-tuberculous treatment.
- The patient ultimately succumbed to Pneumocystis carinii pneumonia.
Implications:
- Disseminated BCG infection should be suspected in symptomatic HIV-infected infants from BCG-immunized regions.
- This case highlights the potential severity of BCG complications in immunocompromised infants.
- Further research into BCG safety in HIV-infected populations may be warranted.
Abstract:
An 8-month-old boy with vertically acquired HIV-infection who developed a disseminated BCG infection is described. The patient had been immunized at birth with BCG. In spite of a normal CD-4 lymphocyte count, he suffered from fever, anaemia and failure to thrive. BCG was isolated by culture from CSF, bone marrow and peripheral blood. Anti-tuberculous treatment initially seemed successful, but shortly after, the patient died from Pneumocystis carinii pneumonia. In symptomatic HIV-infected children originating from countries with BCG immunization programs, disseminated BCG infection should be considered.