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Osteitis caused by bacille Calmette-Guérin vaccination: an emergent problem in Chile?
J A Castro-Rodríguez1, R González, G Girardi
1Exequiel González Cortés Children's Hospital, Department of Pediatrics, University of Chile, Santiago, Chile.
Setting:
Osteitis caused by bacille Calmette-Guérin (BCGOST) vaccination has not been described in Latin American countries.
Objective:
To evaluate the incidence, clinical features and prognosis of patients with BCGOST in one of the most populated areas of Santiago, Chile.
Design:
A retrospective analysis of medical records kept over twenty years (1976-1995).
Results:
In ten children (four in the last five years), diagnostic criteria of BCGOST were fulfilled. Six were boys, the mean age was 11 months (range 6.5-21), symptoms were present with a mean of 31 days (range 15-60) before diagnosis and the sites of predilection of osteitis were the lower extremity (8/10 cases). Culture was positive in one case, and nine patients had typical histopathological lesions (two with acid-fast bacilli). All had normal chest X-ray. Mantoux testing was performed in four cases (mean 21.5 mm, range 16-28). None of the ten patients had a history of underlying immunodeficiency. In this area BCG coverage was 90.2 +/- 9.7% of all newborn infants, and the annual risk of tuberculosis infection was 24.6/100,000 population per year.
Conclusion:
Our study demonstrated an estimated incidence for BCGOST in this area of 3.2/100,000 vaccinated newborns. Based on the epidemiological situation of tuberculosis in Chile (29.5/100,000), universal BCG vaccination in newborns should be encouraged.