Effect of BCG vaccine on tuberculin skin tests in 7-11-year-old children.

AIM: To determine the effect of Bacillus Calmette Guerin (BCG) vaccination on tuberculin skin test responses in 7-11-year-old children, and also to clarify whether the number of vaccinations and the time interval between vaccination and tuberculin skin test have an effect on the test responses. METHOD: 1200 primary school children were evaluated for the presence and number of BCG scars. They were then given 5 TU PPD-S intra-dermally. Seventy-two hours after the application of tests, PPD indurations were measured. RESULTS: Mean indurations were 3.7 +/- 3.9, 6.5 +/- 5.4 and 9.2 +/- 7.1 mm in children with no scar, one scar and two scars, respectively. No statistical difference was found between mean induration of children with one scar and those with two scars. CONCLUSION: The effect of the number of BCG vaccinations and the time interval between vaccination and tuberculin skin test application on tuberculin skin test responses was statistically insignificant.

A rare syndrome in the differential diagnosis of hepatosplenomegaly and pancytopenia: report of identical twins with Griscelli disease.

White, identical twin boys aged 3 months were referred to our centre with persisting fever, mouth ulcers, hepatosplenomegaly, pancytopenia and failure to thrive. The parents were first cousins and there was a history of a sibling with similar manifestations who had died. The infants had silvery-grey hair and pigment clumps on the hair shafts, and skin biopsy showed accumulation of melanocytes on melanosomes. Bone marrow revealed hypercellularity and haemophagocytosis. HLH-94 chemotherapy (initial therapy with daily dexamethasone and etoposide, maintenance with dexamethasone pulses, etoposide and cyclosporin A) was started. Though partial haematological remission was achieved, one of the boys died on the 34th day following aspiration pneumonia. No pathogen could be identified. The second boy responded to therapy but had a haematological relapse and died 68 days after first being admitted. Genetic study revealed a 5 bp deletion in the RAB27A gene (510 del AAGCC in exon 5). Transient haematological remission can be achieved with chemotherapy but allogeneic bone marrow transplantation is the only curative therapy in Griscelli disease, as in other familial haemophagocytic syndromes. Identification of the mutation also provides an opportunity for prenatal diagnosis.

Acute infantile haemorrhagic oedema associated with hepatitis A.

Acute infantile haemorrhagic oedema (AIHO) is characterised by purpura, ecchymosis and inflammatory oedema of the face and extremities. It is seen in children aged 4-24 months. The atiology is not known. We report a case of AIHO diagnosed by skin biopsy demonstrating leukocyte-elastic vasculitis. Laboratory studies showed positive hepatitis A IgM and IgG antibodies. The liver function tests were normal, indicating subclinical hepatitis. Cryoglobulinaemia was detected, suggesting that the disease was related to hepatitis A.

Effect of BCG vaccine on tuberculin skin tests in 1-6-year-old children.

UNLABELLED: Bacillus Calmette Guerin (BCG) vaccination used in the prevention of tuberculosis may cause problems in interpreting the tuberculin skin test (TST), which is commonly used in the diagnosis of infection. A limited number of studies have been undertaken to investigate how length of time after BCG vaccination affects TST results. TST induration values of unvaccinated children were compared with those of children vaccinated once in order to determine the changes in TST responses after BCG vaccination. Mantoux TSTs were administered to 1145 children aged 1-6 y and induration was measured at 72 h. BCG scar status and average TST induration diameters were identified for each age group. CONCLUSION: Average TST induration in vaccinated children is significantly higher than that in unvaccinated children, and in the vaccinated group there is no statistically significant difference between induration values in the different age groups. BCG vaccination at the age of 0-2 mo affects TST for a long period and this condition does not change until 6 y of age.