Effective anti-mycobacterial treatment for BCG disease in patients with Mendelian Susceptibility to Mycobacterial Disease (MSMD): a case series.
Ann Clin Microbiol Antimicrob
; 21(1): 8, 2022 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-35232430
ABSTRACT
BACKGROUND:
Post-vaccination BCG disease typically attests to underlying inborn errors of immunity (IEIs), with the highest rates of complications in patients with Mendelian susceptibility to mycobacterial disease (MSMD). However, therapeutic protocols for the management of BCG-osis (disseminated) and persistent BCG-itis (localized) are still controversial.METHODS:
Twenty-four Iranian patients with MSMD (BCG-osis or BCG-itis), followed from 2009 to 2020 in Tehran, were included in the study. Their medical records were retrospectively reviewed for demographics, clinical features, laboratory findings, and molecular diagnosis. The therapeutic protocol sheets were prepared to contain the types and duration of anti-mycobacterial agents.RESULTS:
BCG disease either as BCG-itis (33.3%) or BCG-osis (66.7%) was confirmed in all patients by positive gastric washing test (54.2%), microbial smear and culture (58.3%), or purified protein derivative (PPD) test (4.2%). The duration between BCG-osis onset and MSMD diagnosis was 21.6 months. All except three patients were initiated on second-line anti-mycobacterial agents with either a fluoroquinolone (levofloxacin 15 mg/kg/day, ciprofloxacin 20 mg/kg/day, ofloxacin 15 mg/kg/day), aminoglycoside (amikacin 10-15 mg/kg/day, streptomycin 15 mg/kg/day), and/or macrolide (clarithromycin 15 mg/kg/day) along with oral rifampin (10 mg/kg/day), isoniazid (15 mg/kg/day), and ethambutol (20 mg/kg/day). Three patients showed a clinical response to rifampin, despite in vitro resistance. Fourteen (58.3%) patients received also adjuvant subcutaneous IFN-γ therapy, 50 µ/m2 every other day. At the end of survey, most patients (n = 22, 91.7%) were alive and two patients died following BCG-osis and respiratory failure.CONCLUSIONS:
We recommend the early instigation of second-line anti-mycobacterial agents in MSMD patients with BCG disease.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vacina BCG
/
Infecções por Mycobacterium
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Observational_studies
Limite:
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
Ann Clin Microbiol Antimicrob
Assunto da revista:
MICROBIOLOGIA
/
TERAPIA POR MEDICAMENTOS
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Irã