Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.589
Filtrar
1.
Eur Urol Oncol ; 3(3): 259-261, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32327396

RESUMEN

The debate around the role of vaccination with Bacillus Calmette-Guérin has revived right in the time of the Coronavirus disease 19 pandemic. Since Bacillus Calmette-Guérin is one of the most commonly delivered therapies in urology, in this editorial we discuss some points that we think will be of interest and guidance to practicing urologists during this public health emergency.


Asunto(s)
Antineoplásicos/administración & dosificación , Vacuna BCG/administración & dosificación , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/prevención & control , Accesibilidad a los Servicios de Salud , Inmunización , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neoplasias Urológicas/tratamiento farmacológico , Vacunas Virales/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos/provisión & distribución , Vacuna BCG/efectos adversos , Vacuna BCG/provisión & distribución , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Europa (Continente)/epidemiología , Humanos , Inmunización/efectos adversos , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Neoplasias Urológicas/epidemiología , Neoplasias Urológicas/inmunología , Vacunas Virales/efectos adversos , Vacunas Virales/provisión & distribución
4.
World Neurosurg ; 133: 416-418, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31181358

RESUMEN

BACKGROUND: Brain tuberculoma is a rare manifestation of tuberculosis especially in immunosuppressed patients. The definitive diagnosis may be difficult owing to mimicking brain tumors and the absence of the common presentation. Bacille Calmette-Guérin (BCG) vaccine is used for protection against tuberculous meningitis and miliary disease, more so in children, and also for the treatment of bladder cancer. CASE DESCRIPTION: The following case of brain tuberculoma is a boy aged 6 months who was presented to our hospital with poor feeding, nausea and vomiting, and confusion lasting 1 month. A brain magnetic resonance imaging scan showed a large mass lesion in the pineal region with generalized hydrocephaly in which polymerase chain reaction assays of the tissue was positive for Mycobacterium bovis and had a good response to antituberculosis drugs and surgery. CONCLUSIONS: We present a case of brain tuberculoma as the complication of BCG vaccine. To our knowledge, this case is the first case of brain tuberculoma after BCG vaccination. We should consider brain tuberculoma that presents with a similar presentation in any infants with a history of BCG vaccination.


Asunto(s)
Antituberculosos/uso terapéutico , Vacuna BCG/efectos adversos , Infecciones por Mycobacterium/etiología , Glándula Pineal/diagnóstico por imagen , Tuberculoma Intracraneal/etiología , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Infecciones por Mycobacterium/diagnóstico por imagen , Infecciones por Mycobacterium/tratamiento farmacológico , Mycobacterium bovis , Resultado del Tratamiento , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/tratamiento farmacológico
5.
Urology ; 137: 79-83, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31705946

RESUMEN

OBJECTIVE: To investigate severe infectious complications after intravesical treatment with bacillus Calmette-Guérin (BCG). We examine a retrospective case series of 10 patients between 2006 and 2018 with severe cystitis or systemic infection after BCG. METHODS: Patients with BCG cystitis or disseminated infection were retrospectively identified between 2006 and 2018 at our institution. Cases were reviewed for bladder cancer treatments, demographics, treatment of infection, and outcomes. RESULTS: There was a 0.8% rate of severe BCG cystitis or disseminated infection. Seven patients experienced delayed-onset infections >3 months after last BCG instillation. Four had isolated bladder symptoms, and 5 had diverse systemic manifestations. One patient was asymptomatic and diagnosed on cystoscopic findings. All were treated with varied antibiotic regimens; 9 included antituberculous therapy, and 1 was treated with levofloxacin alone. Two underwent cystectomy for end-stage bladder. The remaining patients are asymptomatic with no residual effects. All are in remission for bladder cancer. CONCLUSION: Severe infectious complications after BCG are rare and thus difficult to study. Treatment regimens can vary widely. Thorough reporting of patient outcomes is essential to expand the limited body of knowledge.


Asunto(s)
Antibacterianos , Vacuna BCG , Cistectomía/métodos , Cistitis , Sepsis , Neoplasias de la Vejiga Urinaria/terapia , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/efectos adversos , Administración Intravesical , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/clasificación , Vacuna BCG/administración & dosificación , Vacuna BCG/efectos adversos , Cistitis/diagnóstico , Cistitis/etiología , Cistitis/fisiopatología , Cistitis/terapia , Femenino , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Sepsis/diagnóstico , Sepsis/etiología , Sepsis/fisiopatología , Sepsis/terapia , Índice de Severidad de la Enfermedad
6.
BMJ Case Rep ; 12(12)2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31826907

RESUMEN

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.


Asunto(s)
Antibióticos Antituberculosos/uso terapéutico , Vacuna BCG/efectos adversos , Isoniazida/uso terapéutico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Rifampin/uso terapéutico , Anciano , Artroplastia de Reemplazo de Cadera , Vacuna BCG/uso terapéutico , Humanos , Masculino , Infecciones por Mycobacterium no Tuberculosas/diagnóstico por imagen , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Resultado del Tratamiento
7.
BMJ Case Rep ; 12(12)2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31843771

RESUMEN

A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG) injections. Following the injections, he developed deranged liver function tests and hepatomegaly. Liver biopsy revealed granulomatous hepatitis compatible with disseminated mycobacterial infection (BCG-osis) and was treated with anti-tuberculosis agents for 12 months. A surveillance CT scan performed as a follow-up for his bladder cancer in 2018 revealed a saccular thoracic aneurysm at the ligamentum arteriosum, which was metabolically active on positron emission tomography (PET) scan. Given the timeframe from intravesical instillation of BCG and the metabolic activity on PET scan, the lesion was consistent with a mycotic aneurysm secondary to disseminated mycobacterial infection. Following multidisciplinary team discussion, a thoracic endovascular aneurysm repair was performed. The stent grafts were placed distal to the left subclavian artery with good angiographic results and no immediate postoperative complications. He was initiated on long-term antibiotics to cover potential bacterial pathogens including mycobacterium.


Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Aneurisma de la Aorta Abdominal/etiología , Vacuna BCG/efectos adversos , Infecciones por Mycobacterium/etiología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Adyuvantes Inmunológicos/administración & dosificación , Anciano , Animales , Antibacterianos/uso terapéutico , Antituberculosos/uso terapéutico , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/microbiología , Aneurisma de la Aorta Abdominal/cirugía , Vacuna BCG/administración & dosificación , Humanos , Masculino , Infecciones por Mycobacterium/tratamiento farmacológico , Infecciones por Mycobacterium/microbiología , Tomografía Computarizada por Tomografía de Emisión de Positrones
8.
BMJ Case Rep ; 12(12)2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31857290

RESUMEN

A 91-year-old man with a history of intravesicular BCG therapy for recurrent bladder cancer and bilateral total hip arthroplasty (THA) presented with left hip pain. He was noted to have a fluid collection over the left lateral hip and hip X-ray showed loosening of the prosthetic hip stem indicative of a prosthetic joint infection (PJI). He subsequently underwent removal of the THA and insertion of an antibiotic spacer. He was discharged on intravenous ceftriaxone for presumed culture negative PJI. Intraoperative acid fast bacillus culture later grew Mycobacterium tuberculosis complex, which was then differentiated to M. bovis The M. bovis infection was thought to be a complication of the patient's prior BCG therapy. He was initially started on isoniazid, rifampin, pyrazinamide and ethambutol pending cultures and sensitivities; pyrazinamide was discontinued after M. bovis was isolated on culture and susceptibility data confirmed the expected inherent resistance of M. bovis to pyrazinamide. The patient underwent successful THA revision and remains symptom-free at 1 year.


Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/efectos adversos , Prótesis de Cadera , Mycobacterium bovis/aislamiento & purificación , Recurrencia Local de Neoplasia , Infecciones Relacionadas con Prótesis/diagnóstico , Neoplasias de la Vejiga Urinaria , Adyuvantes Inmunológicos/administración & dosificación , Administración Intravesical , Anciano de 80 o más Años , Animales , Antituberculosos/uso terapéutico , Vacuna BCG/administración & dosificación , Bovinos , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapia , Pirazinamida/uso terapéutico , Tuberculosis Bovina/diagnóstico , Tuberculosis Bovina/diagnóstico por imagen , Tuberculosis Bovina/terapia
9.
Arch. argent. pediatr ; 117(5): 497-501, oct. 2019. ilus, tab
Artículo en Español | LILACS, BINACIS | ID: biblio-1054970

RESUMEN

La vacuna con el bacilo de Calmette-Guérin es una vacuna atenuada utilizada para prevenir formas graves de tuberculosis. Se aplica a los recién nacidos en países con alta prevalencia de tuberculosis. Pueden presentarse, después de su aplicación, complicaciones a nivel local, como supuración o adenopatías regionales. La enfermedad por diseminación del bacilo es infrecuente y ocurre, por lo general, en pacientes con alteraciones inmunitarias subyacentes. Se presenta el caso de un niño de 5 meses que ingresó por un cuadro de 2 meses de evolución con detención del aumento de peso y nódulos subcutáneos. Se sospechó enfermedad por diseminación del bacilo y se diagnosticó por la biopsia de las lesiones. Se realizó el tratamiento con tres drogas antituberculosas, y se recuperó clínicamente. Si bien se realizaron estudios inmunológicos, no logró demostrarse ninguna inmunodeficiencia como afección predisponente.


The bacillus Calmette-Guérin vaccine is an attenuated vaccine historically used to prevent severe forms of tuberculosis. It is applied to all newborns in countries with high prevalence of tuberculosis. Local complications, such as suppuration or regional adenopathies, may occur after application. Disease due to the spread of the bacillus is infrequent, usually occurring in a patient with an underlying immune alteration. We present the case of a 5-month-old child who was admitted due to a 2-month evolution with weight loss and subcutaneous nodules. Disease was suspected to be due to bacillus Calmette-Guérin dissemination, being diagnosed by biopsy of the lesions. Treatment was carried out with three antituberculous drugs, evolving towards clinical recovery. Although immunological studies were carried out, no immunodeficiency could be demonstrated as a predisposing condition.


Asunto(s)
Humanos , Masculino , Lactante , Vacuna BCG/efectos adversos , Rifampin/uso terapéutico , Biopsia , Etambutol/uso terapéutico , Isoniazida/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Mycobacterium bovis
10.
Rev. esp. quimioter ; 32(5): 445-450, oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-188711

RESUMEN

INTRODUCCIÓN: Las terapias inmunosupresoras en el tratamiento de las enfermedades inflamatorias mediadas por la inmunidad (EIMI) predisponen a la tuberculosis, por lo que el cribado de infección tuberculosa latente (ITL) y su tratamiento reduce la probabilidad de progresión a tuberculosis activa. El objetivo del estudio fue analizar la concordancia entre la prueba de la tuberculina (PT) e "Interferon Gamma Release Assay-IGRA" en relación con el tipo de EIMI y tratamiento inmunosupresor (IS). MATERIAL Y MÉTODOS: Estudio transversal en pacientes con EIMI candidatos o en tratamiento IS remitidos para cribado de ITL, de Abril del 2017 hasta Mayo del 2018. Variables resultado fueron PT e IGRA. Variables explicativas: EIMI, IS, edad, sexo, vacunación BCG previa y factores de riesgo de tuberculosis. RESULTADOS: Se estudiaron 146 pacientes (33 [22,6%] vacunados con BCG, 1 [0,7%] con diagnóstico previo de tuberculosis y 22 [15,1%] originarios de país endémico). Índice de Kappa (k) fue de 0,338 entre PT e IGRA para la totalidad de la muestra. Menor concordancia en pacientes con enfermedad de Crohn (k=0,125), en los tratados con corticoides (k=0,222), vacunados con BCG (k=0,122) y en pacientes procedentes de países endémicos de tuberculosis (k=0,128). CONCLUSIONES: La concordancia entre la PT y el IGRA se ve afectada en pacientes con EIMI y en mayor medida en la enfermedad inflamatoria intestinal, con la corticoterapia, con la vacunación con BCG o en los procedentes de países endémicos


INTRODUCTION: The immunosuppressive therapies in the treatment of the immune-mediated inflammatory diseases (EIMI) predispose individuals to the tuberculosis, so the screening of latent tuberculosis infection (ITL) and the treatment reduces the likelihood of a progression to an active tuberculosis. The aim of the study was to analyze the concordance between the test of the tuberculin (PT) and "Interferon Gamma Release Assay-IGRA" in relation to the type of EIMI and the immunosuppressive treatment (IS). MATERIAL AND METHODS: Transversal study of patients with EIMI candidates or in treatment IS forwarded to the ITL screening, from April 2017 until May 2018. The outcome variables were PT and IGRA. The explicative variables were: EIMI, IS, age, gender, prior BCG vaccination and tuberculosis risk factors. RESULTS: A total of 146 patients were analyzed (33[22.6%] vaccinated with BCG, 1 [0.7%] with a pre-diagnosis of tuberculosis, and 22 [15.1%] from an endemic country). Kappa index (k) was 0,338 between PT and IGRA for the whole sample. A lower concordance was found in patients with the Crohn's disease (k=0.125), in the ones treated with corticosteroids (k=0.222), vaccinated with BCG (k=0.122) and in patients from tuberculosis endemic countries (k=0.128). CONCLUSION: The concordance between PT and IGRA is affected in patients with EIMI, and to a greater extent to patients with the inflammatory bowel disease, with the corticotherapy, with the BCG vaccination, or in the ones from endemic countries


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades del Sistema Inmune/tratamiento farmacológico , Inmunosupresores/efectos adversos , Tuberculosis Latente/diagnóstico , Vacuna BCG/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Estudios Transversales , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Ensayos de Liberación de Interferón gamma , Sensibilidad y Especificidad , Prueba de Tuberculina , Corticoesteroides/uso terapéutico , Factores de Edad , Artritis Reumatoide/tratamiento farmacológico , Vacuna BCG/administración & dosificación
11.
Medicine (Baltimore) ; 98(36): e16873, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31490371

RESUMEN

At present, intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for prophylaxis purposes after transurethral resection of bladder tumor, but has chances of recurrence. Radical cystectomy reduces the risk of recurrence in bladder cancer patients, but may have chances of postoperative complications. The objective of the study was to test the hypothesis that radical cystectomy has overtreatment and definitive BCG immunotherapy has undertreatment in intermediate or high-risk nonmuscle invasive bladder cancer patients. Data regarding biopsies, ultrasound, the computed tomography scan, adopted treatment strategy, treatment-emergent adverse effect, and a follow-up period of 312 patients with confirmed nonmuscle invasive bladder cancer (pTa, pTis, or pT1 stage; intermediate or high-risk cancer) were reviewed. Patients who had received definitive intravesical BCG immunotherapy were included in BCG group (n = 210) and those who underwent radical cystectomy were included in RXC group (n = 87). Clinical decision-making for treatment strategies was evaluated for both groups. Cystitis was frequently observed in all patients who received BCG immunotherapy. In RXC group, ileus was frequently observed in all patients in early days after the operation. During 2 years of the follow-up period, biopsies, ultrasound, and the computed tomography scan reported that BCG group had fewer numbers of negative cancer patients after treatment than the RXC group after surgery (P < .0001). Total expenditure for BCG immunotherapy was higher than radical cystectomy (22,945 ±â€Š945 ¥/patient vs 17,985 ±â€Š545 ¥/patient; P < .0001). Definitive BCG immunotherapy had undertreatment and radical cystectomy had overtreatment for intermediate or high-risk invasive bladder cancer patients (level of evidence III).


Asunto(s)
Vacuna BCG/uso terapéutico , Cistectomía/estadística & datos numéricos , Inmunoterapia/métodos , Neoplasias de la Vejiga Urinaria/terapia , Administración Intravesical , Adolescente , Adulto , Anciano , Vacuna BCG/efectos adversos , Vacuna BCG/economía , Análisis Costo-Beneficio , Cistectomía/efectos adversos , Cistectomía/economía , Femenino , Conductas Relacionadas con la Salud , Humanos , Inmunoterapia/economía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores Socioeconómicos , Neoplasias de la Vejiga Urinaria/patología , Adulto Joven
12.
Rev Esp Quimioter ; 32(5): 445-450, 2019 Oct.
Artículo en Español | MEDLINE | ID: mdl-31523944

RESUMEN

OBJECTIVE: The immunosuppressive therapies in the treatment of the immune-mediated inflammatory diseases (EIMI) predispose individuals to the tuberculosis, so the screening of latent tuberculosis infection (ITL) and the treatment reduces the likelihood of a progression to an active tuberculosis. The aim of the study was to analyze the concordance between the test of the tuberculin (PT) and "Interferon Gamma Release Assay-IGRA" in relation to the type of EIMI and the immunosuppressive treatment (IS). METHODS: Transversal study of patients with EIMI candidates or in treatment IS forwarded to the ITL screening, from April 2017 until May 2018. The outcome variables were PT and IGRA. The explicative variables were: EIMI, IS, age, gender, prior BCG vaccination and tuberculosis risk factors. RESULTS: A total of 146 patients were analyzed (33[22.6%] vaccinated with BCG, 1 [0.7%] with a pre-diagnosis of tuberculosis, and 22 [15.1%] from an endemic country). Kappa index (k) was 0,338 between PT and IGRA for the whole sample. A lower concordance was found in patients with the Crohn's disease (k=0.125), in the ones treated with corticosteroids (k=0.222), vaccinated with BCG (k=0.122) and in patients from tuberculosis endemic countries (k=0.128). CONCLUSIONS: The concordance between PT and IGRA is affected in patients with EIMI, and to a greater extent to patients with the inflammatory bowel disease, with the corticotherapy, with the BCG vaccination, or in the ones from endemic countries.


Asunto(s)
Enfermedades del Sistema Inmune/tratamiento farmacológico , Inmunosupresores/efectos adversos , Ensayos de Liberación de Interferón gamma , Tuberculosis Latente/diagnóstico , Prueba de Tuberculina , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Adulto , Factores de Edad , Artritis Reumatoide/tratamiento farmacológico , Vacuna BCG/administración & dosificación , Vacuna BCG/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Estudios Transversales , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Ensayos de Liberación de Interferón gamma/estadística & datos numéricos , Tuberculosis Latente/prevención & control , Masculino , Persona de Mediana Edad , Psoriasis/tratamiento farmacológico , Sensibilidad y Especificidad , Prueba de Tuberculina/estadística & datos numéricos
13.
Adv Respir Med ; 87(4): 239-242, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31476012

RESUMEN

INTRODUCTION: Immunodeficient children are at a high risk of disseminated Bacillus Calmette-Guérin [BCG] infection. We assessed the literature on clinical manifestations of BCGosis in children with specific primary immunodeficiencies. MATERIAL AND METHODS: We conducted a systematic review of clinical practice articles by searching Medline, PubMed, Embase, Scopus, Web of Science and Google Scholar from their inception to date. RESULTS: Thirty-seven articles were included regarding BCG vaccination and its dissemination in children with primary immunodeficiencies. Articles on dissemination after intravesicular BCG were excluded from the study. CONCLUSIONS: Since disseminated BCG vaccination may be the first manifestation of a primary immunodeficiency disease, a comprehensive search for immunological defects in children developing these problems after BCG vaccination seems rational.


Asunto(s)
Vacuna BCG/efectos adversos , Síndromes de Inmunodeficiencia/diagnóstico , Mycobacterium bovis/patogenicidad , Tuberculosis/prevención & control , Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/administración & dosificación , Humanos , Síndromes de Inmunodeficiencia/inmunología , Vacunación/efectos adversos
14.
Int J Infect Dis ; 87: 32-38, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31442625

RESUMEN

BACKGROUND: Mycobacterium bovis BCG is a live, attenuated tuberculosis vaccine. While the vaccine protects infants from tuberculosis, complications including disseminated infections have been reported following vaccination. Genetically diverse BCG sub-strains now exist following continuous passaging of the original Pasteur strain for vaccine manufacture. This genetic diversity reportedly influences the severity of disseminated BCG infections and the efficacy of BCG immunization. METHODS: M. bovis BCG was isolated from infants suspected of being infected with tuberculosis. The whole genome of the clinical isolates and BCG Moscow were sequenced using Illumina Miseq and the sequences were analysed using CLC Genomics Workbench 7.0, PhyResSE v1.0, and Parsnp. RESULTS AND CONCLUSIONS: Genetic variations between the clinical strains and the reference BCG Copenhagen were identified. The clinical strains shared only one mutation in a secretion protein. Mutations were identified in various antibiotic resistance genes in the BCG isolates, which suggests their potential as multidrug-resistant (MDR) phenotypes. Phylogenetic analysis showed that the two isolates were distantly related, and the M1_S48 clinical isolate was closely related to M. bovis BCG Moscow. The phylogenomics results imply that two different BCG strains may be circulating in South Africa. However, it is difficult to associate the BCG vaccine strain administered and the BCG strain supplied with specific adverse events, as BCGiosis is under-reported. This study presents background genomic information for future surveillance and tracking of the distribution of BCGiosis-associated mycobacteria. It is also the first to report on the genomes of clinical BCG strains in Africa.


Asunto(s)
Vacuna BCG/efectos adversos , Mycobacterium bovis/clasificación , Filogenia , Tuberculosis/virología , Vacuna BCG/genética , Vacuna BCG/inmunología , Secuencia de Bases , Femenino , Humanos , Lactante , Masculino , Mutación , Mycobacterium bovis/genética , Mycobacterium bovis/inmunología , Mycobacterium bovis/aislamiento & purificación , Sudáfrica/epidemiología , Tuberculosis/epidemiología , Tuberculosis/etiología , Tuberculosis/prevención & control , Vacunas Atenuadas/efectos adversos , Vacunas Atenuadas/genética , Vacunas Atenuadas/inmunología
15.
Pediatr Int ; 61(10): 982-987, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31465608

RESUMEN

BACKGROUND: Interferon-γ (IFN-γ) and interleukin-12 (IL-12) play a crucial role in the defense against mycobacteria, and in the response to bacillus Calmette-Guérin (BCG) vaccination. We have previously reported clinical and outcome data of 222 BCG osteitis cases diagnosed in 1960-1988 in Finland. The immunological and genetic reports have been based on 132 blood samples obtained in 2007-2008. METHODS: We compared IFNγ rs2430561 and rs35314021, IL12A rs568408 and rs2243115, and IL12B rs3212227 single-nucleotide polymorphisms (SNP) between 132 BCG osteitis patients and 99 population-based controls. In addition, stimulated production of IFN-γ and IL-12 in cell culture was evaluated in relation to the presence of IFNγ and IL12 wild versus variant genotypes, respectively. RESULTS: The distributions of IFNγ rs2430561, IFNγ rs35314021, IL12A rs568408, IL12A rs2243115 and IL12B rs3212227 SNP did not differ between BCG osteitis patients and Finnish population-based controls. For IFNγ rs2430561, IFNγ rs35314021 and IL12A rs2243115, the negative result was confirmed by comparing the minor allele frequencies (MAF) in BCG osteitis cases with those in the publicly available genome aggregation database, including data for 3,472 Finnish persons. Instead, for IL12A rs568408 and IL12B rs3212227, the comparison of MAF in BCG osteitis cases with those in population-based and in aggregation-based controls gave conflicting results. The presence of the wild versus variant genotype had no significant association with IL-12 or IFN-γ production in BCG-stimulated cell cultures. CONCLUSION: IFNγ gene polymorphisms did not show any association with BCG osteitis after newborn vaccination.


Asunto(s)
Interferón gamma/genética , Subunidad p35 de la Interleucina-12/genética , Subunidad p40 de la Interleucina-12/genética , Infecciones por Mycobacterium/genética , Mycobacterium bovis , Osteítis/genética , Polimorfismo de Nucleótido Simple , Adulto , Vacuna BCG/efectos adversos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Marcadores Genéticos , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Osteítis/microbiología
16.
Radiología (Madr., Ed. impr.) ; 61(4): 337-340, jul.-ago. 2019. ilus
Artículo en Español | IBECS | ID: ibc-185312

RESUMEN

La instilación endovesical de bacilo de Calmette-Guérin (BCG) es un tratamiento complementario eficaz para el cáncer de vejiga superficial, una vez realizada la resección transuretral. Se ha comprobado que este tratamiento retrasa la progresión tumoral, disminuye la probabilidad de que el paciente tenga que someterse a una cistectomía futura y mejora la supervivencia. En general se trata de un tratamiento eficaz y bien tolerado. Entre las complicaciones locales más frecuentes están el síndrome miccional irritativo, la hematuria y casos de infección genitourinaria local. Las complicaciones sistémicas son mucho menos frecuentes. Presentamos el caso de un varón de 71 años, en tratamiento con bacilo de Calmette-Guérin intravesical por cáncer de vejiga, que presenta de forma adversa una tuberculosis miliar secundaria al tratamiento. Se trata de una complicación excepcional por su frecuencia, potencialmente letal y que requiere la interrupción inmediata del tratamiento


The intravesical instillation of bacillus Calmette-Guérin (BCG) is an efficacious complementary treatment for superficial bladder cancer after transurethral resection. This treatment delays progression, decreases the probability that the patient will have to undergo cystectomy in the future, and improves survival; it is generally efficacious and well tolerated. Among the most common local complications are irritative symptoms, hematuria, local genitourinary infection. Systemic complications are much less common. We present the case of a 71-year-old man who developed miliary tuberculosis secondary to treatment with intravesical bacillus Calmette-Guérin for bladder cancer. This is exceptionally uncommon complication is potentially lethal and requires the immediate discontinuation of treatment


Asunto(s)
Humanos , Masculino , Anciano , Tuberculosis Miliar/etiología , Vacuna BCG/efectos adversos , Mycobacterium bovis/patogenicidad , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Tomografía Computarizada por Rayos X/métodos
18.
PLoS One ; 14(7): e0219324, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31291329

RESUMEN

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months and 11/26 (42.3%) were followed for atleast one year. 13/26 (50%) were male. All 26 patients were prescribed isoniazid and rifampicin for 3 months. 3/26 (11.5%) were lost to follow-up before completion of anti-tuberculous drugs (ATT). Lesions at the BCG site were observed in 16/26 (61.5%) infants, of which 15 (93.8%) had a papule, 3 (18.8%) developed a pustule, 3 (18.8%) had skin induration and 2 (12.5%) had skin erythema. Axillary lymphadenopathy was observed in 1/26 (3.8%) patient. Coagulation was deranged in 3/26 (11.5%) of babies. Intracranial bleeding was observed in 1/26 (3.8%) case. Localized skin lesions were the most common adverse events. None of them developed clinical tuberculosis. Chemoprophylaxis for inadvertent high dose BCG administration should be given for atleast 3 months. Furthermore, vigilant follow-up, transparency and disclosure are the vital steps in the management of any medical error.


Asunto(s)
Antituberculosos/administración & dosificación , Vacuna BCG/administración & dosificación , Relación Dosis-Respuesta a Droga , Tuberculosis/tratamiento farmacológico , Antituberculosos/efectos adversos , Vacuna BCG/efectos adversos , Combinación de Medicamentos , Femenino , Humanos , Lactante , Recién Nacido , Isoniazida/administración & dosificación , Masculino , Mycobacterium bovis/efectos de los fármacos , Mycobacterium bovis/patogenicidad , Pakistán/epidemiología , Rifampin/administración & dosificación , Centros de Atención Terciaria , Tuberculosis/epidemiología , Tuberculosis/microbiología , Vacunación
19.
Clin Immunol ; 207: 40-42, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31301515

RESUMEN

Mutations in MYD88 cause susceptibility to invasive bacterial infections through impaired signaling downstream of toll-like receptors (TLRs) and IL-1 receptors. We studied a patient presenting with neutropenia, delayed umbilical cord separation, BCG adenitis, andP. aeruginosapneumonia. Next-generation DNA sequencing identified a novel homozygous truncation mutation in MYD88 that abolishes MyD88 expression. The patient's dermal fibroblasts had severely impaired IL-6 production after stimulation with ligands for the MyD88-dependent receptors TLR2, TLR4 and IL-1R, while responses to ligands for the MyD88-independent receptors TLR3 and TNF-α were preserved. Notably, secretion of TNF-α, which is essential for BCG control, was also impaired after LPS stimulation. In this first report of BCG infection in MyD88 deficiency, data suggest that MyD88-dependent TNF-α production contributes to control of mycobacterial disease.


Asunto(s)
Vacuna BCG/efectos adversos , Linfadenitis/patología , Factor 88 de Diferenciación Mieloide/genética , Neutropenia/genética , Neumonía Bacteriana/microbiología , Cordón Umbilical/patología , Vacuna BCG/inmunología , Predisposición Genética a la Enfermedad , Humanos , Masculino , Neutropenia/patología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa
20.
Pediatr Dermatol ; 36(5): 672-676, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31309596

RESUMEN

Bacille Calmette-Guérin (BCG), a live attenuated vaccine prepared using Mycobacterium bovis, can prevent tuberculosis in children and is routinely administered to infants in China and many other countries. A serious complication following vaccination is disseminated BCG infection. The risk is greatly increased in patients with severe combined immunodeficiency disease (SCID), a syndrome characterized by deficiency of both humoral and cellular immunity. We report a case of disseminated BCG infection in an infant with SCID caused by two novel janus kinase 3 (JAK3) gene mutations.


Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/efectos adversos , Janus Quinasa 3/genética , Mutación/genética , Inmunodeficiencia Combinada Grave/complicaciones , Tuberculosis/etiología , Femenino , Humanos , Lactante , Mycobacterium bovis , Inmunodeficiencia Combinada Grave/genética
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA