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2.
World Neurosurg ; 133: 416-418, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31181358

RESUMO

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.


Assuntos
Antituberculosos/uso terapêutico , Vacina BCG/efeitos adversos , Infecções por Mycobacterium/etiologia , Glândula Pineal/diagnóstico por imagem , Tuberculoma Intracraniano/etiologia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Infecções por Mycobacterium/diagnóstico por imagem , Infecções por Mycobacterium/tratamento farmacológico , Mycobacterium bovis , Resultado do Tratamento , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculoma Intracraniano/tratamento farmacológico
3.
Medicine (Baltimore) ; 98(36): e16873, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490371

RESUMO

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).


Assuntos
Vacina BCG/uso terapêutico , Cistectomia/estatística & dados numéricos , Imunoterapia/métodos , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adolescente , Adulto , Idoso , Vacina BCG/efeitos adversos , Vacina BCG/economia , Análise Custo-Benefício , Cistectomia/efeitos adversos , Cistectomia/economia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Imunoterapia/economia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Neoplasias da Bexiga Urinária/patologia , Adulto Jovem
4.
Int J Infect Dis ; 87: 32-38, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442625

RESUMO

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.


Assuntos
Vacina BCG/efeitos adversos , Mycobacterium bovis/classificação , Filogenia , Tuberculose/virologia , Vacina BCG/genética , Vacina BCG/imunologia , Sequência de Bases , Feminino , Humanos , Lactente , Masculino , Mutação , Mycobacterium bovis/genética , Mycobacterium bovis/imunologia , Mycobacterium bovis/isolamento & purificação , África do Sul/epidemiologia , Tuberculose/epidemiologia , Tuberculose/etiologia , Tuberculose/prevenção & controle , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/genética , Vacinas Atenuadas/imunologia
5.
Radiología (Madr., Ed. impr.) ; 61(4): 337-340, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185312

RESUMO

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


Assuntos
Humanos , Masculino , Idoso , Tuberculose Miliar/etiologia , Vacina BCG/efeitos adversos , Mycobacterium bovis/patogenicidade , Neoplasias da Bexiga Urinária/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos
6.
Rev. méd. Urug ; 35(2): 155-164, jun. 2019. fig
Artigo em Espanhol | LILACS | ID: biblio-999629

RESUMO

La tuberculosis cutánea es una enfermedad infecciosa crónica y poco frecuente ocasionada por Mycobacteriun tuberculosis. Existen varias formas de la infección cutánea, siendo el lupus vulgar la más frecuente y común en los países industrializados. Las variantes clínicas dependerán de la vía de llegada del bacilo a la piel, del estado inmunológico del paciente y del medio ambiente. En el lupus vulgar, además de M. tuberculosis puede estar implicado M. bovis y menos frecuentemente el bacilo de Calmette y Guérin. Esta entidad presenta una evolución crónica, es de carácter progresivo y es rara de ver en niños. Se presenta el caso de una niña en la cual se diagnosticó una forma de tuberculosis cutánea denominada lupus vulgar provocada por el bacilo de Calmette y Guérin. Caso clínico: niña de 10 años que presentaba lesiones cutáneas de diferentes características, de evolución tórpida y asintomáticas; la de mayor tamaño se localizaba en la cara externa del deltoides derecho en forma de placa eritematosa de 20 por 10 cm con bordes sobreelevados presentando en su centro micropápulas que coalescen dejando una zona de atrofia central. Esta había comenzado en etapa neonatal luego de la vacunación por el bacilo de Calmette y Guérin. Desde hacía tres años presentaba una segunda lesión más pequeña en cara externa de muslo derecho de similares características y otras de carácter múltiple en dorso con forma de micropápulas rojo vinosas. Los exámenes de valoración general fueron normales, al igual que la radiografía de tórax y de los miembros. El test de la tuberculina mostró una induración de 15 mm y las baciloscopias fueron negativas. La biopsia de la lesión de piel del deltoides mostró granulomas caseosos y las técnicas moleculares diagnosticaron Mycobacterium bovis atenuado. Con ese diagnóstico, recibió tratamiento antituberculoso por diez meses con buena tolerancia y con mejoría de las lesiones.


Cutaneous TB is a rather unusual chronic infectious disease caused by Mycobacteriun tuberculosis. There are several forms of cutaneous infection, lupus vulgaris being the most frequent and ordinary one in developed countries. Clinical variations will depend on the site of infiltration of the skin by the bacillus, the patient's immune condition and the environment. In the case of lupus vulgaris, apart from Mycobacteriun tuberculosis, M. bovis may be involved, and the Bacille Calmette Guérin involvement is less frequent. The latter presents a chronic evolution, being progressive and unusual in children. The study presents the case of a girl who was diagnosed with a form of cutaneous tuberculosis called lupus vulgaris caused by the Bacille Calmette-Guérin vaccine. Clinical case: a 10 year old girl who evidenced skin lesions of different kinds, of slow evolution and asymptomatic: the largest one was in the external part of the right deltoid muscle as an erythematous plaque of 20 by 10 cm with higher borders evidencing micro papules in the center that coalesce leaving a central atrophy zone. The latter had started in the neonatal stage after the Bacille Calmette-Guérin vaccine. For three years she had evidenced a second smaller lesion in the outer face of the right thigh of similar characteristics and other multiple lesions in the back with the shape of vinous red micro papules. Assessment tests were generally normal, as well as the chest and limbs X-ray. The tuberculin test evidenced a 15 mm induration and smears were negative. The deltoid muscle skin lesion biopsy showed caseous granulomas and molecular techniques diagnosed attenuated Mycobacteriumbovis. Given that diagnose the patient received anti-TB treatment during 10 months, tolerance being good and the lesions improved.


A tuberculose cutânea é uma doença infecciosa crônica e pouco frequente causada pelo Mycobacteriun tuberculosis. Existem várias formas de infecção cutânea, sendo o lúpus vulgar a mais frequente e comum nos países industrializados. As variantes clínicas dependerão da via de entrada do bacilo à pele, do estado imunológico do paciente e do ambiente. No lúpus vulgar, além do M. tuberculosis podem estar implicados o M. bovis e mais raramente o bacilo de Calmette-Guérin. Esta entidade apresenta uma evolução crônica, é progressiva e é rara em crianças. Apresenta-se o caso de uma paciente de sexo feminino com 10 anos que foi diagnosticada com uma forma de tuberculose cutânea denominada lúpus vulgar provocada pelo bacilo de Calmette-Guérin. Caso clínico: paciente de sexo feminino com 10 anos que apresentava lesões cutâneas de diferentes características, com evolução letárgica e assintomática; a maior lesão estava localizada na face externa do deltoide direito sob a forma de placa eritematosa de 20 x 10 cm com bordes sobrelevados apresentando no centro micropápulas que coalescem deixando una zona de atrofia central. Esta lesão começou na etapa neonatal depois da vacinação com o bacilo de Calmette-Guérin. Desde 3 anos apresentava uma segunda lesão menor na face externa da coxa direita com características similares e outras múltiplas no dorso com forma de micropápulas com coloração de manchas em vinho do Porto. Os exames de avaliação geral foram normais, bem como as radiografias de tórax e de membros. O teste da tuberculina mostrou uma induración de 15 mm e as baciloscopias foram negativas. A biopsia da lesão de pele dos deltoides mostrou granulomas caseosos e as técnicas moleculares diagnosticaram Mycobacterium bovis atenuado. Com esse diagnóstico recebeu tratamento antituberculoso por 10 meses com boa tolerância e melhoria das lesões.


Assuntos
Criança , Tuberculose Cutânea/diagnóstico , Lúpus Vulgar/diagnóstico , Vacina BCG/efeitos adversos , Criança
8.
Acta Med Port ; 32(4): 316-320, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31067427

RESUMO

Granulomatous pneumonitis is a rare complication of bacillus Calmette-Guerin immunotherapy following intravesical administration of bacillus Calmette-Guerin. The authors present an unusual case of a 67-year-old man who developed mild and non-specific symptoms, following intravesical bacillus Calmette-Guerin instillations. Examinations revealed features of miliary tuberculosis and granuloma suggestive of mycobacterial infection. Anti-tuberculosis treatment resulted in a remarkable improvement in his symptoms and gradually upgrading of radiological appearance. The symptoms were less severe than some others described but this case provides evidence that, even in some cases, specific treatment may be necessary. We highlight the importance of recognizing miliary Mycobacterium bovis as a probable complication of bacillus Calmette-Guerin immunotherapy. The clinical disease course can be mild, despite extensive bilateral miliary nodules on primary presentation.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Granuloma/etiologia , Pneumonia/etiologia , Doenças Raras/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Administração Intravesical , Idoso , Vacina BCG/administração & dosagem , Granuloma/diagnóstico por imagem , Humanos , Imunoterapia/efeitos adversos , Masculino , Pneumonia/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/etiologia
9.
Rev Peru Med Exp Salud Publica ; 36(1): 134-137, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31116327

RESUMO

The Bacillus Calmette-Guerin (BCG) vaccine given to newborns in countries with a high incidence of tuberculosis may cause local reactions up to disseminated infection in immunocompromised patients. We report the case of a six-monthold male infant with a history of having received the BCG vaccine at birth, and presenting repeated infectious, soft violet nodules in the trunk and extremities with the presence of acid-alcohol-resistant bacilli (BAAR) in histopathology and skin culture; the molecular study reported the presence of Mycobacterium bovis BCG. In the tomography, interstitial opacities were observed in the lungs and in the gastric lavage BAAR was identified. The genetic study of the patient and the mother revealed the presence of a mutation in the IL2RG gene confirming the diagnosis of severe combined immunodeficiency. Received treatment with human immunoglobulin and anti-tuberculosis scheme with isoniazid, rifampicin, and ethambutol. We present the case because of the implication in the life prognosis of these patients and because of the need for an accurate and timely diagnosis.


Assuntos
Vacina BCG/efeitos adversos , Imunodeficiência Combinada Severa/complicações , Tuberculose/etiologia , Humanos , Lactente , Masculino , Tuberculose/microbiologia
10.
BMC Infect Dis ; 19(1): 331, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999879

RESUMO

BACKGROUND: Prosthetic joint infections remain a significant cause of morbidity and are frustrating for patients and physicians alike. Unusual causes of infection may be seen in selected circumstances and a high index of suspicion and a careful history are required to ensure an accurate and timely diagnosis can be made. CASE PRESENTATION: We present a case of Mycobacterium bovis prosthetic joint infection secondary to intravesicular Bacillus Calmette-Guérin (BCG) treatment for prior bladder cancer definitively identified by spoligotyping. A favorable clinical outcome was observed following surgical intervention and a 12-month course of anti-mycobacterial therapy. CONCLUSIONS: BCG therapy, a live attenuated strain of M. bovis, has become the mainstay of adjunctive therapy for bladder cancer and infectious complications, including those affecting the musculoskeletal system, may be seen years after initial therapy. An awareness of this complication and appropriate discussions with the institution's microbiology laboratory may allow for an accurate and timely identification.


Assuntos
Artrite Infecciosa/diagnóstico , Vacina BCG/uso terapêutico , Neoplasias da Bexiga Urinária/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Vacina BCG/efeitos adversos , Quadril/diagnóstico por imagem , Humanos , Masculino , Mycobacterium bovis/fisiologia
12.
Clin Rheumatol ; 38(6): 1773-1783, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30868320

RESUMO

Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.


Assuntos
Vacina BCG/efeitos adversos , Dor nas Costas/etiologia , Osteomielite/etiologia , Neoplasias da Bexiga Urinária/complicações , Administração Intravesical , Idoso , Vacina BCG/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Mycobacterium bovis , Osteomielite/diagnóstico por imagem , Neoplasias da Bexiga Urinária/terapia
13.
Front Immunol ; 10: 58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30740107

RESUMO

Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare condition of primary immunodeficiency disorder. Interleukin-12 receptor ß1 (IL12RB1) deficiency, is the most common genetic etiology of MSMD, which is characterized by the selective predisposition to clinical disease caused by weakly-virulent mycobacteria, such as Bacillus Calmette-Guérin (BCG) vaccines, and environmental non-tuberculous mycobacteria (NTM). To the best of our knowledge, this is the first case of IL12RB1 deficiency to be reported from Iraq. Our case is an 8-year-old Syrian girl, for first-cousin parents, with a refugee-status in the North of Iraq. She had a history of disseminated BCG infection 2 months after receiving BCG vaccine, in addition to repeated episodes of mild or severe illnesses, such as maculopapular skin rash, lymphadenopathy, gastroenteritis, meningitis, and clinically diagnosed tuberculosis (TB) based on local TB-prevalence setting. Because of limited medical facilities in the war-torn countries; in Syria and Iraq, no diagnosis could be reached. We used Flinders Technology Associates (FTA) cards to transfer her bone marrow aspirate to Japan. A homozygous IL12RB1 mutation was detected by whole exome sequencing in Japan, using genomic-DNA extracted from dried bone marrow sample spots on FTA filter paper. In conclusion, diagnosis of MSMD due to IL12RB1 deficiency was possible by transferring the FTA sample of the patient for genetic evaluation in Japan. Our report recalls the need of pediatricians in countries with TB-prevalence and high parental consanguinity, to consider IL12RB1 deficiency in the differential diagnosis of a child with clinical evidence of TB, especially with the history of disseminated BCG disease.


Assuntos
Teste em Amostras de Sangue Seco , Síndromes de Imunodeficiência/diagnóstico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Receptores de Interleucina-12/deficiência , Refugiados , Tuberculose/diagnóstico , Antibacterianos/uso terapêutico , Vacina BCG/efeitos adversos , Criança , Consanguinidade , Diagnóstico Diferencial , Feminino , Predisposição Genética para Doença , Humanos , Síndromes de Imunodeficiência/tratamento farmacológico , Iraque , Japão , Mutação , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Síria , Resultado do Tratamento , Sequenciamento Completo do Exoma
14.
JAAPA ; 32(3): 25-31, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30741851

RESUMO

Acute monoarthritis affects a single joint and has many potential underlying causes, including crystal deposition diseases, infection, trauma, and osteoarthritis. A comprehensive health history and physical examination can help narrow the list of differential diagnoses; judicious diagnostic testing can help pinpoint the diagnosis. Clinicians also must be able to recognize which patients require emergency referral to prevent long-term adverse consequences.


Assuntos
Artralgia/etiologia , Artrite/diagnóstico , Artrite/etiologia , Doença Aguda , Corticosteroides/efeitos adversos , Anticoagulantes/efeitos adversos , Artralgia/patologia , Artrite/classificação , Artrite/patologia , Artrite Infecciosa/complicações , Artrite Reumatoide/complicações , Vacina BCG/efeitos adversos , Condrocalcinose/complicações , Artropatias por Cristais/complicações , Diagnóstico Diferencial , Difosfonatos/efeitos adversos , Diuréticos/efeitos adversos , Gota/complicações , Humanos , Articulações/patologia , Osteoartrite/complicações , Espondiloartropatias/complicações
15.
Bull Exp Biol Med ; 166(4): 469-472, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30788744

RESUMO

Correlations between extracellular matrix components in mouse liver revealed the pathogenetically determined dynamic structure of these interrelations (some correlations appeared while others disappeared) at various terms of BCG-induced granulomatosis. The correlations between the studied parameters were strong during the first (postinfection days 3-10) and the second (postinfection days 60-90) periods but became moderate during the third period manifested by chronic inflammation (postinjection day 180). The greatest number of correlations was observed at the beginning of the stabilization period (postinjection day 60). At this period, the content of all structural components of hepatic proteoglycans closely correlated with that of hydroxyproline. These findings attested to systemic changes in metabolism of extracellular matrix components and interrelation between some structural units of proteoglycans in the liver and the components of extracellular matrix in the lungs. The common and typical organ-specific correlations in the liver and lungs suggest the existence of correlations between different organs during progression of BCG-induced granulomatosis.


Assuntos
Vacina BCG/efeitos adversos , Matriz Extracelular/metabolismo , Granuloma/induzido quimicamente , Granuloma/metabolismo , Fígado/metabolismo , Animais , Fígado/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C
16.
Emerg Infect Dis ; 25(3): 451-456, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789145

RESUMO

Mycobacterium bovis bacillus Calmette-Guérin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions.


Assuntos
Vacina BCG/efeitos adversos , Notificação de Doenças , Tuberculose/epidemiologia , Tuberculose/microbiologia , Vacina BCG/genética , Notificação de Doenças/estatística & dados numéricos , Feminino , Genótipo , História do Século XXI , Humanos , Masculino , Vigilância da População , Tuberculose/diagnóstico , Tuberculose/história , Estados Unidos/epidemiologia
17.
Front Immunol ; 10: 73, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30761141

RESUMO

Background: Disseminated Bacillus Calmette-Guérin disease (D-BCG) in children with chronic granulomatous disease (CGD) can be fatal, while its clinical characteristics remain unclear because both diseases are extremely rare. The patients with CGD receive BCG vaccination, because BCG vaccination is usually performed within 24 h after delivery in China. Methods: We prospectively followed-up Chinese patients with CGD who developed D-BCG to characterize their clinical and genetic characteristics. The diagnoses were based on the patients' clinical, genetic, and microbiological characteristics. Results: Between September 2009 and September 2016, we identified 23 patients with CGD who developed D-BCG. Their overall 10-year survival rate was 34%. We created a simple dissemination score to evaluate the number of infected organ systems and the survival probabilities after 8 years were 62 and 17% among patients with simple dissemination scores of ≤3 and >3, respectively (p = 0.0424). Survival was not significantly associated with the CGD stimulation index or interferon-γ treatment. Eight patients underwent umbilical cord blood transplantation and 5 of them were successfully treated. The genetic analyses found mutations in CYBB (19 patients), CYBA (1 patient), NCF1 (1 patient), and NCF2 (1 patient). We identified 6 novel highly likely pathogenic mutations, including 4 mutations in CYBB and 2 mutations in NCF1. Conclusions: D-BCG is a deadly complication of CGD. The extent of BCG spreading is strongly associated with clinical outcomes, and hematopoietic stem cell transplantation may be a therapeutic option for this condition.


Assuntos
Doença Granulomatosa Crônica/complicações , Doença Granulomatosa Crônica/genética , Mycobacterium bovis/imunologia , Tuberculose/etiologia , Tuberculose/genética , Vacina BCG/efeitos adversos , Criança , Pré-Escolar , China , Feminino , Seguimentos , Testes Genéticos , Genótipo , Doença Granulomatosa Crônica/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Humanos , Interferon gama/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Mutação , NADPH Oxidase 2/genética , NADPH Oxidases/genética , Estudos Prospectivos , Rodaminas/análise , Taxa de Sobrevida , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Vacinação/efeitos adversos
18.
Ann Vasc Surg ; 59: 310.e7-310.e11, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802589

RESUMO

BACKGROUND: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is an effective and widely used treatment for patients with in situ bladder cancer. Major complications are quite uncommon, but a systemic dissemination of the attenuated strain of Mycobacterium bovis is possible. Few cases of aortic rupture caused by M bovis infection are described in literature. METHODS: A 70-year-old male, treated 3 months before with BCG instillation, presented to the emergency department because of a ruptured abdominal aortic aneurysm. The patient was hemodynamically stable, with a "hostile" abdomen. Therefore, an Endologix AFX endograft was deployed. During the postoperative period, his blood inflammatory markers increased, suspicious of a graft infection. Single-photon emission computed tomography (CT)/CT scan showed aortic increased uptake. Antibiotic therapy was continued, but after some days, the patient presented with hematemesis, and the CT scan showed an aortoenteric fistula. In emergency, the infected graft and aneurysm were removed, enteric fistula was closed, and an axillobifemoral bypass was performed. The patient died 25 days after endovascular aneurysm repair explantation. RESULTS: Despite the high suspicion of mycotic aortic aneurysm and graft infection by M bovis, there is no proof of this theory because of the absence of any positive culture test. M bovis is a slow-growing bacteria, and specific culture tests are required to identify it; indeed, all our blood and intraoperative samples were positive to other bacteria, probably the contaminant ones. CONCLUSIONS: Mycotic aneurysm is an extremely rare complication of intravesical BCG therapy, but it must be taken into consideration in patients with rapidly growing aortic aneurysms or rupture of a normal aorta, who have been previously submitted to this kind of instillation.


Assuntos
Aneurisma Infectado/microbiologia , Antineoplásicos/efeitos adversos , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vacina BCG/efeitos adversos , Mycobacterium bovis/patogenicidade , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Antineoplásicos/administração & dosagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aortografia/métodos , Vacina BCG/administração & dosagem , Angiografia por Tomografia Computadorizada , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
19.
Tuberculosis (Edinb) ; 114: 47-53, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30711157

RESUMO

A global BCG vaccine shortage began in 2013 which impacted availability for infant vaccinations, as well as preclinical studies and clinical trials of new TB vaccines. Stakeholders met in 2015 at McGill University in Montreal to discuss the shortage and potential mitigation strategies. Manufacturing BCG through a more tractable liquid fermentation process instead of the traditional pellicle growth method was considered a potentially viable strategy. This pilot program compared pellicle-grown and shake flask-grown BCG strains (as a first step towards modeling fermenter-produced BCG vaccine) in selected quality control assays, as well as mouse and guinea pig protection studies. Conventional pellicle-grown, lyophilized BCG WHO Reference Reagents (Danish, Moreau, Russian, Tokyo strains) were obtained from the National Institute for Biological Standards and Control (NIBSC), UK. Strains were grown in shake flasks and glycerol stocks prepared. Shake flask-grown BCG culture preparations generally met the requirements of quality control testing at NIBSC. In mouse and guinea pig protection studies there were no significant differences in lung colony forming units (CFUs) between shake flask-grown and pellicle-grown preparations, with the exception of BCG Russian, where the shake flask-grown preparation protected better in mice (P = 0.0042), but the pellicle-grown preparation protected better in guinea pigs (P = 0.0015). Producing BCG vaccines by a more tractable liquid growth process could be a viable solution to the global BCG shortage.


Assuntos
Vacina BCG/normas , Técnicas Bacteriológicas/métodos , Mycobacterium bovis/crescimento & desenvolvimento , Animais , Vacina BCG/efeitos adversos , Vacina BCG/imunologia , Contagem de Colônia Microbiana , Feminino , Cobaias , Hipersensibilidade Tardia/etiologia , Camundongos Endogâmicos BALB C , Mycobacterium bovis/imunologia , Controle de Qualidade , Tuberculose/prevenção & controle
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