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1.
Rev Med Suisse ; 16(710): 1920-1923, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058578

RESUMO

Intravesical bacillus Calmette-Guérin immunotherapy is currently the most effective treatment for non-infiltrating bladder tumors. Although rare, « BCGitis ¼, local or disseminated, is a serious complication of this therapy. The diagnosis is difficult and often delayed but the infection may progress to multi-systemic failure and can be fatal. The microbiological samples are often negative, and biopsies sometimes do not help. Treatment consists of antimycobacterial agents in combination with corticosteroids in case of severe presentation.


Assuntos
Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Imunoterapia/efeitos adversos , Inflamação/induzido quimicamente , Administração Intravesical , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Neoplasias da Bexiga Urinária/terapia
2.
Medicine (Baltimore) ; 99(35): e21930, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871933

RESUMO

BACKGROUND: This study will systematically assess the efficacy and safety of Bacillus Calmette-Guerin (BCG) for patients with bladder cancer (BC). METHODS: Literature searches will be performed in multiple electronic databases from inception to present: MEDLINE, EMBASE, CINAHL, Science Direct, Cochrane Library, Web of Science, and China National Knowledge Infrastructure. We will also examine grey literature through identifying conference proceedings, thesis, dissertations, and website of clinical trials registry. Two investigators will independently scan all citation titles, abstracts, and full-text studies. The study quality will be assessed by Cochrane Risk of Bias Tool. If possible, we will perform meta-analysis. Additional analyses will be carried out to test the potential sources of heterogeneity among included trials. RESULTS: The present study will summarize high quality trials on investigating the efficacy and safety of BCG for patients with BC. CONCLUSION: The results of this study will supply helpful evidence to determine whether BCG is effective or not for BC. STUDY REGISTRATION NUMBER: INPLASY202070042.


Assuntos
Vacina BCG/efeitos adversos , Vacina BCG/uso terapêutico , Revisões Sistemáticas como Assunto , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Cell ; 183(2): 315-323.e9, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32941801

RESUMO

BCG vaccination in children protects against heterologous infections and improves survival independently of tuberculosis prevention. The phase III ACTIVATE trial assessed whether BCG has similar effects in the elderly. In this double-blind, randomized trial, elderly patients (n = 198) received BCG or placebo vaccine at hospital discharge and were followed for 12 months for new infections. At interim analysis, BCG vaccination significantly increased the time to first infection (median 16 weeks compared to 11 weeks after placebo). The incidence of new infections was 42.3% (95% CIs 31.9%-53.4%) after placebo vaccination and 25.0% (95% CIs 16.4%-36.1%) after BCG vaccination; most of the protection was against respiratory tract infections of probable viral origin (hazard ratio 0.21, p = 0.013). No difference in the frequency of adverse effects was found. Data show that BCG vaccination is safe and can protect the elderly against infections. Larger studies are needed to assess protection against respiratory infections, including COVID-19 (ClinicalTrials.gov NCT03296423).


Assuntos
Vacina BCG/efeitos adversos , Vacina BCG/imunologia , Infecções Respiratórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Vacina BCG/administração & dosagem , Método Duplo-Cego , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/imunologia , Viroses/imunologia , Viroses/prevenção & controle
4.
BMC Infect Dis ; 20(1): 708, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993546

RESUMO

BACKGROUND: Intravesical administration of Bacillus Calmette-Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. CASE PRESENTATION: A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. CONCLUSIONS: We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.


Assuntos
Antituberculosos/uso terapêutico , Vacina BCG/efeitos adversos , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Esteroides/uso terapêutico , Exacerbação dos Sintomas , Administração Intravesical , Idoso , Autopsia , Vacina BCG/administração & dosagem , Vacina BCG/uso terapêutico , Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/prevenção & controle , Evolução Fatal , Humanos , Doenças Pulmonares Intersticiais/microbiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium bovis/genética , Resultados Negativos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/prevenção & controle , Pulsoterapia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/prevenção & controle
5.
Tokai J Exp Clin Med ; 45(3): 136-138, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901902

RESUMO

In recent years, BCG vaccination is routinely performed worldwide. The Ministry of Health, Labor and Welfare of Japan reported that the vaccination rate was as high as 92.9% in 2011. Majority of the reported local adverse reactions to BCG vaccination included lymph node swelling, keloid formation, and abscesses. Subcutaneous tuberculous granuloma is a rare local adverse reaction to BCG vaccination. Herein, we report two cases of developing subcutaneous tuberculous granuloma associated with BCG vaccination. Both of them were treated with isoniazid. There is no standard management for BCG-induced subcutaneous tuberculous granuloma, however, treatment with anti-tuberculosis drugs should be considered for cases of BCGinduced subcutaneous tuberculous granuloma with abscesses or ulcerations.


Assuntos
Vacina BCG/efeitos adversos , Granuloma/etiologia , Dermatopatias/etiologia , Tuberculose Cutânea/etiologia , Antituberculosos/uso terapêutico , Feminino , Granuloma/tratamento farmacológico , Humanos , Lactente , Isoniazida/uso terapêutico , Masculino , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico
6.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 91-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965364

RESUMO

INTRODUCTION: In this retrospective study, we aimed to investigate the frequency of COVID-19 in patients with and without BCG application due to bladder tumors. METHODS: The presence of COVID-19 was investigated in 167 patients with BCG and 167 without bladder cancer. All patients were compatible with COVID-19 infection. Patients with RT-PCR positive for SARS-CoV-2 and/or Chest CT positive for viral pneumonia between March and May 2020 were included in the study. RESULTS: A total of 334 patients were included in the study. The mean age of the 167 patients in the study group was 71.1±14.2 1 (min. 38.0- max. 98.0 years), 141 (84.4%) were male. The mean age of the 167 patients in the control group was 70.5±13.8 years (min. 41.0- max. 96.0 years), and 149 were male (p> 0.05). COVID-19 was detected in 5 patients in the BCG group and in 4 patients in the control group (P> 0.05). CONCLUSION: Intravesical BCG administration does not decrease the frequency of COVID-19 infection.


Assuntos
Vacina BCG/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Vacina BCG/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Trials ; 21(1): 799, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943115

RESUMO

OBJECTIVES: The Bacille Calmette-Guérin (BCG) vaccine against tuberculosis is associated with non- specific protective effects against other infections, and significant reductions in all-cause morbidity and mortality have been reported. We aim to test whether BCG vaccination may reduce susceptibility to and/or the severity of COVID-19 and other infectious diseases in health care workers (HCW) and thus prevent work absenteeism.The primary objective is to reduce absenteeism due to illness among HCW during the COVID-19 pandemic. The secondary objectives are to reduce the number of HCW that are infected with SARS-CoV-2, and to reduce the number of hospital admissions among HCW during the COVID-19 pandemic. HYPOTHESIS: BCG vaccination of HCW will reduce absenteeism by 20% over a period of 6 months. TRIAL DESIGN: Placebo-controlled, single-blinded, randomised controlled trial, recruiting study participants at several geographic locations. The BCG vaccine is used in this study on a different indication than the one it has been approved for by the Danish Medicines Agency, therefore this is classified as a phase III study. PARTICIPANTS: The trial will recruit 1,500 HCW at Danish hospitals.To be eligible for participation, a subject must meet the following criteria: Adult (≥18 years); Hospital personnel working at a participating hospital for more than 22 hours per week.A potential subject who meets any of the following criteria will be excluded from participation in this study: Known allergy to components of the BCG vaccine or serious adverse events to prior BCG administration Known prior active or latent infection with Mycobacterium tuberculosis (M. tuberculosis) or other mycobacterial species Previous confirmed COVID-19 Fever (>38 C) within the past 24 hours Suspicion of active viral or bacterial infection Pregnancy Breastfeeding Vaccination with other live attenuated vaccine within the last 4 weeks Severely immunocompromised subjects. This exclusion category comprises: a) subjects with known infection by the human immunodeficiency virus (HIV-1) b) subjects with solid organ transplantation c) subjects with bone marrow transplantation d) subjects under chemotherapy e) subjects with primary immunodeficiency f) subjects under treatment with any anti-cytokine therapy within the last year g) subjects under treatment with oral or intravenous steroids defined as daily doses of 10 mg prednisone or equivalent for longer than 3 months h) Active solid or non-solid malignancy or lymphoma within the prior two years Direct involvement in the design or the execution of the BCG-DENMARK-COVID trial Intervention and comparator: Participants will be randomised to BCG vaccine (BCG-Denmark, AJ Vaccines, Copenhagen, Denmark) or placebo (saline). An adult dose of 0.1 ml of resuspended BCG vaccine (intervention) or 0.1 ml of sterile 0.9% NaCl solution (control) is administered intradermally in the upper deltoid area of the right arm. All participants will receive one injection at inclusion, and no further treatment of study participants will take place. MAIN OUTCOMES: Main study endpoint: Days of unplanned absenteeism due to illness within 180 days of randomisation.Secondary study endpoints: The cumulative incidence of documented COVID-19 and the cumulative incidence of hospital admission for any reason within 180 days of randomisation.Randomisation: Randomisation will be done centrally using the REDCap tool with stratification by hospital, sex and age groups (+/- 45 years of age) in random blocks of 4 and 6. The allocation ratio is 1:1.Blinding (masking): Participants will be blinded to treatment. The participant will be asked to leave the room while the allocated treatment is prepared. Once ready for injection, vaccine and placebo will look similar, and the participant will not be able to tell the difference.The physicians administering the treatment are not blinded.Numbers to be randomised (sample size): Sample size: N=1,500. The 1,500 participants will be randomised 1:1 to BCG or placebo with 750 participants in each group.Trial Status: Current protocol version 5.1, from July 6, 2020.Recruitment of study participants started on May 18, 2020 and we anticipate having finished recruiting by the end of December 2020. TRIAL REGISTRATION: The trial was registered with EudraCT on April 16, 2020, EudraCT number: 2020-001888-90, and with ClinicalTrials.gov on May 1, 2020, registration number NCT04373291.Full protocol: The full protocol is attached as an additional file, accessible from the Trialswebsite (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
Vacina BCG/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vacinação , Absenteísmo , Vacina BCG/efeitos adversos , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dinamarca , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Admissão do Paciente , Pneumonia Viral/imunologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
8.
Clin Imaging ; 68: 179-183, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32841934

RESUMO

Mycobacterium bovis (M. bovis) Bacillus Calmette-Guerin (BCG) - an attenuated strain of M. bovis - is closely related to Mycobacterium tuberculosis and may be used as a vaccine against tuberculosis as well as a treatment for urinary bladder cancer. Complications of M. bovis BCG administration, while rare, can occur. While a few cases of vertebral osteomyelitis secondary to BCG therapy exist in the literature, and while there are case reports of osteomyelitis and septic arthritis from BCG vaccination (Chen et al., 2017; Huang et al., 2019; Lin et al., 2015 [1-3]), there are no reported cases of osteomyelitis and septic arthritis involving the foot from BCG therapy for urinary bladder cancer. We present an unusual presentation of osteomyelitis and septic arthritis of the tarsometatarsal joints after M. bovis BCG therapy for urinary bladder cancer. We will describe MRI and ultrasound findings in our case of M. bovis BCG osteomyelitis and septic arthritis.


Assuntos
Artrite Infecciosa , Mycobacterium bovis , Osteomielite , Neoplasias da Bexiga Urinária , Administração Intravesical , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/etiologia , Vacina BCG/efeitos adversos , Humanos , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/tratamento farmacológico
9.
Asian Pac J Allergy Immunol ; 38(3): 150-161, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32686943

RESUMO

SARS-CoV-2 had already killed more than 400,000 patients around the world according to data on 7 June 2020. Bacillus Calmette-Guérin (BCG) vaccine is developed from live-attenuated Mycobacterium bovis, which is a microorganism found in a cow. Discovered by Dr. Albert Calmette and Camille Guérin since 1921, the BCG has served as a protection against tuberculosis and its complications. It is noticeable that countries which use mandatory BCG vaccination approach had lower COVID-19 infection and death rate. Current review aims to clarify this issue through epidemiological illustration of correlation between national BCG immunization and COVID-19 mortality, in addition to biological background of BCG-induced immunity Epidemiological data shows that universal BCG policy countries have lower median mortality rate compare to countries with past universal BCG policy and non-mass immunization BCG. (18 May 2020). Still, the links between BCG vaccination and better COVID-19 situation in certain countries are unclear, and more data on actual infection rate using SAR-CoV-2 antibody testing in large population sample is crucial for disease spreading comparison. Two immunological mechanisms, heterologous effects of adaptive immunity and trained innate immunity which induced by BCG vaccination, may explain host tolerance against COVID-19 infection, however, there is no direct evidence to support this biological background. Clinical trials related to BCG vaccination against COVID-19 are under investigation. Without a strong evidence, BCG must not be recommended for COVID-19 prevention, although, this should not be absolute contraindication. Risk of local and systemic complications from the vaccine should be informed to individual, who request BCG immunization.


Assuntos
Vacina BCG/administração & dosagem , Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vacinação , Vacinas Virais/administração & dosagem , Imunidade Adaptativa , Vacina BCG/efeitos adversos , Vacina BCG/imunologia , Causas de Morte , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Interações Hospedeiro-Patógeno , Humanos , Imunidade Inata , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Resultado do Tratamento , Vacinação/efeitos adversos , Vacinas Virais/efeitos adversos , Vacinas Virais/imunologia
10.
Sci Rep ; 10(1): 9763, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32555265

RESUMO

The objective of this study was to evaluate risk factors for bacillus Calmette-Guerin-induced prostatitis in patients with non-muscle invasive bladder cancer following bacillus Calmette-Guerin therapy. Clinical findings from patients with non-muscle invasive bladder cancer who underwent multi-parametric magnetic resonance imaging before transurethral resection of bladder tumor and post-bacillus Calmette-Guerin therapy from March 2004 to August 2018 were evaluated. The population was grouped into patients with or without newly developed lesions on multi-parametric magnetic resonance imaging performed 3 months after bacillus Calmette-Guerin instillation. Patients with prostate-specific antigen levels ≥ 4 ng/mL or prostate cancer were excluded. Univariable and multivariable analyses were performed to determine the predictors of prostate lesions in patients with prior bacillus Calmette-Guerin exposure. Post bacillus Calmette-Guerin-induced prostatitis was found in 50 of the 194 patients (25.8%). No significant differences were observed between the groups except for prostate volumes (33.8 mL vs. 30.8 mL, P = 0.012) and body mass index (25.2 kg/m2 vs. 24.1 kg/m2, P = 0.044). After bacillus Calmette-Guerin exposure, no significant differences in prostate-specific antigen levels, international prostate symptom scores, or post-voiding residual volume were noted. Multivariable regression analysis showed that body mass index (odds ratio, OR = 1.115, P = 0.038) and prostate volume (OR = 3.080, P = 0.012) were significant predictors of post-bacillus Calmette-Guerin prostate lesions. Body mass index and prostate volume may be clinical predictors of prostate lesions after bacillus Calmette-Guerin exposure. Awareness of potential risk factors for this entity should contribute to the clinical decision-making process for patients following bacillus Calmette-Guerin therapy.


Assuntos
Vacina BCG/efeitos adversos , Prostatite/patologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Vacina BCG/administração & dosagem , Progressão da Doença , Humanos , Masculino , Invasividade Neoplásica , Prostatite/etiologia , Fatores de Risco , Neoplasias da Bexiga Urinária/patologia
11.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 157-166, jun. 2020. []
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1125554

RESUMO

Introducción: La vacuna BCG (bacilo de Calmette-Guérin) para prevenir las formas graves de tuberculosis, es la vacuna más difundida en el mundo. Los efectos adversos asociados a la vacunación son poco frecuentes, y la mayoría de ellos ocurren en el sitio de inoculación. Presentamos un caso de osteomielitis de tibia secundaria a la vacuna BCG en un paciente pediátrico inmunocompetente. Conclusiones: El compromiso óseo secundario a la vacuna BCG en pacientes previamente sanos es muy raro. Es importante sospecharlo, para diagnosticarlo y administrar el tratamiento adecuado. Se obtuvieron buenos resultados administrando fármacos antituberculosos, sin necesidad de limpieza quirúrgica. Nivel de Evidencia: IV


Introduction: The Bacillus Calmette-Guérin (BCG) vaccine, used to prevent severe forms of tuberculosis (TB), is the most extensively used vaccine worldwide. Adverse events associated with BCG vaccination are rare, and most of them occur at the inoculation site. We present a tibia Osteomyelitis case secondary to BCG vaccination in an immunocompetent infant. Conclusions: Bone involvement secondary to BCG vaccination in previously healthy patients is extremely rare. Healthcare providers must consider such settings in order to make the diagnosis and institute the appropriate treatment. Antituberculous drugs produced good therapeutic results with no need for surgical toilette. Level of Evidence: IV


Assuntos
Lactente , Osteíte , Osteomielite , Tíbia , Tuberculose/terapia , Vacina BCG/efeitos adversos
12.
Int J Infect Dis ; 97: 117-125, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497805

RESUMO

BACKGROUND: Disseminated Bacillus Calmette-Guérin (BCG) disease (BCGosis) is a classical feature of children with primary immunodeficiency disorders (PIDs). METHODS: A 15-year retrospective review was conducted in KK Women's and Children's Hospital in Singapore, from January 2003 to October 2017. RESULTS: Ten patients were identified, the majority male (60.0%). The median age at presentation of symptoms of BCG infections was 3.8 (0.8 - 7.4) months. All the patients had likely underlying PIDS - four with Severe Combined Immunodeficiency (SCID), three with Mendelian Susceptibility to Mycobacterial Diseases (MSMD), one with Anhidrotic Ectodermal Dysplasia with Primary Immunodeficiency (EDA-ID), one with combined immunodeficiency (CID), and one with STAT-1 gain-of-function mutation. Definitive BCGosis was confirmed in all patients by the identification of Mycobacterium bovis subsp BCG from microbiological cultures. The susceptibility profiles of Mycobacterium bovis subsp BCG are as follows: Rifampicin (88.9%), Isoniazid (44.47%), Ethambutol (100.0%), Streptomycin (100.0%), Kanamycin (100.0%), Ethionamide (25.0%), and Ofloxacin (100.0%). Four patients (40.0%) received a three-drug regimen. Five patients (50.0%) underwent hematopoietic stem cell transplant (HSCT), of which three (60%) have recovered. Overall mortality was 50.0%. CONCLUSION: Disseminated BCG disease (BCGosis) should prompt immunology evaluation to determine the diagnosis of the immune defect. A three-drug regimen is adequate for treatment if the patient undergoes early HSCT.


Assuntos
Vacina BCG/efeitos adversos , Mycobacterium bovis , Doenças da Imunodeficiência Primária/complicações , Tuberculose/etiologia , Vacina BCG/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças da Imunodeficiência Primária/terapia , Estudos Retrospectivos , Singapura , Tuberculose/tratamento farmacológico , Tuberculose/etnologia
13.
Clin Nucl Med ; 45(7): e323-e324, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32433172

RESUMO

We report the case of a 64-year-old man who presented with back pain, anorexia, and weight loss 9 months following bacillus Calmette-Guérin immunotherapy for high-grade transitional cell carcinoma of the bladder. A FDG PET/CT was performed, which demonstrated osteolysis and intense FDG avidity of the T6/T7 and T8/T9 vertebral endplates. In addition, an aneurysm with FDG-avid soft tissue was present of the distal left common iliac artery. The provisional diagnosis was disseminated bacillus Calmette-Guérin infection, resulting in spondylodiscitis and a mycotic aneurysm. A CT-guided vertebral biopsy confirmed the presence of Mycobacterium tuberculosis DNA on polymerase chain reaction testing.


Assuntos
Vacina BCG/efeitos adversos , Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/diagnóstico por imagem , Administração Intravesical , Vacina BCG/administração & dosagem , Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/imunologia , Carcinoma de Células de Transição/terapia , Humanos , Imunoterapia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tuberculose/complicações , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/terapia
15.
Eur Urol Oncol ; 3(3): 259-261, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-47181
16.
Eur Urol Oncol ; 3(3): 259-261, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32327396
18.
Intern Med ; 59(5): 733-737, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115520

RESUMO

A 74-year-old man underwent intravesical bacillus Calmette-Guerin (BCG) therapy for bladder cancer and later presented with lower left back pain. Magnetic resonance imaging of the spine showed high signal intensity, diagnosed as a cystic lesion in the epidural and bilateral intestinal psoas muscle. A computed tomography-guided needle biopsy and histological examination revealed bacteria from the family Mycobacteriaceae, and Mycobacterium bovis was identified using multiplex polymerase chain reaction. If lower back pain appears in a patient who has undergone BCG therapy, it is necessary to test for tuberculous spondylitis. In addition, QuantiFERON is useful for the differential diagnosis of M. bovis BCG infection.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Espondilite/induzido quimicamente , Tuberculose da Coluna Vertebral/induzido quimicamente , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Administração Intravesical , Idoso , Antineoplásicos Imunológicos/administração & dosagem , Vacina BCG/administração & dosagem , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética/efeitos adversos , Masculino , Mycobacterium bovis , Tomografia Computadorizada por Raios X/efeitos adversos
19.
Cancer Epidemiol ; 65: 101696, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32203929

RESUMO

Lymphoma etiology remains ill-defined, but immune factors seem to play a major role. The Bacillus Calmette-Guérin (BCG) vaccine, a non-specific stimulator of the cellular immune response, could influence lymphoma risk. Previous studies addressing this issue showed conflicting results. In this study, we performed a systematic review and meta-analysis to synthesize the epidemiological evidence. We conducted a systematic search of all relevant articles in PubMed, Embase, Library and Archives Canada, and Cochrane databases, up to November 1st 2018. A total of 11 studies were included. Each study was summarized, methodological quality was assessed by independent evaluators, and a consensus score was generated. Heterogeneity and publication bias were evaluated. Summary odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated separately for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) by either a fixed effect (FE) or a random effect (RE) model depending on heterogeneity. In this meta-analysis, BCG vaccination was not associated with HL (FE summary OR = 1.10; 95 % CI 0.93-1.30), but positively associated with NHL (RE summary OR = 1.20; 95 % CI 1.01-1.43). However, when restricting to higher quality studies, no association was found between BCG vaccination and either HL (RE summary OR = 0.97; 95 % CI 0.67-1.43) or NHL (RE summary OR = 1.15; 95 % CI 0.84-1.59). Overall, our findings do not support that BCG vaccination is associated with lymphoma risk. Yet, lack of statistical power and relatively high heterogeneity among studies prevent us from making definitive conclusions. Future studies investigating this issue are needed, using robust methodology.


Assuntos
Vacina BCG/administração & dosagem , Linfoma não Hodgkin/epidemiologia , Vacina BCG/efeitos adversos , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/etiologia , Vacinação/efeitos adversos , Vacinação/estatística & dados numéricos
20.
Sci Rep ; 10(1): 4072, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139769

RESUMO

No standard treatment for Bacille Calmette-Guérin (BCG)-associated osteomyelitis, a rare but serious complication of the BCG vaccine, has been established. This study explored the short- and long-term outcomes of surgical intervention for BCG-associated osteomyelitis. Four patients with BCG osteomyelitis aged 9-21 months when diagnosed and treated at the Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan, between January 2001 and April 2019 were analysed. Radiography revealed osteolytic lesions of the involved sites. Magnetic resonance imaging revealed physeal involvement in three patients. Debridement was performed for all four patients. One patient then underwent additional arthroscopy because of suspect intra-articular involvement. Specimens obtained intraoperatively were sent for pathology, culture, and to the national reference mycobacterial laboratory for BCG detection using polymerase chain reaction. All four patients had positive results for Mycobacterium bovis and satisfactory short-term results. Functional monitoring using QuickDASH or the Lower Extremity Functional Scale revealed excellent long-term outcomes despite tiny limb length discrepancy observed during follow-up in two patients. Prompt diagnosis plus proper intervention is required to prevent further major complications of BCG osteomyelitis. Minimally invasive debridement led to positive clinical outcomes and is therefore recommended.


Assuntos
Vacina BCG/efeitos adversos , Imunocompetência , Imagem por Ressonância Magnética/métodos , Osteomielite/etiologia , Vacinação/efeitos adversos , Antituberculosos/uso terapêutico , Vacina BCG/administração & dosagem , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/patologia , Taiwan
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