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. 2002 Jun;78(920):327–329. doi: 10.1136/pmj.78.920.327

Bacille Calmette-Guérin lymphadenitis

J Goraya 1, V Virdi 1
PMCID: PMC1742390  PMID: 12151684

Abstract

Bacille Calmette-Guérin (BCG) lymphadenitis is the most common complication of BCG vaccination. Two forms of BCG lymphadenitis can be recognised in its natural course—simple or non-suppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative BCG lymphadenitis distinguished by the development of fluctuations in the swelling, with erythema and oedema of overlying skin. Healing in suppurative glands occurs through spontaneous perforation and sinus formation, followed by closure of the sinus by cicatrisation. Non-suppurative BCG lymphadenitis is best managed with expectant follow ups only, because medical treatment with erythromycin or antituberculous drugs do not hasten the regression or prevent development of suppuration. Suppurative BCG lymphadenitis may be treated by needle aspiration to hasten resolution and prevent spontaneous perforation and sinus formation. Surgical excision is rarely needed and is meant for cases of failed needle aspiration or for draining BCG nodes.

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Selected References

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  1. Banani S. A., Alborzi A. Needle aspiration for suppurative post-BCG adenitis. Arch Dis Child. 1994 Nov;71(5):446–447. doi: 10.1136/adc.71.5.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bannon M. J. BCG and tuberculosis. Arch Dis Child. 1999 Jan;80(1):80–83. doi: 10.1136/adc.80.1.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Caglayan S., Arikan A., Yaprak I., Aksoz K., Kansoy S. Management of suppuration in regional lymph nodes secondary to BCG vaccination. Acta Paediatr Jpn. 1991 Dec;33(6):699–702. doi: 10.1111/j.1442-200x.1991.tb02593.x. [DOI] [PubMed] [Google Scholar]
  4. Caglayan S., Yegin O., Kayran K., Timocin N., Kasirga E., Gun M. Is medical therapy effective for regional lymphadenitis following BCG vaccination? Am J Dis Child. 1987 Nov;141(11):1213–1214. [PubMed] [Google Scholar]
  5. Chaves-Carballo E., Sanchez G. A. Regional lymphadenitis following BCG vaccination (BCGitis). Clinical comments based upon 25 instances among 1295 childhood vaccinees. Clin Pediatr (Phila) 1972 Dec;11(12):693–697. doi: 10.1177/000992287201101211. [DOI] [PubMed] [Google Scholar]
  6. Close G. C., Nasiiro R. Management of BCG adenitis in infancy. J Trop Pediatr. 1985 Oct;31(5):286–286. doi: 10.1093/tropej/31.5.286. [DOI] [PubMed] [Google Scholar]
  7. Goraya J. S., Virdi V. S. Treatment of Calmette-Guérin bacillus adenitis: a metaanalysis. Pediatr Infect Dis J. 2001 Jun;20(6):632–634. doi: 10.1097/00006454-200106000-00020. [DOI] [PubMed] [Google Scholar]
  8. Gupta K., Singh N., Bhatia A., Arora V. K., Singh U. R., Singh B. Cytomorphologic patterns in Calmette Guerin bacillus lymphadenitis. Acta Cytol. 1997 Mar-Apr;41(2):348–350. doi: 10.1159/000332523. [DOI] [PubMed] [Google Scholar]
  9. HSING C. T. Local complications of BCG vaccination in pre-school children and new-born babies. Bull World Health Organ. 1954;11(6):1023–1029. [PMC free article] [PubMed] [Google Scholar]
  10. Helmick C. G., D'Souza A. J., Goddard N. An outbreak of severe BCG axillary lymphadenitis in Saint Lucia, 1982-83. West Indian Med J. 1986 Mar;35(1):12–17. [PubMed] [Google Scholar]
  11. Hengster P., Sölder B., Fille M., Menardi G. Surgical treatment of bacillus Calmette Guérin lymphadenitis. World J Surg. 1997 Jun;21(5):520–523. doi: 10.1007/pl00012279. [DOI] [PubMed] [Google Scholar]
  12. Kuyucu N., Kuyucu S., Ocal B., Teziç T. Comparison of oral erythromycin, local administration of streptomycin and placebo therapy for nonsuppurative Bacillus Calmette-Guérin lymphadenitis. Pediatr Infect Dis J. 1998 Jun;17(6):524–525. doi: 10.1097/00006454-199806000-00020. [DOI] [PubMed] [Google Scholar]
  13. Lotte A., Wasz-Hockert O., Poisson N., Engbaek H., Landmann H., Quast U., Andrasofszky B., Lugosi L., Vadasz I., Mihailescu P. Second IUATLD study on complications induced by intradermal BCG-vaccination. Bull Int Union Tuberc Lung Dis. 1988 Jun;63(2):47–59. [PubMed] [Google Scholar]
  14. Lugosi L. Theoretical and methodological aspects of BCG vaccine from the discovery of Calmette and Guérin to molecular biology. A review. Tuber Lung Dis. 1992 Oct;73(5):252–261. doi: 10.1016/0962-8479(92)90129-8. [DOI] [PubMed] [Google Scholar]
  15. Milstien J. B., Gibson J. J. Quality control of BCG vaccine by WHO: a review of factors that may influence vaccine effectiveness and safety. Bull World Health Organ. 1990;68(1):93–108. [PMC free article] [PubMed] [Google Scholar]
  16. Noah P. K., Pande D., Johnson B., Ashley D. Evaluation of oral erythromycin and local isoniazid instillation therapy in infants with Bacillus Calmette-Guérin lymphadenitis and abscesses. Pediatr Infect Dis J. 1993 Feb;12(2):136–139. doi: 10.1097/00006454-199302000-00006. [DOI] [PubMed] [Google Scholar]
  17. O'Brien K. L., Ruff A. J., Louis M. A., Desormeaux J., Joseph D. J., McBrien M., Coberly J., Boulos R., Halsey N. A. Bacillus Calmette-Guérin complications in children born to HIV-1-infected women with a review of the literature. Pediatrics. 1995 Mar;95(3):414–418. [PubMed] [Google Scholar]
  18. Oğuz F., Müjgan S., Alper G., Alev F., Neyzi O. Treatment of Bacillus Calmette-Guérin-associated lymphadenitis. Pediatr Infect Dis J. 1992 Oct;11(10):887–888. [PubMed] [Google Scholar]
  19. Power J. T., Stewart I. C., Ross J. D. Erythromycin in the management of troublesome BCG lesions. Br J Dis Chest. 1984 Apr;78(2):192–194. [PubMed] [Google Scholar]
  20. Talbot E. A., Perkins M. D., Silva S. F., Frothingham R. Disseminated bacille Calmette-Guérin disease after vaccination: case report and review. Clin Infect Dis. 1997 Jun;24(6):1139–1146. doi: 10.1086/513642. [DOI] [PubMed] [Google Scholar]
  21. Tam P. K., Stroebel A. B., Saing H., Lau J. T., Ong G. B. Caseating regional lymphadenitis complicating BCG vaccination: a report of 6 cases. Arch Dis Child. 1982 Dec;57(12):952–954. doi: 10.1136/adc.57.12.952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. USTVEDT H. J. Local reaction in BCG vaccination. Bull World Health Organ. 1950;2(3):441–468. [PMC free article] [PubMed] [Google Scholar]
  23. Victoria M. S., Shah B. R. Bacillus Calmette-Guérin lymphadenitis: a case report and review of the literature. Pediatr Infect Dis. 1985 May-Jun;4(3):295–296. [PubMed] [Google Scholar]
  24. Yan J. J., Chen F. F., Jin Y. T., Chang K. C., Wu J. J., Wang Y. W., Su I. J. Differentiation of BCG-induced lymphadenitis from tuberculosis in lymph node biopsy specimens by molecular analyses of pncA and oxyR. J Pathol. 1998 Jan;184(1):96–102. doi: 10.1002/(SICI)1096-9896(199801)184:1<96::AID-PATH989>3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]

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