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Effectiveness Of Bacillus Calmette Guerin (BCG) Vaccination In The Prevention Of Tuberculosis Of Skin : A Case Control Study.
Zodpey S.P,Shrikhande S. N,Maldhure B.R,Kulkarni S W
Indian Journal of Dermatology , 1998,
Abstract: A hospital based pair matched case control study was performed at Government Medical College Hospital Nagpur to estimate the effectiveness of Bacillus Calmette Guerin (BGG) vaccination against tuberculosis of skin. The study included 48 cases of tuberculosis of skin in the age group of 21 a€" 34 years and equal number of controls, matched for the age, sex and socioeconomic status. The estimates of protective effectiveness and prevented fraction were non-significantly higher for the subjects in the age group 21-30 years, males and subjects from lower strata of socioeconomic status. The overall vaccine effectiveness and prevented fraction was estimated to be 60. 87 (15.46- 81.89) and 36.83 (06.40 a€" 62.89) percent respectively. Results of this study thus indicated that BCG vaccination was moderately effective against tuberculosis of skin, in this population.
Clinical Outcome of Children with Post Bacillus Calmette and Guerin Vaccination Complications: A Single Center Experience  [PDF]
Nermeen M. Galal
World Journal of Vaccines (WJV) , 2012, DOI: 10.4236/wjv.2012.21007
Abstract: Background: Bacillus Calmette ET Guerin (BCG) vaccine, compulsory in endemic areas, remains the only available vaccine for prevention of Tuberculosis (TB) despite its modest protective value. Complications may arise in healthy/ immunocompromized hosts. Methods: Children presenting with BCG vaccine related complications in the form of local/distant complications were enrolled from 2007-2010 at Cairo University Pediatric hospital. Objectives: assess outcome of BCG related complications in a group of children with post vaccination incidents, identify risk factors for complications among vaccinated children and identify cases of underlying Primary Immunodeficiency (PID) among presenting cases. Results: Fifty one eligible patients were included, forty three were proved immunocompetent, and eight had underlying primary immunodeficiency disorders. Presentations included localized axillary lymphadenopathy, cervical sinuses, granulomatous lesions and disseminated forms Faulty injection sites were strongly associated with complications (p value < 0.001).Patients without underlying PID had larger scar size and younger age at presentations (p values: 0.02, 0.0001 respectively).Resolution of lesions was observed in 97 % (95% CI 97% ± 3%) of cases without underlying PID versus fatal outcome in all cases with underlying immune defects. Conclusion: Local BCG related complications do not necessarily indicate underlying PID, disseminated complications are more serious and warrant further investigations. If PID is suspected, vaccination should be deferred to avoid its potentially fatal outcome.
Clinical Efficacy and Laboratory Improvement of Bacillus Calmette-Guerin Vaccination on Adult Atopic Asthma A Cohort Study
Eulis A Datau, H Mewengkang, JC Matheos, I Purnawan, M Wibisono, K Wongdjaja, C Wibowo, E Surachmanto, FP Salim
World Allergy Organization Journal , 2008, DOI: 10.1097/wox.0b013e31816c8b85
Abstract: To investigate whether thrice BCG vaccinations are clinically effective and could induce laboratory improvement compared with placebo on phase 1 (12 weeks) and single BCG vaccination on phase 2 of the study, then finding out whether the effect might last until 9 months after thrice vaccination and 9 months after single vaccination on adult atopic extrinsic asthma.According to the Global Initiative for Asthma criteria, 40 mild to moderate persistent atopic asthma patients were randomly assigned in a double-blind fashion into groups that received intra-dermal injection of 0.1 mL of BCG (n = 20) or 0.1 mL of placebo (n = 20) on the first day. On the first phase, subjects on BCG vaccinations were given intradermal injections 3 times on the deltoid region every 4 weeks. On the second phase, at the 12th week, the placebo group was given BCG vaccination once, and this group became the single BCG group. The symptom score (SS) and drug score (DS), lung function, eosinophil blood count (EBC), total serum immunoglobulin E, interferon-? (IFN-?), interleukin 4, and transforming growth factor-?1 (TGF-?1) were examined on the first phase (before the treatment and at the 12th week) and on the second phase (on the sixth and ninth months after the third vaccination for thrice BCG group or after single BCG for control group) to monitor the efficacy.There were some improvements of asthma SS (P < 0.05) and DS (P < 0.05), forced expiratory volume in 1 second (P < 0.05), peak expiratory flow rate (P < 0.05), EBC (P > 0.05), IFN-? (P < 0.05), and TGF-?1 (P < 0.05) on thrice BCG group compared with prevaccination and with placebo on the first phase and second phase of the study compared with single BCG (formerly placebo).Based on the previous findings, we could confirm that thrice BCG vaccinations proved to be better than the placebo group and single vaccination. The efficacy of thrice BCG vaccinations on asthma was detected by the improvement of SS, DS, forced expiratory volume in 1 second
Oral Vaccination of White-Tailed Deer (Odocoileus virginianus) with Mycobacterium bovis Bacillus Calmette-Guerin (BCG)  [PDF]
Mitchell V. Palmer, Tyler C. Thacker, W. Ray Waters, Suelee Robbe-Austerman
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097031
Abstract: Wildlife reservoirs of Mycobacterium bovis represent serious obstacles to the eradication of tuberculosis from livestock, particularly cattle. In Michigan, USA tuberculous white-tailed deer transmit M. bovis to other deer and cattle. One approach in dealing with this wildlife reservoir is to vaccinate deer, thus interfering with the intraspecies and interspecies transmission cycles. Thirty-three white-tailed deer were assigned to one of two groups; oral vaccination with 1×108 colony-forming units of M. bovis BCG Danish (n = 17); and non-vaccinated (n = 16). One hundred eleven days after vaccination deer were infected intratonsilarly with 300 colony-forming units of virulent M. bovis. At examination, 150 days after challenge, BCG vaccinated deer had fewer gross and microscopic lesions, fewer tissues from which M. bovis could be isolated, and fewer late stage granulomas with extensive liquefactive necrosis. Fewer lesions, especially those of a highly necrotic nature should decrease the potential for dissemination of M. bovis within the host and transmission to other susceptible hosts.
Natural Variation in Immune Responses to Neonatal Mycobacterium bovis Bacillus Calmette-Guerin (BCG) Vaccination in a Cohort of Gambian Infants  [PDF]
Chris Finan, Martin O. C. Ota, Arnaud Marchant, Melanie J. Newport
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0003485
Abstract: Background There is a need for new vaccines for tuberculosis (TB) that protect against adult pulmonary disease in regions where BCG is not effective. However, BCG could remain integral to TB control programmes because neonatal BCG protects against disseminated forms of childhood TB and many new vaccines rely on BCG to prime immunity or are recombinant strains of BCG. Interferon-gamma (IFN-γ) is required for immunity to mycobacteria and used as a marker of immunity when new vaccines are tested. Although BCG is widely given to neonates IFN-γ responses to BCG in this age group are poorly described. Characterisation of IFN-γ responses to BCG is required for interpretation of vaccine immunogenicity study data where BCG is part of the vaccination strategy. Methodology/Principal Findings 236 healthy Gambian babies were vaccinated with M. bovis BCG at birth. IFN-γ, interleukin (IL)-5 and IL-13 responses to purified protein derivative (PPD), killed Mycobacterium tuberculosis (KMTB), M. tuberculosis short term culture filtrate (STCF) and M. bovis BCG antigen 85 complex (Ag85) were measured in a whole blood assay two months after vaccination. Cytokine responses varied up to 10 log-fold within this population. The majority of infants (89–98% depending on the antigen) made IFN-γ responses and there was significant correlation between IFN-γ responses to the different mycobacterial antigens (Spearman's coefficient ranged from 0.340 to 0.675, p = 10?6–10?22). IL-13 and IL-5 responses were generally low and there were more non-responders (33–75%) for these cytokines. Nonetheless, significant correlations were observed for IL-13 and IL-5 responses to different mycobacterial antigens Conclusions/Significance Cytokine responses to mycobacterial antigens in BCG-vaccinated infants are heterogeneous and there is significant inter-individual variation. Further studies in large populations of infants are required to identify the factors that determine variation in IFN-γ responses.
FNAC of Bacillus- Calmette- Guerin lymphadenitis masquerading as Langerhans cell histiocytosis.
Gupta Nalini,Kumar Vijay,Nijhawan Raje,Srinivasan Radhika
CytoJournal , 2004, DOI: 10.1186/1742-6413-1-6
Abstract: Bacillus Calmette Guerin (BCG) lymphadenitis is a well known entity. Disseminated BCG infection usually presents as generalized lymphadenopathy, skin rash and hepatosplenomegaly and at times, can pose a diagnostic challenge to clinicians. There are only a few published studies on the cytological findings of BCG lymphadenitis. In this letter we report the fine needle aspiration cytology (FNAC) of BCG lymphadenitis clinically masquerading as Langerhans cell histiocytosis (LCH). FNA smears showed sheets of foamy macrophages and many polymorphs in a dirty necrotic background with many macrophages as well as polymorphs showing negatively stained rod like structures within their cytoplasm. Zeihl Neelson stain revealed that these cells were heavily loaded with acid fast bacilli (AFB). In the index case, AFB were also seen within the cytoplasm of polymorphs, which has not been documented earlier in the literature.
Intravesical Bacillus Calmette-Guerin for Treatment of Refractory Interstitial Cystitis  [cached]
Seyed Mohammad Kazem Aghamir,Mohammad Ghasem Mohseni,Saeed Arasteh
Urology Journal , 2007,
Abstract: Introduction: The aim of this study was to examine the efficacy and safety of intravesical Bacillus Calmette-Guerin (BCG) in the treatment of refractory interstitial cystitis (IC). Materials and Methods: Thirteen patients with refractory IC were enrolled in the study. They were scheduled to receive 6 weekly courses of treatment with intravesical BCG. Variables including the frequency, nocturia, urgency, pelvic pain, dyspareunia, dysuria, IC symptom index, IC problem index, and average voided volume were assessed every 6 months after the BCG therapy. Results: Thirteen patients received the complete course of intravesical BCG therapy. Twenty-four months after the treatment a mean improvement of 51.9% was seen in frequency (P = .001), 43.2% in nocturia (P = .002), 28.7% in urgency (P = .004), 43.1% in pelvic pain (P = .001), 58.3% in dyspareunia (P = .003), 6.5% in dysuria (P = .16), 57.7% in the O’Leary-Sant IC symptom index (P = .001), and 61.8% in the O’Leary-Sant IC problem index (P = .001) scores. A significant improvement was seen in the mean average voided volume at the 24th follow-up month (89.5%; P = .001). Conclusion: Intravesical BCG is a relatively effective treatment in patients with refractory IC. Its efficacy seems to be modest and lasts for at least 24 months in majority of the patients. It is also safe and well tolerated.
Primary tuberculosis of glans penis after intravesical Bacillus Calmette Guerin immunotherapy  [cached]
Sharma V,Sethy P,Dogra P,Singh Urvashi
Indian Journal of Dermatology, Venereology and Leprology , 2011,
Abstract: A 55-year-old male with carcinoma in situ of urinary bladder was treated with weekly intravesical injections of Bacillus Calmette Guerin (BCG) vaccine. Three days after the sixth injection, he developed low grade fever and multiple grouped punched out, 2-3 mm ulcers around meatus and corona glandis. In addition, multiple, firm, indurated, nontender papules and few deeper nodules were present on the proximal part of glans penis, along with bilateral enlarged, matted and nontender inguinal lymph nodes. There was no history suggestive of sexually transmitted diseases and high risk behavior. Chest X-ray was within normal limits, and Mantoux, Venereal Disease Research Laboratory (VDRL) and HIV antibody tests were negative. The biopsy from the penile ulcer revealed epithelioid cell granuloma with Langhans giant cells. Fine needle aspiration cytology from the lymph node also revealed epithelioid cell granuloma and acid fast bacilli on Ziehl Neelsen′s stain. The tissue biopsy grew Mycobacterium tuberculosis. The BCG immunotherapy was stopped and patient was treated with four drug antitubercular therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide in standard daily doses along with pyridoxine. The edema resolved and the ulcers started healing within 2 weeks, and at 6 weeks after starting antitubercular therapy almost complete healing occurred. To the best of our knowledge, we describe the first case of an Indian patient with BCG induced primary tuberculosis of penis after immunotherapy for carcinoma urinary bladder and review the previously described cases to increase awareness of this condition in dermatologists and venereologists.
Discriminators of mouse bladder response to intravesical Bacillus Calmette-Guerin (BCG)
Marcia R Saban, Cindy Simpson, Carole Davis, Gemma Wallis, Nicholas Knowlton, Mark Frank, Michael Centola, Randle M Gallucci, Ricardo Saban
BMC Immunology , 2007, DOI: 10.1186/1471-2172-8-6
Abstract: C57BL/6 female mice received four weekly instillations of BCG, LPS, or TNF-α. Morphometric analyses were conducted in bladders isolated from all groups and urine was collected for multiplex analysis of 18 cytokines. In addition, chromatin immune precipitation combined with real-time polymerase chain reaction assay (CHIP/Q-PCR) was used to test whether intravesical BCG would alter bladder cytokine gene expression.Acute BCG instillation induced edema which was progressively replaced by an inflammatory infiltrate, composed primarily of neutrophils, in response to weekly administrations. Our morphological analysis suggests that these polymorphonuclear neutrophils are of prime importance for the bladder responses to BCG. Overall, the inflammation induced by BCG was higher than LPS or TNF-α treatment but the major difference observed was the unique granuloma formation in response to BCG. Among the cytokines measured, this study highlighted the importance of IL-1β, IL-2, IL-3, IL-4, IL-6, IL-10, IL-17, GM-CSF, KC, and Rantes as discriminators between generalized inflammation and BCG-specific inflammatory responses. CHIP/Q-PCR indicates that acute BCG instillation induced an up-regulation of IL-17A, IL-17B, and IL-17RA, whereas chronic BCG induced IL-17B, IL-17RA, and IL-17RB.To the best of our knowledge, the present work is the first to report that BCG induces an increase in the IL-17 family genes. In addition, BCG induces a unique type of persisting bladder inflammation different from TNF-α, LPS, and, most likely, other classical pro-inflammatory stimuli.Intravesical Bacillus Calmette-Guerin (BCG) has been presented as a promising option for treatment of interstitial cystitis [1]. However, intravesical BCG is best known as the most effective agent for the treatment of high-grade superficial bladder cancer [2-4]. In this context, BCG is used to reduce both the recurrence rate of bladder tumor and to diminish the risk of its progression [2,3]. As an adjunct to transurethral
Prosthetic Joint Infection due to Mycobacterium bovis after Intravesical Instillation of Bacillus Calmette-Guerin (BCG)  [PDF]
Eric Gomez,Tom Chiang,Ted Louie,Madhavi Ponnapalli,Robert Eng,David B. Huang
International Journal of Microbiology , 2009, DOI: 10.1155/2009/527208
Abstract: Intravesical instillation of Bacillus Calmette-Guerin (BCG) is a treatment to prevent recurrence of superficial urothelial bladder carcinoma. Complications after bladder instillation of BCG have been reported including locally invasive and systemic infections due to dissemination of Mycobacterium bovis from the bladder. We present an uncommon case and literature review of prosthetic joint infection due to M. bovis after intravesical BCG treatment of bladder cancer.
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