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Volume 13, Number 5—May 2007

Letter

Disseminated Bacillus Calmette-Guérin Infection and Immunodeficiency

Ewa Anna Bernatowska*Comments to Author , Beata Wolska-Kusnierz*, Malgorzata Pac*, Magdalena Kurenko-Deptuch*, Zofia Zwolska†, Jean-Laurent Casanova‡, Barbara Piatosa*, Jacques van Dongen§, Kazimierz Roszkowski†, Bozena Mikoluc¶, Maja Klaudel Dreszler*, and Anna Liberek¶
Author affiliations: *Children's Memorial Health Institute, Warsaw, Poland; †National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland; ‡University Rene Descartes, Paris, France; §University Medical Center, Utrecht, the Netherlands; ¶Medical University of Gdańsk, Gdańsk, Poland;

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Table

Suggested diagnostic criteria for disseminated bacillus Calmette-Guérin (BCG) infection in persons with primary immunodeficiency*

Diagnosis Clinical Laboratory
Definitive
Systemic symptoms like fever or subfebrile status, weight loss, or stunted growth, and ≥2 areas of involvement beyond the site of BCG vaccination†
Identification of Mycobacterium bovis BCG substrain from the patient’s organs by culture and/or standard PCR, as well as typical histopathologic changes with granulomatous inflammation
Probable
    Systemic symptoms like fever or subfebrile status, weight loss or stunted growth, and ≥2 areas of involvement beyond the site of BCG vaccination†
    Identification of M. tuberculosis complex from the organs by PCR, without differentiation of M. bovis BCG substrain or other members of the M. tuberculosis complex and negative mycobacterial cultures, with the presence of typical histopathologic changes with granulomatous inflammation
Possible
Systemic symptoms like fever or subfebrile condition, weight loss or stunted growth, and ≥2 areas of involvement beyond the site of BCG vaccination†
No identification of mycobacteria by PCR and culture, with presence of typical histopathologic changes with granulomatous inflammation
Exclusion criteria
    Any inflammation without typical histopathologic changes, with no isolation of M. tuberculosis complex by PCR analysis in patient with primary immunodeficiency
Differential diagnosis Severe, long-term inflammation with granuloma formation in patient with primary immunodeficiency

*Male or female patient with or without genetic confirmation of severe combined immunodeficiency, deficiency of interferon-γ–receptor
deficiency, interleukin-12–receptor deficiency, or other primary immunodeficiency with disseminated BCG infection.
†Areas of involvement may include lymph nodes, skin, soft tissues, lungs, spleen, liver, bones.

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