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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;

Main Article

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.

Main Article

Page created: June 23, 2010
Page updated: June 23, 2010
Page reviewed: June 23, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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