Treating BCG-induced disease in children

Therapies for BCG induced disease in children

Carlos A Cuello-García1,*, Giordano Pérez-Gaxiola2, Carlos Jiménez Gutiérrez3

Escuela de Medicina-ITESM, Centre for Evidence Based Practice Tecnológico de Monterrey, Monterrey NL, Mexico
Hospital Pediátrico de Sinaloa, Evidence-Based Practice Department, Culiacán Sinaloa, Mexico
Instituto Nacional de Perinatología, Subdirección de Investigación en Intervenciones Comunitarias, México.DF, DF, Mexico

Treating BCG-induced disease in children. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD008300.

To read the full review please follow this link: DOI: 10.1002/14651858.CD008300.pub2.

Bacillus Calmette-Guérin (BCG) is a widely used tuberculosis vaccine derived from a non-infectious strain of the bovine tuberculosis bacillus (Mycobacterium bovis) and mainly given to young children. Usually, the only adverse reaction to the vaccine is an ulcer at the site of injection, which may leave a small scar.

Very occasionally, however, especially in children with weakened immune systems, the vaccine can cause more serious side effects. These can include local infections at the injection site, which may spread to the lymph nodes, causing lymphadenopathy, and the bones, and can even prove life-threatening. These adverse reactions to the BCG vaccine are a particular risk for children infected with the Human Immunodeficiency Virus (HIV), where the condition is known as BCG immune reconstitution inflammatory syndrome (BCG-IRIS).

In many cases, the infections resolve without any intervention, but treatments can include oral antibiotics, needle aspiration, draining abscesses, and surgically removing infected lymph nodes. This review was conducted to try to determine the effectiveness of these different treatments.

The review found no evidence of any benefit of using oral antibiotics to treat local or regional BCG-induced disease. In patients with abscess-forming lymphadenopathy, the only intervention with proven benefit was needle aspiration of the abscesses with or without local injection of the antibiotic isoniazid.

Based on these findings, the review authors recommend a 'wait and see' approach with follow-up visits for minor reactions and lymphadenopathy without abscesses. For abscess-forming lymphadenopathy, which can cause distress and discomfort, they advise needle aspiration. However, this review is based on only five studies, all of which were assessed as having a low or very low quality of evidence. As a consequence, the authors conclude there is an urgent need for more and better studies on ways to prevent and treat BCG-induced disease, especially BCG-IRIS.