Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications
Main Article Content
Keywords
BCGosis, Primary immunodeficiency disorders, vaccination
Abstract
Background: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects.
Methods: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination.
Results: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients.
Conclusion: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency.
References
2. Chapter hot. Bacille calmette-guérin vaccines. In: Handbook of Child and Adolescent Tuberculosis; 2016. p. 359.
3. Nicol M, Eley B, Kibel M, Hussey G. Intradermal BCG vaccination-adverse reactions and their management. South African Med J. 2002;92(1):39.
4. FitzGerald JM. Management of adverse reactions to bacille Calmette-Guerin vaccine. Clin Infect Dis. 2000;31 Supplement 3:S75-6.
5. Grange J. Complications of bacille Calmette-Guerin (BCG) vaccination and immunotherapy and their management. Commun Dis Public Health. 1998;1(2):84-8.
6. Ying W, Sun J, Liu D, Hui X, Yu Y, Wang J, et al. Clinical characteristics and immunogenetics of BCGosis/BCGitis in Chinese children: a 6 year follow-up study. PLoS One. 2014;9(4):e94485.
7. Norouzi S, Aghamohammadi A, Mamishi S, Rosenzweig SD, Rezaei N. Bacillus Calmette-Guérin (BCG) complications associated with primary immunodeficiency diseases. J Infect. 2012;64(6):543-54.
8. Jeena PM, Chhagan MK, Topley J, Coovadia HM. Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa. Bull World Health Organ. 2001;79:337-43.
9. McCusker C, Warrington R. Primary immunodeficiency. Allergy Asthma Clin Immunol. 2011;7(1):S11.
10. Azizi G, Yazdani R. Predominantly Antibody Deficiencies. Immunol Genet J. 2018;1(2):52-80.
11. Fekrvand S, Yazdani R, Olbrich P, Gennery A, Rosenzweig SD, Condino-Neto A, et al. Primary immunodeficiency diseases and Bacillus Calmette-Guérin (BCG)-vaccine-derived complications: a systematic review. J Allergy Clin Immunol Pract. 2020.
12. Abolhassani H, Kiaee F, Tavakol M, Chavoshzadeh Z, Mahdaviani SA, Momen T, et al. Fourth Update on the Iranian National Registry of Primary Immunodeficiencies: Integration of Molecular Diagnosis. J Clin Immunol. 2018;38(7):816-32.
13. Abolhassani H, Tavakol M, Chavoshzadeh Z, Mahdaviani SA, Momen T, Yazdani R, et al. National Consensus on Diagnosis and Management Guidelines for Primary Immunodeficiency. Immunol Genet J. 2019;2(1):1-21.
14. Seidel MG, Kindle G, Gathmann B, Quinti I, Buckland M, van Montfrans J, et al. The European Society for Immunodeficiencies (ESID) Registry Working Definitions for the Clinical Diagnosis of Inborn Errors of Immunity. J Allergy Clin Immunol Pract. 2019;7(6):1763-70.
15. Casanova J-L-L, Jouanguy E, Lamhamedi S, Blanche S, Fischer A. Immunological conditions of children with BCG disseminated infection. Lancet. 1995;346(8974):581.
16. Marciano BE, Huang C-Y-Y, Joshi G, Rezaei N, Carvalho BC, Allwood Z, et al. BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies. J Allergy Clin Immunol. 2014;133(4):1134-41.
17. Sadeghi-Shanbestari M, Ansarin K, Maljaei SH, Rafeey M, Pezeshki Z, Baradaran R, et al. Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in northwest of Iran. Ital J Pediatr. 2009;35(1):42.
18. Kourime M, Akpalu E, Ouair H, Jeddane L, Benhsaien I, Ailal F, et al. Bécégites de l’enfant: diagnostic, classification et exploration. Archives de pédiatrie. 2016;23(7):754-9.
19. Pourakbari B, Sadeghi RH, Mahmoudi S, Parvaneh N, Valian SK, Mamishi S. Evaluation of interleukin-12 receptor 1 and interferon-gamma receptor 1 deficiency in patients with disseminated BCG infection. Allergologia et immunopathologia. 2019;47(1):38-42.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.