گزارش 8 مورد سل منتشر ناشي از تلقيح واكسن ب .ث .ژ در مركز طبي كودكان تهران طي سال هاي 76-1380

Report on eight miliary tuberculosis ceses due to BCG vaccination in Tehran pediatrics center in 1997-2001

Background and purpose : Miliary tuberculosis to due BCG vaccination is very rare and threatening, which occurs generally in immunocompromised patients. Aim of this study is to determine clinical feature, radiologic, laboratory, predisposing factor and factors related to prognosis of such patients in order of prompt diagnosis and proper treatment. Materials and methods : As being of a rare disease, the study was retrospective, by reviewing of patientʹs files. All the children diagnosed with miliary disease caused by BCG vaccination and were discharged from hospital or expired during 1997-2001 were under our study. Of 1 I patients diagnosed with the above problem,8 of them who had complete and proper file were selected, data were collected in questionnair and statistical analysis was performed. Results : Five boys and 3 girls with age range of 2.5 to 32 months (averange of 11 months) were under investigation. All the patients had regional lymphodenopathy and fistula containing prullent discharges at the time of referring and the mean incubation of this problem from the time of vaccination was about 10 weeks. All the patients had fever, and the other prevalent clinical symptoms were coughing, dyspnea, spreaded cutaneous lesions, enlargement of liver and bladder. Tuberculin test(PPD) in all patients was negative.In pulmonary radiography of all patients relicular opacity particularly near the region of mediastin was observable. Bone marrow aspiration was more helpful in diagnosis (positive culture for M. bovis or granulomatous lesions or caseous necrosis). All the patients had degree of immune defect, of which the most prevalents were lymphadenopathy and T-helper cells deficiency, loac of natural killer cells and chronic granulomatosis. in spite of the start of treatment with 4 drugs three of them died on admitting with spreading intra vascular coagulation. Conclusion : Presence of mild fever, organomegally, spreading cutaneous lesions and reduction of weight in children with purullent lymphadenopathy due to BCG vaccination in the referring patients, must be serious warning for admitting the patients for immunological investigation and start of immediate treatment, particularly if the PPD test is negative. Also in the other members of the family investigation shonld be done prior to vaccination.