Su W J, Huang C Y, Huang C Y, Perng R P
Chest Department, Taipei Veterans General Hospital, Taiwan, ROC.
Int J Tuberc Lung Dis. 2001 Apr;5(4):380-4.
We report Mycobacterium bovis BCG infection in two children vaccinated with BCG (Tokyo strain) on the first day of life. Their diagnoses were made by biopsy of skin lesions and pus from an anterior chest wall abscess, respectively, yielding a positive culture of mycobacteria fully susceptible to rifampicin, isoniazid and ethambutol, but resistant to pyrazinamide. M. bovis BCG was identified by a negative niacin test, absence of nitrate reductase and resistance to pyrazinamide and cycloserine. The diagnoses were further confirmed by a combination of an allele-specific polymerase chain reaction ated strain of Mycobacterium bovis, is the only available vaccine for the prevention of tuberculosis. Although complications are rare after BCG vaccination and the outcome is usually favourable, serious BCG infections can occur. We report two cases of M. bovis BCG infection in children, a 4-year-old immunocompetent girl and an 8-month-old immunodeficient boy. To our knowledge, this is the first report of BCG complications in children in which two recently developed polymerase chain reaction (PCR) based methods were used for rapid identification of M. bovis BCG infection. (PCR) and a multiplex PCR method. Based on the drug susceptibility results, treatment with rifampicin, isoniazid and ethambutol was instituted. One patient (Case 1) improved clinically and is well after treatment. However, the other patient with severe combined immunodeficiency died of disseminated BCG infection in spite of intensive anti-tuberculosis therapy. Although BCG is considered to be a safe vaccine, it should be kept in mind that complications related to BCG do occur.
我们报告了两例在出生第一天接种卡介苗（东京株）的儿童发生牛分枝杆菌卡介苗感染的病例。他们分别通过对皮肤病变组织活检和取自前胸壁脓肿的脓液进行诊断，培养出对利福平、异烟肼和乙胺丁醇完全敏感但对吡嗪酰胺耐药的分枝杆菌。通过烟酸试验阴性、无硝酸盐还原酶以及对吡嗪酰胺和环丝氨酸耐药鉴定为牛分枝杆菌卡介苗。通过等位基因特异性聚合酶链反应（PCR）和多重PCR方法进一步确诊。牛分枝杆菌卡介苗是预防结核病的唯一可用疫苗。尽管卡介苗接种后并发症罕见且预后通常良好，但严重的卡介苗感染仍可能发生。我们报告了两例儿童牛分枝杆菌卡介苗感染病例，一例是4岁免疫功能正常的女孩，另一例是8个月大免疫缺陷的男孩。据我们所知，这是首次在儿童卡介苗并发症报告中使用两种最新开发的基于聚合酶链反应（PCR）的方法快速鉴定牛分枝杆菌卡介苗感染。根据药敏结果，采用利福平、异烟肼和乙胺丁醇进行治疗。一名患者（病例1）临床症状改善，治疗后情况良好。然而，另一名患有严重联合免疫缺陷的患者尽管接受了强化抗结核治疗，仍死于播散性卡介苗感染。尽管卡介苗被认为是一种安全的疫苗，但应牢记与卡介苗相关的并发症确实会发生。
