Samileh Noorbakhsh, Ahmad Siadati, Farzaneh Ashtiani, Shahnaz Rimaz, Lida Fereidoni, Mohammad Nikbin
Department of Pediatrics, Iran University of Medical Sciences, Research Center of Pediatric Infectious Diseases, Hazrat Rasool Hospital, Niayesh Ave, Satarkhan Street, Tehran 14455, Republic of Iran.
Saudi Med J. 2006 Nov;27(11):1719-24.
To determine the immunity status of children with Bacille Calmette-Guerin (BCG) lymphadenitis (patient group) and unaffected children (control group) in Iran.
We performed this longitudinal case-control study on 75 children between 2 months to 14 years old in Rasool Akram and Markaz Tebbi Hospital, Tehran, Iran during the period of 2 years (2000-2002).
Ninety percent of patients had normal immunoglobulin, 10% had low level, 96.1% had normal nitro blue tetrazolium test and 3.9% had lower activity. There was a significant difference in the total lymphocyte CD3, CD8, CD19, CD16/CD56 and natural killers (NK) cell but no significant difference in the CD4/CD8 ratio and CD4 between case (n=75) and control (n=100) groups. Thirty-eight cases with mild lymphopenia, isolated CD4, CD3, CD19, NK cells (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients were observed. Thirty-eight cases were diagnosed as mild immune deficient without any previous recurrent infections (mild lymphopenia; Isolated CD4; CD3 or CD19 deficiency. Natural killers (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients. The natural killers (CD16/CD56) deficient cases responded well to 3 antimycobacterial drugs without immunomodulator. Natural killers cell deficiency not yet reported as a risk factor for progression and complication of BCG infection. All cases of idiopathic disseminated BCG infection (unknown immunodeficiency type) with nonlethal and indulgent BCG infections responded well to needle aspiration and antimycobacterial drugs with immunomodulator (gamma interferon).
In cases with multiple and recurrent BCG lymphadenitis without any previous recurrent infection complete immunological studies should be carried out. Most cases with mild immune deficiency usually response well to needle aspiration alone or combine with antimycobacterial drugs. The combination of IFN-gamma and chemotherapy in cases of idiopathic disseminated infections caused by BCG and without previous recurrent other infection except mycobacterium species, can limit the disease.
确定伊朗卡介苗（BCG）淋巴结炎患儿（患者组）和未受影响儿童（对照组）的免疫状态。
在2年期间（2000 - 2002年），我们在伊朗德黑兰的拉苏勒·阿克拉姆医院和马尔卡兹·泰比医院对75名2个月至14岁的儿童进行了这项纵向病例对照研究。
90%的患者免疫球蛋白正常，10%水平较低，96.1%的硝基四氮唑蓝试验正常，3.9%活性较低。病例组（n = 75）和对照组（n = 100）之间，总淋巴细胞CD3、CD8、CD19、CD16/CD56和自然杀伤（NK）细胞存在显著差异，但CD4/CD8比值和CD4无显著差异。观察到38例轻度淋巴细胞减少，3例（22%）孤立性CD4、CD3、CD19、NK细胞（CD16/CD56）缺乏；3例（22%）患者为特发性播散性卡介苗感染（免疫缺陷类型不明）。38例被诊断为轻度免疫缺陷，之前无任何反复感染（轻度淋巴细胞减少；孤立性CD4；CD3或CD19缺乏。3例（22%）自然杀伤（CD16/CD56）缺乏；3例（22%）患者为特发性播散性卡介苗感染（免疫缺陷类型不明）。自然杀伤（CD16/CD56）缺乏的病例对3种抗分枝杆菌药物反应良好，无需免疫调节剂。自然杀伤细胞缺乏尚未被报道为卡介苗感染进展和并发症的危险因素。所有特发性播散性卡介苗感染（免疫缺陷类型不明）且为非致死性和轻度卡介苗感染的病例对针吸活检和含免疫调节剂（γ干扰素）的抗分枝杆菌药物反应良好。
对于有多次复发性卡介苗淋巴结炎且之前无任何反复感染的病例，应进行全面的免疫学研究。大多数轻度免疫缺陷病例通常对单独针吸活检或联合抗分枝杆菌药物反应良好。对于由卡介苗引起的特发性播散性感染且除分枝杆菌属外之前无其他反复感染的病例，γ干扰素与化疗联合使用可控制病情。
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