Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Int J Infect Dis. 2018 Jul;72:63-68. doi: 10.1016/j.ijid.2018.05.006. Epub 2018 May 17.
Intravesical bacillus Calmette-Guérin (BCG) is widely used for high-risk, non-muscle-invasive bladder cancer. This report describes four cases that illustrate the spectrum of BCG-induced complications, varying from granulomatous prostatitis to sepsis. There is considerable debate regarding whether inflammation or infection is the predominant mechanism in the pathogenesis of BCG disease. In two patients with a systemic illness, the symptoms first resolved after adding prednisone, indicating a principal role for inflammation in systemic disease. In vitro testing of T-cell responses and a mycobacterial growth inhibition assay were performed for these patients with systemic disease. The patient with mild symptoms showed more effective in vitro growth reduction of BCG, while the patient with sepsis and organ involvement had high T-cell responses but ineffective killing. While these findings are preliminary, it is believed that immunological assays, as described in this report, may provide a better insight into the pathogenesis of BCG disease in individual patients, justifying further research.
膀胱内卡介苗（BCG）被广泛用于治疗高危、非肌肉浸润性膀胱癌。本报告描述了 4 例病例，说明了 BCG 诱导的并发症谱，从肉芽肿性前列腺炎到脓毒症不等。关于炎症还是感染是 BCG 疾病发病机制中的主要机制，存在相当大的争议。在 2 名患有系统性疾病的患者中，加用泼尼松后症状首先缓解，这表明炎症在系统性疾病中起主要作用。对这 2 名患有系统性疾病的患者进行了 T 细胞反应和分枝杆菌生长抑制试验的体外检测。症状较轻的患者显示出更有效的 BCG 体外生长减少，而脓毒症和器官受累的患者则具有较高的 T 细胞反应但无效杀伤。虽然这些发现是初步的，但据信，如本报告所述的免疫测定法可能会更好地了解个体患者的 BCG 疾病发病机制，从而证明进一步研究是合理的。
