Nunes-Santos Cristiane de Jesus, Rosenzweig Sergio D
Faculdade de Medicina, Instituto da Crianca, Universidade de São Paulo, São Paulo, Brazil.
Immunology Service, Department of Laboratory Medicine, NIH Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States.
Front Immunol. 2018 Jun 22;9:1423. doi: 10.3389/fimmu.2018.01423. eCollection 2018.
Bacille Calmette-Guerin (BCG) vaccine is widely used as a prevention strategy against tuberculosis. BCG is a live vaccine, usually given early in life in most countries. While safe to most recipients, it poses a risk to immunocompromised patients. Several primary immunodeficiency diseases (PIDD) have been classically associated with complications related to BCG vaccine. However, a number of new inborn errors of immunity have been described lately in which little is known about adverse reactions following BCG vaccination. The aim of this review is to summarize the existing data on BCG-related complications in patients diagnosed with PIDD described since 2010. When BCG vaccination status or complications were not specifically addressed in those manuscripts, we directly contacted the corresponding authors for further clarification. We also analyzed data on other mycobacterial infections in these patients. Based on our analysis, around 8% of patients with gain-of-function mutations in had mycobacterial infections, including localized complications in 3 and disseminated disease in 4 out of 19 BCG-vaccinated patients. Localized BCG reactions were also frequent in activated PI3Kδ syndrome type 1 (3/10) and type 2 (2/18) vaccinated children. Also, of note, no BCG-related complications have been described in either CTLA4 or LRBA protein-deficient patients; and not enough information on BCG-vaccinated NFKB1 or NFKB2-deficient patients was available to drive any conclusions about these diseases. Despite the high prevalence of environmental mycobacterial infections in GATA2-deficient patients, only one case of BCG reaction has been reported in a patient who developed disseminated disease. In conclusion, BCG complications could be expected in some particular, recently described PIDD and it remains a preventable risk factor for pediatric PIDD patients.
卡介苗（BCG）疫苗被广泛用作预防结核病的策略。卡介苗是一种活疫苗，在大多数国家通常在生命早期接种。虽然对大多数接种者来说是安全的，但它对免疫功能低下的患者构成风险。几种原发性免疫缺陷疾病（PIDD）传统上与卡介苗疫苗相关的并发症有关。然而，最近描述了一些新的先天性免疫缺陷，对卡介苗接种后的不良反应知之甚少。本综述的目的是总结自2010年以来诊断为PIDD的患者中与卡介苗相关并发症的现有数据。当这些手稿中未具体提及卡介苗接种状态或并发症时，我们直接联系了通讯作者以获取进一步的澄清。我们还分析了这些患者中其他分枝杆菌感染的数据。根据我们的分析，约8%的功能获得性突变患者发生了分枝杆菌感染，其中19名接种卡介苗的患者中有3例出现局部并发症，4例出现播散性疾病。在1型（3/10）和2型（2/18）活化PI3Kδ综合征的接种疫苗儿童中，局部卡介苗反应也很常见。同样值得注意的是，在CTLA4或LRBA蛋白缺陷患者中未描述与卡介苗相关的并发症；并且没有足够的关于接种卡介苗的NFKB1或NFKB2缺陷患者的信息来得出关于这些疾病的任何结论。尽管GATA2缺陷患者中环境分枝杆菌感染的患病率很高，但仅报告了1例发生播散性疾病的患者出现卡介苗反应的病例。总之，在一些最近描述的特定PIDD中可能会出现卡介苗并发症，并且它仍然是儿童PIDD患者的一个可预防的危险因素。
