BCG Vaccine


BCG Vaccine is widely used throughout the world to prevent tuberculosis. Other indications are intralesional treatment in superficial bladder cancer.
 
Incidence
Quite uncommon. Fewer than ten cases in neonates or infants have been reported.
 
Clinical manifestations
Differentiate from lymphadenitis or generalized granulomatosis.
 
Anaphylaxis.
 
Urticaria.
 
Lupus vulgaris +/- urticarial vasculitis.
 
Acute febrile neutrophilic dermatosis (Sweet’s syndrome).
 
Pustular vasculitis.
 
Erythema multiforme.
 
Dermatomyositis (conflictual).
 
Diagnostic methods
Dextran reactive antibodies: in a few cases where high titers of DRA were found in a maternal blood sample or child’s blood sample.
 
Mechanisms
Concerning the neonatal anaphylactic reactions reported after BCG vaccination, passively acquired maternal dextran antibodies reacted with the 100 KD dextran which is a component of the BCG vaccine.
 
Management
Use BCG vaccine without dextran (sodium glutamate).
 
Dextran 1 should be used in the vaccines, instead of high molecular weight (100 KD) dextran.

References

  1. Rudin C, Gunthard J, Halter C, Staehlin J, Berglund A, "Anaphylactoïd reaction to BCG vaccine containing high molecular weight dextran", Eur. J. Pediatr. 1995;154 (11): 941-2
  2. Barbaud A, Schmutz JL, Mougeolle JM, "Reactions immunoallergiques cutanées dues aux vaccins", Ann. Dermatol. Vénéréol. 1995;122: 129-38
  3. Sosnowski JT, "Complications of bacillus Calmette - Guérin (BCG) immunotherapy in superficial bladder cancer", Compr. Therapy. 1994;20 (12): 695-701
  4. Pönnighaus JM, Fine PEM, Moreno C, "Hypersensitivity of dextran in BCG vaccine", Lancet. 1991;337: 1039

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.