Letter to the Editor
BCGitis in children
BCGite nas crianças
a Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG), Vila Nova de Gaia, Portugal
b Center of Pulmonology Diagnostics (CDP), Vila Nova de Gaia, Portugal
c Public Health Department, ARS Norte, I.P. Porto, Portugal
d Department of Epidemiology, Preventive Medicine and Health of Medicine Faculty, Oporto University, Porto, Portugal
e Institute of Public Health, Porto University, Porto, Portugal
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"apellidos" => "Duarte" "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG), Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Center of Pulmonology Diagnostics (CDP), Vila Nova de Gaia, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Public Health Department, ARS Norte, I.P. Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Epidemiology, Preventive Medicine and Health of Medicine Faculty, Oporto University, Porto, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Institute of Public Health, Porto University, Porto, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "BCGite nas crianças" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 561 "Ancho" => 750 "Tamanyo" => 41668 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left axillary lymphadenitis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The bacille Calmette-Guérin (BCG) vaccine is a live-bacteria vaccine with attenuated strains of Micobacterium bovis,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> currently reaching >80% of infants in countries such as Portugal<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (97% coverage in 2011<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>) where it is part of the childhood immunization programme.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Adverse effects are rare and mostly include local reactions – lymphadenitis is the most common event,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> characterized by ipsilateral regional lymph nodes enlargement (nonsuppurative or suppurative), 2–8 months after vaccination. There is no consensus about the best treatment for lymphadenitis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From 2010 to 2012, 4209 children were born in Vila Nova Gaia, of which 4059 received BCG vaccine and 4 cases of BCGitis occurred in our center – 3 were boys and none had immunity disorders or known family diseases. In all of them, nodal involvement was ipsilateral to BCG administration, without associated symptoms or physical examination abnormalities and happened less than 1 year after vaccination (1–10 months). One child had persistent non-suppurative lymphadenitis and three developed suppurative disease (1–3 months after node enlargement) – <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Two children had lymph-nodes surgical exeresis – one with persistent axillary lymph-node (aspirative biopsy positive for Micobacterium bovis) and other with suppurative lymphadenitis (exeresis during suppuration phase). Two others (suppurative lymph-nodes) had spontaneous drainage (positive for Micobacterium bovis) with complete fistulae resolution for 2–9 months (without being submitted to surgery, needle aspiration or antibiotics).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our rate of lymphadenitis is lower than those presented in previous studies<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> – early vaccination is associated with a lower risk<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and the lower the dose administered, the lower the risk of adverse events<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> – we had 0.05<span class="elsevierStyleHsp" style=""></span>mL administered at birth.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The nurses’ experience does not seem to affect the outcome<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but it could not be evaluated in our context.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The nonsuppurative form usually has a benign clinical course. The suppurative form is characterized by a suppurative material collection that can rupture with persistent caseous discharge and wound healing taking several months – secondary bacterial infection, scarring or keloid formation are common. Our incidence of suppurative lymphadenitis is similar to worldwide data – 30–80%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The risk of suppuration is higher in younger ages and in those who rapidly develop BCGitis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> – our suppurative cases developed lymphadenitis less than 4 months after being vaccinated.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is no consensus about the management of BCGitis but treatment is not usually necessary for local reactions<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and no clear benefit of active treatment (pharmacologic treatment, needle aspiration or surgical excision) over expectant attitude<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> was found, although some studies advise aspiration or surgery to reduce healing time and adverse cosmetic effects.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Although two of our children had spontaneous drainage without medical or surgical treatment, none had sequelae.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Management of these cases should consider the risk of invasive procedures versus the length of time for resolution and the cosmetic effects of conservative measures.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 561 "Ancho" => 750 "Tamanyo" => 41668 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left axillary lymphadenitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "World Health Organization: position paper. 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Alborzi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "1994" "volumen" => "71" "paginaInicial" => "446" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7826118" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000002000000003/v3_201610140056/S2173511514000451/v3_201610140056/en/main.assets" "Apartado" => array:4 [ "identificador" => "9715" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002000000003/v3_201610140056/S2173511514000451/v3_201610140056/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514000451?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 10 | 19 |
| 2024 October | 55 | 46 | 101 |
| 2024 September | 53 | 60 | 113 |
| 2024 August | 72 | 56 | 128 |
| 2024 July | 48 | 43 | 91 |
| 2024 June | 37 | 26 | 63 |
| 2024 May | 40 | 33 | 73 |
| 2024 April | 38 | 34 | 72 |
| 2024 March | 38 | 24 | 62 |
| 2024 February | 46 | 26 | 72 |
| 2024 January | 36 | 33 | 69 |
| 2023 December | 30 | 23 | 53 |
| 2023 November | 31 | 32 | 63 |
| 2023 October | 25 | 41 | 66 |
| 2023 September | 29 | 37 | 66 |
| 2023 August | 33 | 7 | 40 |
| 2023 July | 51 | 29 | 80 |
| 2023 June | 39 | 17 | 56 |
| 2023 May | 30 | 32 | 62 |
| 2023 April | 22 | 18 | 40 |
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