Disseminated bacille Calmette-Guérin disease in Saudi children: clinical profile, microbiology, immunology evaluation and outcome.

OBJECTIVE: The bacille Calmette Guérin (BCG) vaccine is administered worldwide to prevent tuberculosis. Although, Post BCG vaccination complications like disseminated BCG infections are rare and immunocompromised children are at high risk of developing BCG-related complications including BCG-lymphadenitis and other disseminated diseases.

PATIENTS AND METHODS: This was a prospective study of children who developed disseminated BCG after vaccination who were admitted in three tertiary care hospital in Riyadh, Saudi Arabia, in the year 2015. The clinical presentation, microbiological/immunological evaluation and outcome will be discussed.

RESULTS: 12 cases (7 males and 5 females) of disseminated BCG infections after vaccination were documented with age ranges 3 and 32 months. Eight (66%) patients had interleukin IL-12 deficiency and 3 (25%) had severe combined immune deficiency (SCID) and 1 (8%) had Interferon gamma receptor II deficiency. 9 (75%) patients presented with generalized lymphadenopathy. Hepatosplenomegaly was present in 6 (50%) patients. 2 (16%) patients presented with a recurrent skin infection and persistent oral candidiasis in one patient and pneumonia in the other. Five (41%) families were from 1st degree consanguineous marriage. Tuberculosis (TB) culture and sensitivity were positive for Mycobacterium bovis from gastric aspirate (GA) in 4 patients and the lymph node in 9 patients and 1 patient had culture positive from both skin lesion and lymph nodes. Mycobacterium bovis PCR was positive in 4 patients. All patients received anti-tuberculosis therapy; all patients survived except one who died due to multi-organ failure.

CONCLUSIONS: These results indicate that the prevalence of disseminated BCG vaccine in immunocompromised Saudi children is significantly high. Since in our region we have a high consanguinity rate and a high number of primary immune deficiency disorder (PID), we believe that BCG vaccination should be postponed till a child reaches one-year-old and appropriate tests exclude the diagnosis of primary immunodeficiency diseases.