Bacille Calmette-Guerin vaccine-induced disease in HIV-infected and HIV-uninfected children
Bacille Calmette-Guerin vaccine-induced disease in HIV-infected and HIV-uninfected children
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DOI：
10.1086/499953
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发表时间：
2006-02-15
影响因子：
11.8
通讯作者：
Beyers, N
中科院分区：
文献类型：
--
作者：
Hesseling, AC;Rabie, H;Beyers, N
背景。卡介苗（BCG）是一种减毒活疫苗，在结核病流行的环境中，无论是否暴露于人类免疫缺陷病毒（HIV），通常都会给新生儿接种。感染艾滋病毒的婴儿和其他免疫缺陷婴儿有发生bcg相关并发症的风险。我们报告儿童卡介苗病的表现、治疗和死亡率，重点是艾滋病毒感染的儿童。此外，我们提出了儿童卡介苗病的修订分类，并提出了标准的诊断和管理指南。这项以医院为基础的回顾性研究是在南非西开普省进行的。采用聚合酶链反应对2002年8月至2005年1月期间从13岁以下儿童中分离的结核分枝杆菌复体进行鉴定，以确认牛分枝杆菌卡介苗。通过查阅病历收集临床资料。根据标准和修订后的疾病分类对卡介苗病进行分类。在研究期结束时评估死亡率。确诊卡介苗病25例；22例（88%）有局部疾病，8例（32%）有远处或播散性疾病；5名儿童（20%）同时患有局部和远处或播散性疾病。17名儿童感染艾滋病毒；2名儿童有其他免疫缺陷。8例远处或播散性疾病患儿均存在免疫缺陷；6人感染艾滋病毒。远处或播散性疾病患儿的死亡率为75%。卡介苗接种对围产期感染艾滋病毒的婴儿和其他原发性免疫缺陷儿童构成风险。建议的儿童卡介苗疾病分类反映了hiv感染儿童的临床相关疾病类别。建议的诊断和治疗指南应改善现有的病例管理和监测。对艾滋病毒感染和未感染儿童卡介苗病的管理策略进行前瞻性评价是必要的。
Background. Bacille Calmette-Guerin ( BCG) - a live, attenuated vaccine - is routinely given to neonates in settings where tuberculosis is endemic, irrespective of human immunodeficiency virus (HIV) exposure. HIV-infected infants and other immunodeficient infants are at risk of BCG-related complications. We report the presentation, treatment, and mortality of children who develop BCG disease, with emphasis on HIV-infected children. In addition, we present a revised classification of BCG disease in children and propose standard diagnostic and management guidelines.Methods. This retrospective, hospital-based study was conducted in the Western Cape Province, South Africa. Mycobacterium tuberculosis complex isolates recovered from children aged < 13 years during the period of August 2002 through January 2005 were speciated by polymerase chain reaction to confirm Mycobacterium bovis BCG. Clinical data were collected through medical file review. BCG disease was classified according to standard and revised disease classifications. Mortality was assessed at the end of the study period.Results. BCG disease was diagnosed in 25 children; 22 (88%) had local disease, and 8 (32%) had distant or disseminated disease; 5 children (20%) had both local and distant or disseminated disease. Seventeen children were HIV infected; 2 children had other immunodeficiencies. All 8 children with distant or disseminated disease were immunodeficient; 6 were HIV infected. The mortality rate was 75% for children with distant or disseminated disease.Conclusions. BCG vaccination poses a risk to infants perinatally infected with HIV and to other primary immunodeficient children. The proposed pediatric BCG disease classification reflects clinically relevant disease categories in HIV-infected children. The suggested diagnostic and treatment guidelines should improve existing case management and surveillance. Prospective evaluation of management strategies for BCG disease in HIV-infected and HIV-uninfected children is essential.