Isfahan University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Disseminated Bacille Calmette-Guerin Vaccine-Induced Disease in a Sample of Iranian Children: A Longitudinal Case-Series Study Publisher



Rahimi Hajiabadi H1 ; Kiani G1 ; Esfahani SNM2 ; Emadoleslami MS3 ; Momen T4 ; Pourmoghaddas Z1, 5
Authors
Show Affiliations
Authors Affiliations
  1. 1. Pediatric Infectious Disease Department, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Department of Asthma, Allergy and Clinical Immunology, Child Growth Research Institute of Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Archives of Pediatric Infectious Diseases Published:2025


Abstract

Background: Approximately a quarter-million Iranian newborns receive the Bacille Calmette-Guerin (BCG) vaccine annually. However, in immunodeficient infants, this vaccine can lead to disseminated BCG disease (DBD). Objectives: This study aims to determine the clinical presentation, comorbidities, underlying immunodeficiency, and prognosis of DBD in a group of Iranian children. Methods: In a longitudinal case-series study, data were collected from the files of infants and children diagnosed with DBD from 2005 to 2017. Immunodeficiency screening was conducted for each patient. For children with normal immunodeficiency screening results, further testing for Mendelian susceptibility to mycobacterial diseases (MSMD) was performed. Detection of DBD in children was achieved by evaluating gastric lavage and bone marrow aspiration samples for mycobacterium. Results: Most of the 22 patients were immunocompromised, with the following distribution: 31.8% had severe combined immunodeficiency (SCID), 45.5% had MSMD (specifically IL-12Rβ1 deficiency), one patient (4.5%) had Wiskott-Aldrich syndrome (WAS), and the remaining 18.1% had unknown immunodeficiency types. Most patients with MSMD were successfully treated and did not show relapse during the follow-up period, even after discontinuing anti-tuberculosis (TB) medications. Conclusions: Due to the similarity of its manifestations to sepsis, diagnosing systemic infections caused by the BCG vaccine in children requires a high level of clinical suspicion and appropriate diagnostic measures, such as mycobacterial culture, biochemical speciation, or polymerase chain reaction (PCR). These diagnostic steps should be taken promptly in cases of DBD, with concurrent treatment using anti-tuberculosis drugs and, if possible, targeted therapies for underlying immunodeficiency. © 2024, Rahimi Hajiabadi et al.
Related Docs
View other Related Docs
1. Molecular Microbiological Investigation of Post-Vaccination Bacille Calmette-Guerin Infection in Iranian Patients, International Journal of Tuberculosis and Lung Disease (2011)
2. Impaired Il-12- and Il-23-Mediated Immunity Due to Il-12Rβ1 Deficiency in Iranian Patients With Mendelian Susceptibility to Mycobacterial Disease, Journal of Clinical Immunology (2018)
3. Mycobacteriosis and Tuberculosis: Laboratory Diagnosis, Open Microbiology Journal (2018)
4. Retroperitoneal Abscess Due to Disseminated Bacille Calmette-Guerin Infection, Japanese Journal of Infectious Diseases (2007)
5. Effectiveness of Hepatitis B Vaccination in Children of Chronic Hepatitis B Mothers, Saudi Medical Journal (2004)
6. Selective Antibody Deficiency and Its Relation to the Igg2 and Igg3 Subclass Titers in Recurrent Respiratory Infections, Iranian Journal of Immunology (2013)
7. Species Identification of Neglected Nontuberculous Mycobacteria in a Developing Country, Japanese Journal of Infectious Diseases (2011)
8. Impaired Il-23–Dependent Induction of Ifn-Γ Underlies Mycobacterial Disease in Patients With Inherited Tyk2 Deficiency, Journal of Experimental Medicine (2022)
Experts (# of related papers)
View all Related Experts
Mazdak Ganjalikhani Hakemi (4)
Hamid Rahimi (4)
Other Related Docs
9. Important Factors Influencing Severity of Common Variable Immunodeficiency, Archives of Iranian Medicine (2016)
10. Exons Analysis of Interferon-Gamma Receptor 1 Gene in Patients With Mendelian Susceptibility to Mycobacterial Diseases (Msmd) in the Central Region of Iran, Journal of Isfahan Medical School (2019)
11. Evaluation of Mutation in B Cell Maturation Antigen (Bcma) Gene in Patients With Common Variable Immunodeficiency (Cvid), Journal of Isfahan Medical School (2016)
12. Primary Antibody Deficiency in a Tertiary Referral Hospital: A 30-Year Experiment, Journal of Investigational Allergology and Clinical Immunology (2015)
13. A Nationwide Study on the Seroprevalence of Measles, Mumps, and Rubella in Iranian Children and Adolescents, Iranian Journal of Public Health (2022)
14. Comparison of Various Classifications for Patients With Common Variable Immunodeficiency (Cvid) Using Measurement of B-Cell Subsets, Allergologia et Immunopathologia (2017)
15. Antibody Titer in Iranian Children 6 Years After Hepatitis B Vaccine Administration, Vaccine (2007)
16. Covid-19 Vaccination in Patients With Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs Related to Covid-19: A Usidnet Report, Journal of Clinical Immunology (2024)
17. Monogenic Primary Immunodeficiency Disorder Associated With Common Variable Immunodeficiency and Autoimmunity, International Archives of Allergy and Immunology (2020)
18. Evaluation of Il-12Rb1, Il-12B, Cxcr-3 and Il-17A Expression in Cases Affected by a Non-Healing Form of Cutaneous Leishmaniasis: An Observational Study Design, BMJ Open (2017)
19. Analysis of Dna Gyra Gene Mutation in Clinical and Environmental Ciprofloxacin-Resistant Isolates of Non-Tuberculous Mycobacteria Using Molecular Methods, Jundishapur Journal of Microbiology (2016)
20. Seroprevalence of Bordetella Pertussis Among a Nationally Representative Sample of Iranian Pediatric Population: The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease-V Study, Journal of Research in Medical Sciences (2021)