BCG OSTEITIS. B. Varbanova 1, V. Vasileva 1, P. Minchev 2, R. Nedeva 1 and E. Dyankov 1 BCG. . Bacille-Calmette Guerin (BCG) BCG.

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1 68 BCG. 1,. 1,. 2, , BCG OSTEITIS B. Varbanova 1, V. Vasileva 1, P. Minchev 2, R. Nedeva 1 and E. Dyankov 1 1 University Hospital Sv. Marina Varna 2 University Children s Clinic of Pulmonary Diseases, Sv. Sofia Sofia. Bacille-Calmette Guerin (BCG) BCG. 7-,, -. CRP. :, -,,. 17 mm, : BCG /, BCG, :..,,.,.. 1, 9010,.: 052/ Summary. Bacille Calmette-Guerin (BCG) osteomyelitis is a very rare, serious complication of BCG immunization. We report a 7- month-old boy who was admitted for 3-day history of fever, limited range of movement of the right shoulder and tenderness of right arm. Laboratory investigations showed mild leucocytosis with relative lymphocytosis, high levels of CRP. CT scan of humeral regions revealed: juxta-articular osteoporosis, well demarcated eccentric osteolytic lesion in proximal right humerus, periostal reaction with cortical infarctions, soft-tissue swelling and liquefaction adjusted to the underlying bone. Hyperergic tuberculin sensitivity 17 mm bullous infiltrate, was detected by Mantoux test. Chest X-ray and QFT were normal. Underlying immunodeficiency syndrome was excluded. Three-month tuberculostatic treatment leaded to the complete resolution of the disease. The case is presented for its rarity in Bulgarian population. Key words: BCG osteitis/osteomyelitis, BCG immunization, child Address for correspondence: Assoc. Prof. B. Varbanova, Head of Second pediatric clinic, UMHAT Sv. Marina, 1 H. Smirnenski blvd., Bg-9010, Varna, tel.: 052/ BCG Mycobacterium bovis, Calmette Guerin ,, -, [16] , [4, 16].

2 .. BCG 69 : 1) ; 2) ; 3) BCG / - ; 4) BCG ; 5) ( - ) [10]. BCG - ycobacterium bovis e - BCG., 25% - [12]. BCG -, , 2560 g, ,5, - -, -. : - ; ; ;,, - - ; - 2 cm, 1 cm;., BCG -, 0.5 cm. : : Hb 99 g/l, 12, /l, 184 x 10 9 /l, - 90%, CRP 180 mg/l ( 6), - -,.,,,. : - ( ): -,., -, - -. : ,, 5/10 mm 8 mm. 3. (2-3 mm) , -. 5., -. : (. 1. 2) , -. : 2 cm, 1 cm,.

3 70.. BCG - Sulperazon Amikacin, : ( )., :, BCG. ( ) -. -,,, CRP 0,14. Dalacin. - -,. 17 mm,, BCG, : 1. BCG - - (, - ) [11, 12] ( - ). 5. ( ) Foucard Hjelmstedt, 1971.: BCG BCG - BCG - BCG -, - - [5, 8, 10] : 10 mg/kg 3, 5 mg/kg 3, 15 mg/kg 2., - (. 3. 4)

4 .. BCG 71 BCG -. Pasteur Albert Calmette Camille Guerin per os (1921.), (1923.) [6] ù [6, 17] BCG (, 1980). - [4, 6, 16]: e 2500 g HIV. BCG -, / [2, 11]. B, e - Gothenburg 0.1 ml). BCG Glaxo - [10]. (1988.) 0,39-30/ [6, 10] ( ), - [11]. - - : [2, 10]. [6, 10, 17]: BCG - -, ,7., - 1,5, - 2, BCG, -, - : 27%, 19%, 8%, 15% : mm/h, - 5,0-23, /l. 78% - BCG, 86% -. (51%), [1, 5, 10, 12]., -, 3%. - : , BCG. -., -, - BCG. -

5 72.. BCG, - [13] , SL BCGI [15]. BCG 222, - BCG BCG Pasteur [14, 15] BCG - - ( ) -, 120 [14].., g, g,. BCG - - [3, 9, 17]. -., -, A f t i m o s, S. et R. Nicol. BCG osteitis: a case report. N. Z. Med. J., 99, 1986, B e r g d a h l, S., M. Fellander et B. Robertson. BCG osteomyelitis experience in the Stokholm region over the years J. Bone Joint Surg., 56-B, 1976, C h a n, P. K., B. K. W. Ng et C. Y. Wong. Bacille Calmette- Guerin osteomyelitis of the proximal femur. Hong Kong Med. J., 16, 2010, E i c k o f f, T. C. Bacilli Calmete-Guerin (BCG) Vaccine. In: Vaccine. Ed. by Plotkin, S. A., Mortimer, E. A. Philadelphia, W. B. Saunders, 1988, F o u c a r d, T. et A. Hjelmstedt. BCG-osteomyelitis and osteoarthritis as a complication following BCG vaccination. Acta Orthop. Scand., 42, 1971, G w o, S. C. et al. Adverse Events induced by BCG immunization in Taiwan. Taiwan Epidemiol. Bull., 24, 2008, 5, H o p p e, J. E. et al BCG osteomyelitis presenting as a tumor. Infection, 20, 1992, K o l a n d a i v e l u, G. et al. Osteitis of humerus following BCG vaccination. J. Indian Med. Assoc., 84, 1986, K o y a m a, A., Is. Toida et S. Nakata. Osteitis as a complication of BCG vaccination. Tuberculosis, 84, 2009, K r o g e r, L. Newborn BCG Vaccination. A study of osteitic complications, tuberculin reactivity and sensitization to atypical mycobacteria (thesis). Kuopio, Kuopio University Publications, K r ö g e r, L. et al. Osteitis caused by bacille Calmette- Guérin vaccination: a retrospective analysis of 222 cases. J. Infect. Dis., 172, 1995, 2, L i n, C. J. et al. Mycobacterium bovis osteomyelitis as a complication of Bacille Calmette-Guérin (BCG) vaccination: rapid diagnosis with use of DNA sequencing analysis: a case report. J. Bone Joint Surg. Am., 81, 1999, R i t z, N. et al. Susceptibility of Mycobacterium bovis BCG vaccine strains to antituberculous antibiotics. Antimicrob. Agents Chemother., 53, 2009, R i t z, N. et N. Curtis. Non-tuberculous mycobacteria: General Mapping the global use of different BCG vaccine strains. Tuberculosis, 89, 2009, S t e f a n o v a, T. et al. Genetic composition of mycobacterium bovis BCG substrain Sofia. J. Clin. Microbiol., 41, 2003, W H O. Supplementary information on vaccine safety by WHO: Part 2: Background and rates of adverse events following immunization. 2000, Y a m a d a, A. F., J. B. Pellegrini et L. M. Cunha. Osteitis after BCG vaccination. J. Bras. Pneumol., 285, 2009,