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BCG INFECTION IN IMMUNOCOMPROMISED PERSONS.

Beata Wolska – Kuśnierz, Ewa Bernatowska,1 Małgorzata Pac, Barbara Pietrucha, Magdalena Kurenko – Deptuch, Edyta Heropolitańska - Pliszka, Zofia Zwolska  

Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland  Department of Microbiology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland

Severe adverse events following BCG vaccination are very rare , but cases of disseminated disease are noted in patients with congenital or aquired immunodeficiencies. In group of seven hundred four patients with primary immunodeficiencies registered in Department of Immunology, Children’s Memorial Health Institute in Warsaw between 1980 – 2003 severe adverse events after BCGvaccination were estimated. The most frequent was group of antibody deficiencies recognised in 399 cases. Tcell or combined immunodeficiencies were diagnosed in 187 patients. Among this group we noted 19 children with severe combined immunodeficiencies, 3 cases of Omenn’s syndrome, 10 children with Di George’a anomaly. Group of phagocytic disorders consists of 77 patients. Deficiencies of IFN –. receptor was recognised in 4 children , we noticed one case of IL- 12 recepto r deficiency. In the group of 33 patients with other deficiencies hyper IgE syndrome was the most frequent. 
Severe adverse events following BCG vaccination were recognised in 9 children: 5 SCID, 3 with IFN –. receptor deficiency and in one child with IL –12 receptor deficiency. In patients with SCID there was high mortality rate – 60 %. Three children died cause of disseminated BCG infection with multiorgan involvement. In two boys reactivation of BCG occured after bone marrow transplantation and in these cases full recovery was observed after antituberculous treatment. The course of BCG infection in group of patients with IFN- . pathway deficiencies were milder with mortality rate 25% and full recovery in 75 % of cases. In group of children with IFN-. receptor deficiency : one girl died cause of disseminated BCG infection, 2 patients with disseminated infection recovered on antituberculous treatment. In a girl with IL-12 receptor deficiency severe local reaction in site of BCG injection with purulent adenitis occured with full recovery on treatment. 
wolska <bwolska@interia.pl>