Diagnostic value of the reaction at the bacillus calmette-guérin vaccination site in kawasaki disease / Utilidade diagnóstica da reação do sítio de vacinação bacillus calmette-guérin na doença de kawasaki

ABSTRACT Objective: To describe the case of an infant - diagnosed with incomplete Kawasaki disease - who developed BCG scar reactivation. Case description: A 6-month-old patient was admitted to hospital with fever associated with ocular hyperemia, cervical lymphadenopathy, and hyperemic lips, and remained hospitalized for 12 days. The physical examination revealed an inflammatory reaction at the site of the BCG scar, leading to the diagnosis of incomplete Kawasaki disease. The patient was treated with venous immunoglobulin, but presented recurrence of Kawasaki disease, with subsequent onset of coronary artery disease. Comments: BCG scar reactivation is an important finding in countries where the vaccine is routinely given and may be a useful marker for early diagnosis of Kawasaki disease, especially in its incomplete form.

RESUMO Objetivo: Descrever o caso de um lactente - com diagnóstico de Doença de Kawasaki incompleta - que desenvolveu reativação da cicatriz da vacina BCG. Descrição do caso: Um paciente de 6 meses de idade foi admitido no hospital com febre, associada à hiperemia ocular, linfadenomegalia cervical e fissuras labiais, permanecendo hospitalizado por 12 dias. Apresentava, no exame físico, reação inflamatória no local da cicatriz da vacina BCG, tendo sido feito o diagnóstico de Kawasaki incompleto. O paciente foi tratado com imunoglobulina venosa, mas apresentou recorrência da doença, com posterior surgimento de coronariopatia. Comentários: A reativação da BCG é um achado importante na doença de Kawasaki em países onde a vacina é aplicada de forma rotineira e pode ser um marcador útil para o diagnóstico precoce da doença de Kawasaki, principalmente em sua forma incompleta.

Prevalence of tuberculous infection among school children in Kerala.

BACKGROUND: There is paucity of information on epidemiological situation of Tuberculosis (TB) in the State of Kerala. The DOTS strategy under the Revised National Tuberculosis Control Programme (RNTCP) was introduced in the year 1998 to cover the entire State by 2002. OBJECTIVE: To estimate the prevalence of tuberculous infection among children attending 1-4th standard in a sample of selected schools in Kerala. METHODS: A cluster-sample school-based tuberculin survey was carried out in 70 schools selected by a two-stage sampling procedure. A total of 4821 children (including those with and without BCG scar) in the age group of 5-9 years were tuberculin tested using 1 TU PPD RT23 with Tween 80 and the maximum transverse diameter of induration was measured about 72 hours later. About 81% of the children were found to have BCG scars. Analysis was also undertaken by mixture model. RESULTS: While 67% of children without BCG scar and 62% with scar did not elicit any induration at the test site, the mode or anti-mode of reactions due to infection with tubercle bacilli could not be identified from the distribution graphs. Analysis by mixture model also did not provide the best fit thus precluding estimation of prevalence of infection. About 5% of children had reactions > or =10 mm, 3% had reactions > or =12 mm and 2% had reactions > or =14 mm. CONCLUSION: Low proportion of reactors indicated a low level of transmission of infection in Kerala. Considering the problems in interpretation of tuberculin survey data, it may not be feasible to use ARTI as an epidemiological parameter to monitor future trends of TB situation in the state.

Scar size and effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of tuberculosis and leprosy: a case-control study.

BACKGROUND: The study was undertaken to estimate the effectiveness of BCG vaccination in relation to scar size in the prevention of tuberculosis and leprosy. METHODS: The present study was designed as hospital-based pair-matched case-control study and was carried out at Government Medical College Hospital, Nagpur, Maharashtra, India. It included 877 cases of tuberculosis and 292 cases of leprosy (diagnosed by WHO criteria), born onwards 1962. Each case was pair-matched with one control for age, sex and socio-economic status. BCG vaccination status was assessed by examination for the presence of BCG scar, immunisation records if available and information from subjects/parents of children. Subjects uncertain about BCG vaccination were not included. The diameter of the BCG scar was measured both across and along the arm in millimeters using a plastic ruler. The average was then calculated. RESULTS: A significant protective association between BCG vaccination and tuberculosis (OR=0.38, 95% CI 0.31-0.47) and leprosy (OR = 0.38, 95% CI 0.26-0.55) was observed. The overall vaccine effectiveness (VE) was 62% (95% CI 53-69) against tuberculosis and 62% (95% CI 45- against leprosy. Vaccine effectiveness against tuberculosis and leprosy was non-significantly greater in the group who had BCG scar size < or =5 mm as compared to subjects who had BCG scar size > 5 mm. Thus there was no clear association between BCG scar size and its effectiveness. CONCLUSION: The current study did not identify any significant association between BCG scar size and its effectiveness against tuberculosis or leprosy.

Tuberculin sensitivity among children vaccinated with BCG under universal immunization programme.

A tuberculin survey was conducted among 45988 children with BCG scar and 54227 children without BCG scar between 1-9 years of age and residing in selected rural areas of three defined zones of India. About 45-60% of the BCG-vaccinated children elicited reactions < 5 mm in size and about 70-80% had reactions < 10 mm. Therefore, in the majority of children (showing tuberculin reaction of < 10 mm), BCG-induced tuberculin sensitivity does not interfere with interpretation of tuberculin test. The study also revealed that a proportion of reactions among BCG vaccinated children in 5-9 mm, 10-14 mm and 15-19 mm range may be attributable to BCG vaccination. Therefore, reactions between 10-14 mm and especially 15-19 mm among the vaccinated children must be interpreted carefully. However, 19 mm was observed as the upper limit for BCG induced tuberculin sensitivity and all reactions >- 20 mm in size may be considered to be due to infection with tubercle bacilli, irrespective of the BCG vaccination status.

Tuberculin reactivity in healthy school children in Pondicherry.

Five hundred healthy school children in the age group 5-9 years underwent tuberculin testing. Seventy nine per cent of the study population had a BCG scar. 9.2% children were found to be suffering from malnutrition, using the Quetlet's Index and 7.8% were found to be malnourished by weight for age method. 18.6% of the children were tuberculin positive (induration > or = 10 mm) and the prevalence of tuberculin positivity increased with age. The numbers of tuberculin reactors or the mean tuberculin reaction were not affected by malnutrition. BCG scar status neither affected the mean tuberculin size nor the number of tuberculin reactors.

Sensibilidade tuberculínica e diâmetro da cicatriz após vacina BCG / Tuberculin sensivity and diameter of cicatrin after vaccination with BCG

Foram estudadas 219 crianças vacinadas como BCG no 1§ mês de vida (34 lactentes, 65 pré-escolares, 53 escolares e 67 adolescentes). Entre as 219 crianças becegeizadas, apenas 39(17,80 por cento) foram reatoras (ò 5mm) ao teste tuberculínico. Näo houve diferença significativa de reatividade entre os quatro períodos da infância e apenas oito (25,9 por cento) lactentes vacinados com BCG reagiram ao teste tuberculínico. Ao ser comparada a reatividade tuberculinica entre 104 crianças com cicatriz de BCG ó 5mm com 115 crianças com cicatriz > 5mm, näo é encontrada diferença significativa (p > 0,05). Quando se compara o diâmetro da cicatriz vacinal em menores de cinco anos, quatro (8,51//) das crianças com BCG ó 5mm foram reatoras ao PPD e 11 (21,15 por cento) das crianças com BCG > 5mm também reagiram, contudo, novamente näo é encontrada diferença de reatividade. (x² = 2,164; p > 0,05). A aplicaçäo da vacina näo influi na utilidade do teste tuberculínico no diagnóstico de tuberculose-infecçäo após o 2§ ano de vida e o tamanho da cicatriz vacinal também näo parece exercer qualquer influência na interpretaçäo do teste

The post-lepromin scar and its significance in the control of HD.

In the past little attention has been paid to the post-lepromin scar (PLS) and its use in controlling Hansen's disease (HD), particularly in the prognosis, classification and measurement of CMI response. The immuno-information of the Mitsuda reaction is thought to be informative only in the extreme range of 10 + mm or in its absence. Previous studies have shown that the range of PLS formation increases proportionally to the degree of lepromin positivity. PLS positive HD patients have a stable form of the disease with good prognosis. Those unable to form a PLS have a marked tendency to downgrade towards the lepromatous form of HD. PLS formation appears to indicate a CMI response to M. leprae implying immunity. It is thought that there exists a correlation between the PLS and the lymphocyte transformation test (LTT), both reaching their optimum measurement three months after the M. leprae injection, either with lepromin or M. leprae suspension used for the anti-HD vaccine. It is proposed to study the use of the PLS in HD control programs on a trial basis with the objective of its general introduction as part of the management of HD control. Considerable improvements in the prognosis, classification and application of treatment can be expected from such a measure. The discovery of the armadilo as a source of M. leprae by Kirchheimer and Storrs facilitates the availability of lepromin A and its purified version, lepromin Ap. The relevant studies have shown that a 40 M/bact/ml lepromin A suspension should be used for the application of lepromin in control programs.(ABSTRACT TRUNCATED AT 250 WORDS)