1653. Long-term prognosis in vaccine associated BCG osteomyelitis
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Long-term prognosis in vaccine associated BCG osteomyelitis.pdf (3.0 MB)
  • Background:  Bacillus Calmette-Guerin (BCG) vaccine is routinely administered to infant in Japan, as Japan is still listed as moderately TB endemic country. BCG osteomyelitis is rare vaccine related complication by M bovis and few cases were reported. We evaluated clinical presentations and long-term prognosis of BCG osteomyelitis.

    Methods:  We retrospectively reviewed medical charts of BCG osteomyelitis between 2000 and 2012 at Tokyo Metropolitan Kiyose Children’s hospital and Tokyo Metropolitan Children's Medical Center. We collected data on demographics, clinical pictures, laboratory results and prognosis.

    Results: Eight BCG osteomyelitis patients were identified. All cases were boy without underlying diseases. The median BCG vaccination age was 3 month old (range 2-5). The median Duration between BCG vaccination and onset of osteomyelitis was 16 months (range 8-36). Symptoms of pain, swelling, fever and redness were 75% (6/8), 50% (4/8), 37.5%(3/8) and 25%(2/8),respectively. Infective site was at tibia (3/8, 37.5%), femur (2/8, 25%), humerus (2/8, 25%) and ulna (1/8, 12.5%). There was no case with multiple osteomyelitis. Arthritis was co-existed in 50% (4/8). Initial laboratory data of white blood cell count and C-reactive protein was 9776±3010 /μl and 1.15±1.22, respectively. Bone biopsy was required in 62.5% (5/8) for differentiating tumors. M tuberculosis complex PCR (M bovis included) was positive in the all cases. M bovis specific PCR was performed in 7 cases and 6 cases were positive. Culture was positive in 62.5% (5/8). The tuberculin skin test was performed in 7 cases and all of them were positive. QFT-2G/3G and T-spot were tested in 7 and 3, respectively and all of them were negative. Cases were treated with isoniazid and rifampicin based regimen. Surgical debridement was performed in 75%(6/8). Duration of treatment was 12 months in 3 cases, 19 months in 2 cases and 25 months in 1 case. One case was lost to follow up and 1 case was still under treatment. Articular contracture and bony growth impairment were 71.4% (5/7) and 42.9% (3/7), respectively. 

    Conclusion: The long-term functional prognosis in BCG osteomyelitis was poor in our study. Current national policy is to continue BCG vaccination for moderate endemicity.  These complications should be monitored and we need to access benefit and risk of BCG vaccination.

    Yoshihiko Morikawa, MD1, Yuho Horikoshi, MD2, Takayo Shoji, MD2, Mihoko Isogai, MD2, Saeko Morino, MD2 and Shintaro Hirotaki, MD, PhD2, (1)Clinical Research, Tokyo Metropolitan Children' s Medical Center, Tokyo, Japan, (2)Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan

    Disclosures:

    Y. Morikawa, None

    Y. Horikoshi, None

    T. Shoji, None

    M. Isogai, None

    S. Morino, None

    S. Hirotaki, None

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