809. Osteitis caused by Bacillus Calmette-Guerin Tokyo 172 strain in immunocompetent patients
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall
Background: Immunization with BCG vaccine has been associated with local and systemic complications. Osteitis secondary to M. bovis-BCG is a rare complication with frequency of 0.1/100,000 doses. Below we report a series of a third level pediatric hospital in Mexico City.

Methods: This is a retrospective, descriptive and observational study of subjects diagnosed with TB at the National Institute of Pediatrics (INP) in Mexico City during the 2010-2018 period. Subjects under 18 years with skeletal TB and positive culture for Mycobacterium bovis-BCG strain were included.

Results: From 2010 to 2018, 118 cases of TB were treated, from which 3 (2.5%) were osteitis secondary to M. bovis-BCG Tokyo 172 strain, two male and one female. All three cases had BCG immunization at birth. The age at diagnosis was 1, 2 and 3 years, respectively. The most common symptoms were pain, edema and limp. Sites of injury were right proximal tibia, epiphysis of left distal femur, and left ileopubic eminence. Lytic lesions with periosteal reaction were reported in plain radiographs of all cases. The TST and COMBE studies were negative. Diagnosis was confirmed by biopsy with identification of M. bovis-BCG Tokyo 172 strain by Genotype. All strains were sensitive to rifampicin. The treatment given was INH, RIF, E, PZA and Clarithromycin during two months of intensive phase followed by seven months of maintenance phase with INH-RIF. A surgical approach was performed with curettage and graft placement in two cases. Tetrazoil nitro blue tests and immunoglobulin levels were normal. Outcome was favorable in all three cases.

Conclusion: In Mexico the BCG vaccine is part of the national immunization program and is applied to 99% of newborns. This work is the first report in Mexico of osteitis secondary to Mycobacterium bovis-BCG strain Tokyo 172. We suggest considering the diagnosis in patients with osteitis under five years of age with a history of BCG vaccination.

Napoleón González Saldaña, PhD1, Mercedes Macías Parra, MD2, Agustín De Colsa Ranero, MD2, Eduardo Arias De La Garza, MD2, Diego Galvis Trujillo, MD2 and José Iván Castillo Bejarano, MD2, (1)Pediatric Infectious Disease, Instituto Nacional de Pediatría, Ciudad de México, Mexico, (2)Instituto Nacional de Pediatría, Ciudad de México, Mexico


N. González Saldaña, None

M. Macías Parra, None

A. De Colsa Ranero, None

E. Arias De La Garza, None

D. Galvis Trujillo, None

J. I. Castillo Bejarano, None

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