Hesseling AC, Schaaf HS, Beyers N, Cotton
MF, Gie RP, Marais BJ, van Helden P, Hanekom
WA, Warren R; IAS Conference on HIV
Pathogenesis and Treatment (2nd : 2003 :
Antivir Ther. 2003; 8 (Suppl.1):
abstract no. 19.
Department of Paediatrics and Child
Health, Tygerberg Children's Hospital
BCG, a live attenuated strain of
Mycobacterium bovis, is widely given but may
be associated with adverse events.
Disseminated BCG disease is rare and seen
predominantly in immunocompromised patients.
Routine identification of mycobacterial
isolates involves isolation of M.
tuberculosis complex and does not
differentiate between M. tuberculosis and
the vaccine strain M. bovis BCG. PCR-based
methodologies can rapidly and accurate
differentiate M. tuberculosis complex. The
study aims were to retrospectively determine
the proportion of BCG-related
culture-confirmed mycobacterial disease in
hospitalized HIV-infected children aged 0-13
years through speciation with a PCR-based
algorithm targeting the TBD1 and RD 10
regions and the ESAT-6 gene. Clinical
features of BCG disease were also described.
183 mycobacterial samples from 49
HIV-infected patients were analyzed. Danish
strain M. bovis BCG was isolated from 15
specimens from 5 patients (10%). All cases
were asymptomatic at birth, younger than 12
months and severely immunodeficient at
presentation. Two patients had probable
disseminated BCG disease, two localized
extraregional disease and one adenitis. One
patient presented with BCG disease related
to immune reconstitution after HAART and two
patients were co-infected with M.
tuberculosis. The clinical picture was
similar to tuberculosis, although right
axillary adenitis is more common. Young
symptomatic HIV-infected infants are at risk
for BCG-related complications. Clinical
features do not adequately distinguish
between BCG and M. tuberculosis.
Co-infection with M. tuberculosis can occur.
Due to study limitations, we are unable to
recommend a change in current vaccination
policy. Population-based controlled studies
are necessary to assess the risk of BCG in
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly
- BCG Vaccine
- HIV Infections
- HIV Seropositivity
- Mycobacterium bovis
- Polymerase Chain Reaction
From Meeting Abstracts