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Sunday, February 7, 2016

An Infant With BCG Adenopathy

An Infant was brought to the clinic by her concerned mother who has noticed a swelling in the baby's armpit while giving him bath yesterday. On history mother mentions the baby was given BCG vaccine a few weeks ago.

1. . What is this problem that occurred in this infant after few weeks of administration of BCG vaccine?
2. When it is more likely to occur?
3. What treatment should be offered to this infant?
4. What is the usual sequence of events after BCG vaccination?
5. What are the main advantages of BCG vaccine administration?

Answers:


1. . What is this problem that occurred in this infant after few weeks of administration of BCG vaccine?

Answer: This infant has developed BCG adenopathy. It is regional suppurative adenopathy in axilla following BCG vaccination. It is seen in 0.1-1% of babies after BCG vaccination. It does not indicate lowered protection afforded to this baby or a lowered immune response.

2. When it is more likely to occur? 

Answer: Ipsilateral cervical or axillary lymphadenopathy may develop a few weeks or months after BCG vaccination.

3. What treatment should be offered to this infant? 

Answer: These enlarged nodes regress spontaneously without any treatment after few months. Needle aspiration cytology if done would reveal presence of acid fast bacilli. But these are bovine vaccine bacilli and should not be inferred as tubercular disease and treated like it.
 Antitubercular therapy is of no benefit in such situations and should not be administered.

4. What is the usual sequence of events after BCG vaccination? 

Answer: Usually a papule forms after 2-3 weeks of administration of BCG which increases in size to 4-8 mm by end of 5-6 weeks. It later bursts to form an ulcer that heals in few weeks spontaneously leaving behind a scar.

5. What are the main advantages of BCG vaccine administration?

Answer: BCG vaccine has limited efficacy but it is only vaccine available against TB. It induces cell mediated immunity. Pulmonary TB protection is around 50%. Main advantage of BCG vaccination appears to be prevention of life threatening meningeal and miliary TB in infants and young children (50- 80%). BCG vaccination is recommended at birth. No tuberculin testing is required before administration of BCG. It can be given with other vaccines simultaneously or at any gap. But a gap of minimum 4 weeks should be kept between BCG and measles/MMR vaccine. BCG may be repeated once in children less than 5 years of age if no reaction or scar is seen after BCG vaccination presuming that BCG has not taken up. Even many of these patients have shown in vitro evidence of cell mediated immunity against TB. Tuberculin testing is not required prior to administration of second dose of BCG.



2 comments:

  1. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
    Is the solution

    ReplyDelete
  2. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
    Is the solution

    ReplyDelete