Generalizuota tuberkuliozė, išsivysčiusi po BCG skiepų = : Generalized tuberculosis, which was developed after the BCG vaccination

Abstract

BCG (Bacillus Callmette-Gūerin) skiepais pasaulyje pradėta skiepyti nuo 1921 m. [1], nuo 1962 m. ja skiepijami ir Lietuvos vaikai [2]. BCG skiepai - tai gyva, susilpninta Mycobacterium bovis forma, turinti Mycobacterium tuberculosis bakterijai panašių an-tigeninių savybių ir sukeliančių antikūnų, kovojančių su Mycobacterium tuberculosis, gamybą žmogaus organizme. [16]. PSO duomenimis, kiekvienais metais BCG skiepais paskiepijama maždaug 100 milijonų naujagimių. Literatūros šaltiniuose minimi tokie BCG skiepų šalutiniai reiškiniai, pvz., susiformavusi papulė, dūrio vietos paraudimas, kitos vietinės reakcijos [3]. Rečiau pasitaiko sunkesnių vietinių bei sisteminių komplikacijų: absceso arba keloido susiformavimas, limfadenitas, generalizuota tuberkuliozė, kaulų (dažniausia žastikaulio arba šonkaulių) tuberkuliozė bei kt. [3, 4]. Sisteminės komplikacijos ypač būdingos imuninės sistemos sutrikimų turintiems žmonėms. Šiame straipsnyje aprašoma generalizuota tuberkuliozė, išsivysčiusi po BCG skiepų, vaikui, kuriam nustatytas pirminis imunodeficitas - granulomatozinė liga, jos metu sutrinka ląstelinis imunitetas. The BCG vaccine is an alive, weakened form of Mycobacterium bovis which has similar antigenical qualities to Mycobacterium tuberculosis bacteria and causes the production of antibodies against Mycobacterium tuberculosis in a humans body [16]. Most often side effects include papula, redness and other injection site reactions [3]. Rare vaccine site and systemic complications manifest as developed abscess or keloid, lymphadenitis, generalized tuberculosis, bone tuberculosis, etc. [3, 4] and are more common to the people with immune system disorders. In this article we discuss a clinical case of generalized tuberculosis which was developed after the BCG shot to the child diagnosed with primary immunodeficiency disease. The patient was presented with multiple bacterial infections since neonatal period, including recurrent lymphadenitis. Antibacterial therapy, surgical removal of suppurative lymph nodes were applied. Primary immunodefciency - phagocite function insufficiency was diagnosed, granulamatous disease was suspected. Primarily Tuberculin skin test, QuantiFERON test of the blood and smear of the sputum were negative, though abdominal ultrasound showed multiple calcinates in mesenteric lymh nodes, spleen and liver. A chest CT scan showed enlarged lymph nodes, consolidation, tissue deformation areas and fibrosis of lungs. Finally, gastric aspirate grew partialy sensitive M.tuberculosis complex bacteria. GenoType MTBC method identified M. bovis BCG and specific treatment was adjusted respectively to antibacterial.