Mycobacterium bovis (BCG) vaccination. Progressive disease in a patient asymptomatically infected with the human immunodeficiency virus.
OBJECTIVE
To report a case of progressive disease caused by Mycobacterium bovis after BCG vaccination in a patient asymptomatically infected with the human immunodeficiency virus (HIV).


METHODS
A 34-year-old white man about to commence employment as a developmental care worker had a BCG vaccination. Five months later, he had a positive result to a serological test for HIV antibody. Nine months after BCG vaccination, he presented with fever (38.7 degrees C), a large left axillary lymph node and a small left pleural effusion. The lymph node was biopsied and acid-fast bacilli observed in Ziehl-Neelsen stained smears. Culture grew Mycobacterium bovis (BCG).


RESULTS
He was successfully treated with isoniazid, rifampicin and ethambutol for a period of nine months.


CONCLUSIONS
BCG vaccination of asymptomatic HIV-positive patients is not recommended. The detection of those at risk for HIV infection before vaccination administration is essential. Self-exclusion based on information supplied to all potential recipients is likely to be the most effective method.
Lumb
R
R
Division of Clinical Microbiology, Institute of Medical and Veterinary Science, Adelaide, SA.
Shaw
D
D
D000328:Adult; D001500:BCG Vaccine / Q000009:adverse effects*; D004977:Ethambutol / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D009163:Mycobacterium bovis; D012293:Rifampin / Q000627:therapeutic use; D014376:Tuberculosis / Q000188:drug therapy / Q000209:etiology*
D001500:BCG Vaccine; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin