Immunity status in children with Bacille Calmette-Guerin adenitis. A prospective study in Tehran, Iran.
OBJECTIVE
To determine the immunity status of children with Bacille Calmette-Guerin (BCG) lymphadenitis (patient group) and unaffected children (control group) in Iran.


METHODS
We performed this longitudinal case-control study on 75 children between 2 months to 14 years old in Rasool Akram and Markaz Tebbi Hospital, Tehran, Iran during the period of 2 years (2000-2002).


RESULTS
Ninety percent of patients had normal immunoglobulin, 10% had low level, 96.1% had normal nitro blue tetrazolium test and 3.9% had lower activity. There was a significant difference in the total lymphocyte CD3, CD8, CD19, CD16/CD56 and natural killers (NK) cell but no significant difference in the CD4/CD8 ratio and CD4 between case (n=75) and control (n=100) groups. Thirty-eight cases with mild lymphopenia, isolated CD4, CD3, CD19, NK cells (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients were observed. Thirty-eight cases were diagnosed as mild immune deficient without any previous recurrent infections (mild lymphopenia; Isolated CD4; CD3 or CD19 deficiency. Natural killers (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients. The natural killers (CD16/CD56) deficient cases responded well to 3 antimycobacterial drugs without immunomodulator. Natural killers cell deficiency not yet reported as a risk factor for progression and complication of BCG infection. All cases of idiopathic disseminated BCG infection (unknown immunodeficiency type) with nonlethal and indulgent BCG infections responded well to needle aspiration and antimycobacterial drugs with immunomodulator (gamma interferon).


CONCLUSIONS
In cases with multiple and recurrent BCG lymphadenitis without any previous recurrent infection complete immunological studies should be carried out. Most cases with mild immune deficiency usually response well to needle aspiration alone or combine with antimycobacterial drugs. The combination of IFN-gamma and chemotherapy in cases of idiopathic disseminated infections caused by BCG and without previous recurrent other infection except mycobacterium species, can limit the disease.
Samileh
Noorbakhsh
N
Department of Pediatrics, Iran University of Medical Sciences, Research Center of Pediatric Infectious Diseases, Hazrat Rasool Hospital, Niayesh Ave, Satarkhan Street, Tehran 14455, Republic of Iran. Samileh_noorbakhsh@yahoo.com/Saminoor@hbi.dmr.or.ir
Ahmad
Siadati
S
Farzaneh
Ashtiani
A
Shahnaz
Rimaz
R
Lida
Fereidoni
F
Mohammad
Nikbin
N
D000293:Adolescent; D015703:Antigens, CD / Q000032:analysis*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000009:adverse effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D004322:Drainage; D004586:Electrophoresis; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D007153:Immunologic Deficiency Syndromes / Q000175:diagnosis; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D007371:Interferon-gamma / Q000627:therapeutic use; D007492:Iran; D007694:Killer Cells, Natural / Q000276:immunology; D008137:Longitudinal Studies; D008199:Lymphadenitis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology* / Q000628:therapy; D008231:Lymphopenia / Q000175:diagnosis; D008297:Male; D011446:Prospective Studies; D014376:Tuberculosis / Q000517:prevention & control
D015703:Antigens, CD; D000995:Antitubercular Agents; D001500:BCG Vaccine; D007136:Immunoglobulins; D007155:Immunologic Factors; D007371:Interferon-gamma