Immunologic analysis of HIV-uninfected Taiwanese children with BCG-induced disease.
OBJECTIVE
The aim of this study was to evaluate immunity in HIV-uninfected children with bacille Calmette-Guerin-induced disease (BCG-ID) over an 8-year period, with particular emphasis on underlying diseases.


METHODS
Patient afflicted with BCG-ID proven by clinical courses, dermatologic features, pathology, specific polymerase chain reaction, and/or spoligotyping were enrolled between 2000 and 2007. Lymphocyte proliferation, polymorphonuclear function, interleukin (IL)-12/23-interferons (IFN)-gamma circuit, and Toll-like receptor 2-associated signaling were investigated.


RESULTS
Of the 271,618 total live births who received the BCG vaccine, eight patients (seven males) with BCG-ID were enrolled during an 8-year period and presented as three disseminated, two distant, and three regional BCG-ID. Their age at onset ranged from 1 to 28 months. All had a vaccine-injection scar except for one with lower CD3 and natural killer cells, compatible with severe combined immunodeficiency (SCID) identified by IL-2 receptor common gamma chain (IL2RG) mutation (Arg226Lys). The other SCID patient with de novo IL2RG mutation (Trp74Gly) had more recurrent infections. The third patient with primary autoimmune neutropenia had disseminated BCG-ID extending to abdominal wall. The fourth patient with chronic mucocutaneous candidiasis had regional BCG-ID and impaired lymphocyte proliferation to Candida and BCG antigens. No defective evidence of polymorphonuclear functions, IL-12/23-IFN-gamma circuit, and Toll-like receptor 2-associated signaling was detected in the remaining four patients.


CONCLUSIONS
Immunologic analysis in HIV-uninfected patients with BCG-ID reveals primary immunodeficiency diseases, especially in those with deficiencies in T-cell and neutrophil functions observed in our cohort, including primary autoimmune neutropenia and chronic mucocutaneous candidiasis.
Lee
Wen-I
WI
Primary Immunodeficiency Care and Research Institute, Chang Gung Memory Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. wen2707@hotmail.com
Liang
Fang-Chen
FC
Huang
Jing-Long
JL
Jaing
Tang-Her
TH
Wang
Chi-Huei
CH
Lin
Tzou-Yien
TY
Huang
Yhu-Chering
YC
Huang
Wei-Lun
WL
Jou
Ruwen
R
Hsieh
Meng-Ying
MY
Chia
Ju-Hsin
JH
Wu
Tsu-Lan
TL
D015551:Autoimmunity; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D002175:Candida / Q000276:immunology*; D002178:Candidiasis, Chronic Mucocutaneous / Q000175:diagnosis / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D049109:Cell Proliferation; D015331:Cohort Studies; D016207:Cytokines / Q000378:metabolism; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008213:Lymphocyte Activation; D008297:Male; D009154:Mutation; D009503:Neutropenia / Q000209:etiology; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D015375:Receptors, Interleukin-2 / Q000235:genetics; D016511:Severe Combined Immunodeficiency / Q000175:diagnosis / Q000209:etiology / Q000235:genetics / Q000276:immunology* / Q000503:physiopathology; D013624:Taiwan; D051195:Toll-Like Receptor 2 / Q000378:metabolism; D014376:Tuberculosis / Q000517:prevention & control*; D014611:Vaccination
D001500:BCG Vaccine; D016207:Cytokines; D015375:Receptors, Interleukin-2; C495342:TLR2 protein, human; D051195:Toll-Like Receptor 2