Wen-Li Lin1, Nan-Chang Chiu2, Pin-Hui Lee3, Angela Song-En Huang3, Fu-Yuan Huang1, Hsin Chi4, Daniel Tsung-Ning Huang5, Pei-Chun Chan6. 1. Department of Pediatrics, MacKay Children's Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei 10449, Taiwan. 2. Department of Pediatrics, MacKay Children's Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei 10449, Taiwan; MacKay Junior College of Medicine, Nursing and Management, No. 42, Sec. 3, Zhongzheng Rd., Sanzhi Dist., 252, New Taipei City, Taiwan. 3. Centers for Disease Control, No. 6, Linsen S. Rd., Jhongjheng District, Taipei 10050, Taiwan. 4. Department of Pediatrics, MacKay Children's Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei 10449, Taiwan; MacKay Junior College of Medicine, Nursing and Management, No. 42, Sec. 3, Zhongzheng Rd., Sanzhi Dist., 252, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren Ai Rd, Taipei 10051, Taiwan. 5. Department of Pediatrics, MacKay Children's Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei 10449, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren Ai Rd, Taipei 10051, Taiwan. 6. Centers for Disease Control, No. 6, Linsen S. Rd., Jhongjheng District, Taipei 10050, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xuzhou Rd., Taipei 10055, Taiwan; Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, College of Medicine, No. 8, Zhongshan S. Rd., Taipei 10041, Taiwan. Electronic address: pcanita.tw@cdc.gov.twg.
Abstract
BACKGROUND: Bacillus Calmette-Guérin (BCG) osteomyelitis/osteitis in immunocompetent children is a rare but serious complication of BCG immunization. Rationale for its treatment is unclear. METHODS: Due to the rarity of this complication, no randomized control trials has ever been conducted to evaluate methods of intervention. As such, we searched the literature for any reported BCG vaccination-related osteomyelitis/osteitis among immunecompetent children published before April 15, 2014. We summarized the data from different affected regions of the body by recording the number of reported cases, while noting outcomes and their medical and/or surgical interventions. RESULTS: From 34 eligible studies gleaned from a screening of 804 articles, a total of 331 cases were enrolled. Involvement of the lower limbs was present in 55.6%, followed by the axial skeleton (26.0%), the upper limbs (15.4%), and multiple bones (3.0%). Of the 64 patients having records of detailed chemotherapy regimens, 45 patients (70%) received two or fewer drugs. Among the 80 patients with detailed surgical records, 50 (62.5%) received surgical procedures for diagnostic purposes. While there were uneventful outcomes for those receiving diagnostic procedures, 7 of the 30 (23.3%) patients receiving surgical interventions had major complications (p=0.002, Fisher's exact test). The overall prognosis was good with a 97.6% cure rate. Nevertheless, eight patients (2.4%) suffered major complications. CONCLUSIONS: The rationale for treatment of BCG osteomyelitis/osteitis in immunocompetent children is highly subjective. However, patients receiving diagnostic procedures instead of surgical interventions may avoid major complications. Because only a few of the publications had detailed treatment information, further studies are needed to identify proper treatments, while infant BCG vaccination is still in use.
BACKGROUND: Bacillus Calmette-Guérin (BCG) osteomyelitis/osteitis in immunocompetent children is a rare but serious complication of BCG immunization. Rationale for its treatment is unclear. METHODS: Due to the rarity of this complication, no randomized control trials has ever been conducted to evaluate methods of intervention. As such, we searched the literature for any reported BCG vaccination-related osteomyelitis/osteitis among immunecompetent children published before April 15, 2014. We summarized the data from different affected regions of the body by recording the number of reported cases, while noting outcomes and their medical and/or surgical interventions. RESULTS: From 34 eligible studies gleaned from a screening of 804 articles, a total of 331 cases were enrolled. Involvement of the lower limbs was present in 55.6%, followed by the axial skeleton (26.0%), the upper limbs (15.4%), and multiple bones (3.0%). Of the 64 patients having records of detailed chemotherapy regimens, 45 patients (70%) received two or fewer drugs. Among the 80 patients with detailed surgical records, 50 (62.5%) received surgical procedures for diagnostic purposes. While there were uneventful outcomes for those receiving diagnostic procedures, 7 of the 30 (23.3%) patients receiving surgical interventions had major complications (p=0.002, Fisher's exact test). The overall prognosis was good with a 97.6% cure rate. Nevertheless, eight patients (2.4%) suffered major complications. CONCLUSIONS: The rationale for treatment of BCGosteomyelitis/osteitis in immunocompetent children is highly subjective. However, patients receiving diagnostic procedures instead of surgical interventions may avoid major complications. Because only a few of the publications had detailed treatment information, further studies are needed to identify proper treatments, while infantBCG vaccination is still in use.
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