Paolo Cabas1, Michele Rizzo2, Mauro Giuffrè3, Roberta Maria Antonello4, Carlo Trombetta2, Roberto Luzzati5, Giovanni Liguori2, Stefano Di Bella5. 1. Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy. Electronic address: paolo.cabas@asuits.sanita.fvg.it. 2. Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy. 3. Department of Medical, Surgical and Health Sciences, Liver Clinical Unit, University of Trieste, Cattinara Hospital, Trieste, Italy; Italian Liver Foundation, Basovizza, Trieste. 4. University of Trieste, Trieste, Italy. 5. Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Abstract
OBJECTIVE: Intravesical Bacillus Calmette-Guèrin (BCG) is an effective treatment in non--muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ. METHODS: We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient. RESULTS: BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. CONCLUSIONS: BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.
OBJECTIVE: Intravesical Bacillus Calmette-Guèrin (BCG) is an effective treatment in non--muscle-invasive bladder cancer, however, extravesical BCGinfection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCGinfection after intravesical administration of BCG could be identified and estimated for each single involved organ. METHODS: We performed a systematic literature review over systemic and genitourinary BCGinfection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCGinfection development were collected and analyzed for each patient. RESULTS:BCGinfection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. CONCLUSIONS:BCGinfection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCGinfection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.