[Generalized BCG infection, expression of multifactorial deficiency of intramacrophage bactericidal action. Anatomo-clinical study of 11 cases].

In France, because of routine vaccination, BCG infection is the rule and not the exception. It may thus incidentally reveal a latent immunodeficiency. Eleven cases (10 fatal) of generalized BCG infection observed from 1967 to 1981 at the Hôpital des Enfants-Malades (Paris) are reviewed. The clinico-pathologic analysis of these 11 cases showed that the underlying immunodeficient states were of various natures. They could be grouped under 3 different headings: (1) Cellular immunodeficiency, as part of a severe combined immunodeficiency (5 cases) and Di George's syndrome (1 case); (2) Deficiency in the bactericidal activity of the macrophages, either isolated (2 cases) or associated with fatal granulomatous disease (1 case); (3) unclassified conditions, probably original, associated with chronic Salmonella infection. The heterogeneity of theses cases emphasizes the complexity and diversity of the mechanisms which lead to the elimination of the intracellular agents. Because they provide useful insight into the poorly understood mechanisms of bactericidal activity of macrophages, further investigations of infantile disseminated BCG infection are necessary.