卡介苗性淋巴结结核局部用药的观察和护理

在我国接种卡介苗(BCG)是为了预防青少年结核病发生，降低结核性脑膜炎和粟粒性结核病死率的重要措施。卡介苗接种后，菌苗迅速自接种部位经淋巴管到达局部淋巴结，因此在接种后一个时期，引起同侧腋下或锁骨下淋巴结反应是正常的，但直径不超过1cm。严重者引起局部细胞浸润和淋巴血行播散性菌栓，可引起淋巴结结核，甚至形成寒性脓肿，脓肿自破或切开引流，创口经久不能愈合，形成瘘道或溃疡。     

卡介苗性淋巴结结核局部用药的观察和护理

在我国接种卡介苗 (BCG)是为了预防青少年结核病发生 ,降低结核性脑膜炎和粟粒性结核病死率的重要措施。卡介苗接种后 ,菌苗迅速自接种部位经淋巴管到达局部淋巴结 ,因此在接种后一个时期 ,引起同侧腋下或锁骨下淋巴结反应是正常的 ,但直径不超过 1cm[1] 。严重者引起局部细胞浸润和淋巴血行播散性菌栓 ,可引起淋巴结结核 ,甚至形成寒性脓肿 ,脓肿自破或切开引流 ,创口经久不能愈合 ,形成瘘道或溃疡。常规抗结核用药 ,不但疗程长 ,易产生肝肾功能损害等作用 ,而且常因药物在病灶内难以达到有效浓度而影响疗效。近 2年来 ,我院门诊针对不同…     

骨髓涂片镜检在马尔尼菲青霉病诊断中的意义

马尔尼菲青霉病系由马尔尼菲青霉菌所致深部真菌感染。该菌常侵入血管导致血行播散[1] 和侵蚀骨组织[2 ] ,故骨髓涂片和培养具较高诊断价值。现将我院有骨髓涂片记录的 9例病例报告如下。一、材料和方法1.一般资料 :男 5例 ,女 4例 ;年龄 4个月到 4 5岁。除骨髓涂片检查外 ,9例中 4例因播散性霉菌病和霉菌败血症死亡 ,死后 2 4ｈ内尸检 (取材部位为淋巴结、肝、肺病变部位 )。5例淋巴结活检 ,9例病理组织中的病原体均经马尔尼菲青霉特异抗体免疫组化染色证实 ,8例培养阳性。2 .临床表现根据病史记载 ,骨髓涂片做瑞氏 姬姆萨及姬姆萨、糖元染…     

小儿卡介苗接种性淋巴结反应10例病理诊断

目的 探讨小儿接种卡介苗后发生的卡介苗性淋巴结反应的病理诊断和鉴别诊断。方法 对10例在接种后2～4个月内出现卡介苗性淋巴结反应的小儿患者的病理特征进行总结和分析。结果 该病的主要诊断依据是：①无结核病接触史，接种后不久发生区域淋巴结病变，符合原发感染；②无结核中毒症状和其他部位结核病，患儿生长发育良好；③淋巴结穿刺物涂片不易查到结核杆菌，普通细菌培养阴性；④病灶以多核巨细胞或朗汉斯巨细胞为主，干酪样变少见。结论 1岁以内小儿腋下淋巴结出现结核样改变时，不要轻易诊断为原发结核，应注意询问接种史及接种时间，如果诊断为卡介苗性淋巴结反应，一般无须特殊治疗。     

26例患儿接种卡介苗致淋巴结异常反应的处理

卡介苗是儿童基础免疫疫苗之一。也是全球应用最广泛的菌苗之一。接种卡介苗可以产生较强的免疫力,这种免疫力可以限制结核杆菌在体内的播散复制,减少结核病的发生,起到预防粟粒性肺结核和结核性脑膜炎的作用。卡介苗是目前接种的疫苗中,唯一可产生接种局部溃烂的菌苗,也是目前出现接种反应较多的菌苗。由于接种的方法、技术不当或接种对象体质不同。可引起接种同侧邻近的淋巴结肿大,甚至出现淋巴结化脓、溃疡等异常反应。新生儿接种卡介苗所致的淋巴结异常反应尽管不会对生长发育或健康产生明显影响,但会给他们带来痛苦,给家长带来精神及心理上的负担。     

全身播散性卡介苗病误诊一例分析

全身播散性卡介苗病误诊一例分析江苏省无锡市解放军１０１医院［２１４０４４］曾昭成有免疫缺陷的患儿，接种卡介苗后会导致致死性播散性卡介苗病。本病极为罕见，容易误诊，而且预后险恶，国内仅见４例报道［１］，现将所见１例报道如下。【病例】男，４个月。因低热半...     

卡介苗接种严重反应一例

1病例资料患儿,女,5个月。因接种卡介苗后出现颈部和腋窝淋巴结大半年入院。患儿出生体重3 kg,出生后接种卡介苗,采用左上臂三角肌下端之皮内注射法,接种制剂卡介苗纯蛋白衍生物(成都生物制品研究所生产),1 m l含菌量0·5 mg,先注入0·1 m l,因注射部位未出现丘疹,再注入0·1 m l,2周后接种处逐渐软化形成白色脓疱,3个月后结痂形成瘢痕;接种1个月后发现左侧腋窝淋巴结大如蚕豆,无红肿,破溃,继之发现左颈淋巴结大,呈进行性,未引起重视,至就诊时颈淋巴结如鸡蛋大小,左腋窝淋巴结如鸭蛋大小,红肿,破溃,有白色脓性分泌物流出。患儿无午后发热,无…     

血行播散型与非血行播散型结核累及腹部淋巴结的CT强化表现及其解剖、病理基础

目的观察血行播散型与非血行播散型结核累及腹部淋巴结的CT强化特征及其优势解剖分布.方法回顾性观察46例腹部淋巴结结核(其中血行播散型13例、非血行播散型33例)的CT强化表现(病灶大小、形态、强化类型)及其解剖分布.血行播散型结核合并有肺部粟粒型肺结核.结果血行播散型与非血行播散型结核常优势地累及网膜、肠系膜、胰周及腹主动脉周围上部淋巴结,但腹主动脉周围下部淋巴结受累常见于血行播散型结核(69.2%),而少见于非血行播散型结核(6.1%,P＜0.01).血行播散型与非血行播散型结核淋巴结CT强化特征无差别,97%病例淋巴结增大呈周边强化,常伴"多房样"征象.结合上述CT征象,诊断腹部淋巴结结核的正确率90%,敏感度93%,特异度89%.全部血行播散型病例肝脏、脾脏增大,肝脏多数呈均匀密度,而脾脏有散在低密度灶,46%血行播散型病例肾脏有低密度灶.结论血行播散型与非血行播散型结核累及腹部淋巴结及淋巴结外器官存在一定的优势解剖分布,这与淋巴结结核的感染途径存在一定相关性.     

卡介苗误种临床分析与护理9例

我科 1994年 1月～ 2 0 0 1年 12月给 386 2人次接种卡介苗 ,并在 4个月时行ＢＣＧ -ＰＰＤ复查 ,其中卡介苗误种 9例 ,发生率 0 .13%。经正确治疗、护理 ,已全部临床治愈 ,现报告如下。1　临床资料1.1　一般资料。 386 2人次接种卡介苗并在 4个月时行ＢＣＧ -ＰＰＤ复查 ,发生前臂掌侧皮内误种 9例 ,男4例 ,女 5例 ,年龄 4～ 9个月 ,发生率 0 .13%。1.2　临床表现。 9例患儿 ,5例在 2 0ｄ后左前臂掌侧注射部位出现 1ｃｍ× (2～ 4 )ｃｍ× (2～ 4 )ｃｍ红肿硬结 ,边界清楚。 4例出现脓疡、破溃 ,流出黄色脓液。 2例出现接种同侧腋下淋巴结…     

婴幼儿肺结核胸外播散的影像学表现

目的探讨婴幼儿肺结核发生胸外播散的影像特征。方法59例诊断肺结核的患儿（男35例,女24例,年龄1天至12个月）中,17例发生肺结核胸外播散,诊断均通过病理检查明确。回顾性分析全部胸片及CT的影像学表现和特征。结果在17例胸外播散的病灶中,包括结核性脑膜（脑）炎11例,腹膜结核6例,脾结核3例,肝结核2例,髋关节结核1例。增强CT显示全部病例均有纵隔淋巴结肿大,中心低密度的占70.6%;52.9%出现肺部团块样实变伴有灶性低密度;47.1%伴发胸腺萎缩;肺内播散结节发生率为29.4%;空洞17.6%;钙化11.7%。结论影像学检查能提供婴幼儿结核全身播散诊断证据,其中肺部急性播散结节、带有灶性低密度区的团块样实变和伴发的胸腺萎缩提示价值最大。     

Super acute-onset disseminated BCG infection: A case report

Intravesical Bacillus Calmette-Guérin (BCG) instillation is an established immunotherapy for superficial bladder cancer. Herein, we describe a case of disseminated BCG infection that developed immediately after the first BCG injection. A 76-year-old man diagnosed with non-invasive bladder cancer underwent intravesical BCG instillation; he developed high fever and systemic arthralgia later that night. General examination did not reveal any infectious sources, and a combination therapy of isoniazid, rifabutin, and ethambutol was initiated after collecting his blood, urine, bone marrow, and liver biopsy samples for mycobacterial cultures. Three weeks later, Mycobacterium bovis was detected in the urine and bone marrow samples, and pathological investigation of liver biopsy revealed multiple small epithelial granulomas with focal multinucleated giant cells, leading to a diagnosis of disseminated BCG infection. The patient recovered after long-term antimycobacterial therapy without remarkable sequelae. Most cases of disseminated BCG infection occur after several doses of BCG injections, and its onset reportedly varies among cases, ranging from a few days to several months. The present case was notable as disease onset was observed only a few hours after the first BCG injection. Although rare, development of disseminated BCG infection should be considered as a differential diagnosis in patients at any time after intravesical BCG instillation therapy.     

Four cases of disseminated Mycobacterium bovis infection following intravesical BCG instillation for treatment of bladder carcinoma

Intravesical BCG (bacillus Calmette-Guérin) instillation is a first-line treatment for superficial transitional cell carcinoma of the bladder. A rare but severe complication of BCG immunotherapy is the development of disseminated BCG disease, which can result in miliary pneumonitis, granulomatous hepatitis, soft tissue infections, bone marrow involvement, and sepsis. Symptoms can present as early as a few hours or as late as several months following the BCG therapy. The key finding in disseminated BCG disease is the formation of caseating granulomas in distant organs; detection of BCG organisms from tissue samples can be difficult. Recommended treatment for disseminated BCG disease includes a combination of antituberculous medications (with the exception of pyrazinamide, to which BCG is typically resistant) and a tapering course of steroids. We present the cases of four patients who developed granulomatous infection consistent with disseminated disease after intravesical BCG treatment and provide a summary of current clinical management recommendations.     

Mycobacterial Sepsis Following Intravesical Instillation of Bacillus Calmette–Guérin

Intravesical bacillus Calmette–Guerin (BCG) administration for bladder cancer may lead to BCG dissemination in the compromised host. A case of a 63–year–old man with shock secondary to BCG sepsis is reported. The recognition and treatment of disseminated BCG infection are discussed. In addition to standard therapy for urosepsis, early therapy with steroids and coverage with antitubercular medications should be initiated for patients with this condition. In general, the author recommends that all febrile patients who have received BCG immunotherapy within three years, and who have no obvious source for their fever, have acid–fast bacilli blood cultures done for Mycobacterium bovis , and that these patients be admitted to the hospital for further evaluation.     

全身播散性非结核分枝杆菌感染1例报告并文献复习

目的探讨非结核分枝杆菌引起全身播散性感染的临床及病理特点,以提高诊断率及对该病的认识。方法报道全身播散性非结核分枝杆菌感染1例,并复习相关文献进行分析。结果患者全身多系统组织活检(包括淋巴结、肝、骨髓、肺、胸膜组织)形态学相似,均表现为肉芽肿性炎,特殊染色可见少量抗酸杆菌,符合非结核分枝杆菌的特点。结论非结核分枝杆菌引起全身播散性感染罕见,确诊主要依靠病理学及微生物学检查,临床与病理均需与结核、麻风及某些淋巴瘤相鉴别,治疗以化疗为主,预后较差。     

Isolated mediastinal lymphadenitis caused by Mycobacterium malmoense in an immunocompromised child

Mycobacterium malmoense is a nontuberculous mycobacteria (NTM), that is uncommon in areas other than Northern Europe. We describe the case of mediastinal lymphadenitis caused by M. malmoense in a 4-year-old boy who has a past medical history of disseminated Bacille de Calmette et Guérin (BCG) infection. He presented with persistent high fever and computed tomography revealed mediastinal lymphadenopathy. We identified M. malmoense by hsp65 gene analysis from a lymph node biopsy sample. We treated him with rifampicin, ethambutol and clarithromycin with reference to the guidelines of the British Thoracic Society. M. malmoense can cause severe infections including mediastinal lymphadenitis in children with susceptibility to acid-fast bacteria (AFB).     

Mode of immunopotentiating action of BCG: persistence and spread of BCG infection.

The mode of action of BCG, strain Japan was investigated using the immune response to sheep red blood cells (SRBC) as an indicator system. When SRBC were injected into the BCG-primed foot pad, the direct plaque forming cells (PFC) and the effector cells responsible for delayed type hypersensitivity (PTH) were produced in various lymphoid organs widely distributed. Furthermore, bacterial counts in the draining popliteal lymph node and the spleen in the mice inoculated with BCG into the hind foot pad suggested that a local infection with BCG has spread to a generalized systemic infection of lymphoid tissues with time. Enhancement of DTH response to SRBC was induced when the mice previously infected with BCG were inmunized with SRBC mixed with purified protein derivative (PPD). These findings suggested that nonspecific augmentation of immune response with BCG was due to a generalized systemic activation of lymphoid system by BCG infection and the long lasting effect of immunopotentiation with BCG was due to persisting BCG infection in the lymphoid tissues.     

Evidence for an alpha/beta T cell-independent mechanism of resistance to mycobacteria. Bacillus-Calmette-Guerin causes progressive infection in severe combined immunodeficient mice, but not in nude mice or in mice depleted of CD4+ and CD8+ T cells

Depleting thymectomized mice of CD4+ T cells, or CD4+ plus CD8+ T cells, rendered them incapable of resolving Bacillus-Calmette-Guerin (BCG) infection in their lives, spleens, kidneys, and lungs. However, it did not render them incapable of stabilizing infection in the latter three organs after an initial period of BCG growth. Athymic nude mice showed a similar capacity to control BCG growth in these organs after a certain stage of infection. In contrast, congenitally severe combined immunodeficient (SCID) mice appeared to offer no resistance to BCG infection, in that the organism grew progressively in all organs of these mice and was lethal for them beginning on day 55 of infection. The results suggest that, although CD4+ T cells are important for resolving BCG infection, an alpha/beta T cell-independent mechanism of resistance can be acquired at 2-3 wk of infection that is capable of inhibiting further BCG growth in all organs except the lungs. Because this mechanism is absent from SCID mice, it is likely that it depends on the functions of gamma/delta T cells, B cells, or both types of cells. In keeping with this possibility is the additional finding that SCID mice engrafted with lymph node cells depleted of CD4+ or CD8+ T cells were capable of expressing an appreciable level of resistance against BCG infection.     

艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT诊断

目的探讨艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT表现及其诊断价值。方法回顾性分析经临床确诊的6例艾滋病合并播散性马尔尼菲青霉菌感染患者的胸部CT扫描的资料。结果肺部片状实变影4例;结节影3例;支气管壁增厚3例;支气管血管束增粗2例;弥漫性粟粒小结节影1例;纵隔及肺门淋巴结肿大3例;胸膜炎4例。结论艾滋病合并播散性马尔尼菲青霉菌胸部感染胸部CT主要表现为肺部片状实变影、结节影、纵隔淋巴结肿大、胸膜炎性反应。胸部CT检查有利于本病临床诊断及治疗。     

Susceptibility of Mycobacterium bovis BCG vaccine strains to antituberculous antibiotics

Mycobacterium bovis BCG is one of the most commonly administered vaccines. Complications, including disseminated BCG disease, are rare but increasingly reported in immunodeficient children. There is growing recognition of the importance of differences between BCG vaccine strains. We determined the susceptibilities of five genetically distinct BCG vaccine strains to 12 antituberculous drugs.