外敷回生膏对卡介苗接种后局部淋巴结肿大的疗效评价(摘要)

卡介苗接种后强烈反应引起局部淋巴结肿大时有发生。传统早期的局部处理是热敷。近年来,我们用回生膏(山西稷王制药有限公司提供)外敷,取得较好效果。1 对象 150例均为卡介苗接种后引起的局部淋巴结肿大(无破溃、脓疡),男83例,女57例。年龄最大7岁,最小6个月。淋巴结肿大部位分别为锁骨上、下(56),腋下(94)。2 治疗方法 将研究对象按随机原则分为两组:①因卡介苗接     

婴儿淋巴结结核的局部护理

目的婴儿接种卡介苗引起淋巴结结核,出现局部红肿、流脓,伤口经久不愈。采用特殊的换药方法,能使加快伤口愈合,局部病灶愈合良好,减轻患儿痛苦。方法对30例因接种卡介苗引起淋巴结结核的患儿的将伤口完全敞开,并进行清创、必要时用INH纱布条填塞,利用在换药过程中加强对患儿及家长进行心理护理和结核专科知识宣教。结果采用特殊的换药方法,结合规则抗结核化疗,30例患儿痊愈。结论通过开放伤口,深部清创,可有效防止伤口窦道形成,消除残留死腔,对缩短伤口愈合时间有明显作用。     

伤口长期不愈原因及处理

自１９９７年至２０００年我科换药室共接诊伤口长期不愈６０例 ,经原因分析及适当措施处理 ,伤口全部愈合。现介绍如下。１临床资料本组共６０例 ,男２４例 ,女３６例 ,年龄１０～５２岁 ;伤口不愈时间最短１个月 ,最长２９个月。伤口长期不愈原因依次为引流不畅、异物存留、慢性骨髓炎、疤痕性溃疡、局部血运不良、癌性溃疡。２原因分析及处理２ １引流不畅共３０例 ,占５０%。原因 :多数为臀部注射感染脓肿破溃或切开引流所致。共同特点为局部脓肿大、引流口较小 ,分泌物排出不畅 ,使伤口不能收缩致伤口长期不愈。处理 :彻底扩创 ,敞开引…     

接种卡介苗后淋巴结炎1例报告

目的总结卡介苗接种后发生1例淋巴结炎处置与体会。方法按预防接种异常反应调查规范对该儿童接种卡介苗后出现不良反应的事件进行调查和处理。结果发现1例儿童接种卡介苗后出现左侧腋下淋巴结脓肿,经预防接种异常反应调查诊断专家组调查诊断为卡介苗淋巴结炎。患儿淋巴结脓肿施行切开排脓,异烟肼纱布条引流、换药,45 d后痊愈。结论卡介苗接种后淋巴结炎是卡介苗接种中较为多见的接种异常反应,对此采用淋巴结脓肿切开排脓,异烟肼纱布条引流的方法简单、易行、有效。     

川崎病引发接种卡介苗局部溃疡1例报告

患者,女,2003年2月5日出生,24h内于左上臂三角肌附着处皮内接种卡介苗0·1ml(上海生物制品研究所生产,批号2002030702,有效期2003-05-29)。接种后局部红肿,无破溃。6个月时洗澡后发现破溃,又因恶心、呕吐、发热、腹泻住院,诊断川崎病。接种卡介苗处已破溃,红肿有分泌物,局部溃疡2cm×2cm×1cm,颈部、腋下淋巴结无肿大。处理:局部用5%异烟肼2ml冲洗,外敷利福平粉、异烟肼粉,每日换药1次,1周后局部溃疡收缩,分泌物减少。2周后溃疡明显愈合无分泌物,1个月后完全愈合。川崎病又称皮肤粘膜淋巴结综合征,是一种血管发炎的特别疾病。常见于6个月~2…     

57例卡介苗接种后淋巴结强反应观察及治疗分析

目的:探讨婴幼儿卡介苗接种后引起淋巴结强反应的观察及治疗。方法:57例患儿均为济南市各大医院出生后,在24h内直接接种卡介苗的婴幼儿。其中男56例,女1例。通过B超和实验室检查确诊后,均给予局部治疗和预防性抗痨治疗,口服异烟肼10mg/(kg·d),1次/d,连服3~6个月。结果:57例患儿经过治疗后,大部分病例在15~30d后淋巴结逐渐缩小、吸收、痊愈。结论:卡介苗接种后密切观察局部反应,早期诊断、早期治疗,可防止化脓、破溃,宿短疗程,预后好。     

新型敷料联合利福平用于颈部淋巴结核伤口的效果观察

目的:探析新型敷料联合利福平用于颈部淋巴结核伤口的临床效果.方法:选取2014年8月-2017年3月我院收治的30例颈部淋巴结结核并已形成脓肿破溃的患者为研究对象,根据随机分配原则将患者分为新型敷料联合利福平观察组15例及外科手术对照组15例,对两组的治疗效果及愈合时间进行观察,患者的各项临床指标进行对比分析.结果:观察组患者的伤口愈合时间明显优于对照组,差异有统计学意义(P<0.05);观察组患者的住院时间、治疗费用与对照组相比差异有统计学意义(P<0.05).结论:新型敷料联合利福平治疗颈部淋巴结核伤口的效果显著,可缩短患者的伤口愈合时间,减少治疗费用,减轻患者及家属的心理压力和经济负担,值得在临床上应用推广.     

放散状体外冲击波治疗慢性难愈合伤口的临床应用

目的观察放散状体外冲击波治疗对单纯伤口护理难以愈合的慢性伤口的治疗效果,为促进慢性伤口快速愈合寻找新的治疗方法。方法选择3例患者4处慢性难愈合伤口,在进行伤口评估、清创、抗炎等伤口护理的同时,局部应用放散状体外冲击波治疗,观察伤口愈合时间。结果 4处经伤口护理数月未愈的伤口,在接受冲击波治疗1～3次后,在7～40 d完全愈合。结论放散状体外冲击波治疗可促进慢性伤口的愈合。     

一起结核菌医源性感染的报告

20 0 1年 2月 14日至 2 8日甘肃某乡村发生一起结核菌医源性感染爆发 ,调查结果报告如下。1.流行特征 :96例患者曾在村个体诊所接受臀部肌肉注射。首发病例在 2月 14日 ,至 2月 2 8日共发病 34例(34.7% )。其中男性 2 1例 ,女性 13例 ;发病年龄为 8个月至 38岁 ;其中 14岁以下 2 5例 ,15岁以上 9例。 34例均无免疫史。临床表现为臀部注射部位无痛性寒性脓肿、结节、溃疡并伴有腹股沟、颈部、耳后、颌下淋巴结肿大。其中 2 6例行脓肿切开引流、清创换药 ,但局部伤口长期不愈。溃疡分泌物涂片抗酸染色查到抗酸杆菌 ;细菌培养查到聚团杆菌 ;霉…     

婴幼儿接种卡介苗后30例淋巴结异常反应分析

目的分析婴幼儿接种卡介苗（BCG）后淋巴结异常反应的原因与处理方法。方法对2004年1月-2010年9月间武汉市医疗救治中心收治的30例接种BCG后淋巴结异常反应的患儿临床资料进行回顾性分析。30例患儿均于接种BCG3-6个月后接种侧腋下及锁骨上淋巴结肿大,胸片与血沉正常,PPD试验（＋）,均无全身结核中毒症状。结果 20例淋巴结直径≤4 cm的患儿仅给予异烟肼口服或加环形封闭治疗2-3个月痊愈;另3例淋巴结〉4 cm者行手术摘除。5例淋巴结化脓者在口服异烟肼治疗的同时,行穿刺抽脓、冲洗及并注入链霉素和异烟肼治疗,3-4周均痊愈。另2例有破溃者经切开排脓,冲洗、使用蘸有利福平粉的凡士林纱条引流及5%异烟肼软膏外敷治疗后痊愈。结论提高接种BCG的技术、接种质量和恰当处理BCG接种后的淋巴结异常反应,是预防与降低BCG接种后淋巴结异常反应发生率的关键措施。     

猫爪草胶囊治疗婴儿接种卡介苗后腋窝淋巴结反应的临床观察

目的探讨猫爪草胶囊治疗婴儿接种卡介苗后腋窝淋巴结反应的疗效。方法将80例患儿随机分为两组,对照组常规应用异烟肼抗结核治疗,治疗组在常规治疗的基础上加用猫爪草胶囊。结果治疗组的临床治愈例数明显高于对照组,治疗2个月治疗组和对照组的治愈率分别达72.5%和40.0%,两组比较,差异有非常显著性(χ2=8.58,P<0.01),治疗组疗程亦明显缩短。结论猫爪草加用异烟肼治疗婴儿接种卡介苗后腋窝淋巴结反应,有明显缩短疗程、提高疗效的作用,且没有毒副作用。     

鼻咽癌患者医院感染的细针抽吸细胞学诊断研究

目的探讨鼻咽癌患者医院感染的细针抽吸细胞学(FNAC)诊断特点. 方法对 280例住院治疗的鼻咽癌患者进行细针抽吸细胞学检查. 结果脓肿17例,占6.1%;淋巴结炎70例,占25.0%;转移癌 155例,占55.4%;转移癌伴感染38例,占13.6%;有炎症症状的,部分合并有癌转移,无炎症症状的,部分为炎症,部分为转移癌,两者有交叉;FNAC诊断鼻咽癌医院感染率为7.5%. 结论鼻咽癌患者是医院感染的高危人群,不能根据有无炎症表现来诊断医院感染;FNAC检查是诊断鼻咽癌患者医院感染快速准确的方法.     

不同等级2所医院新生儿卡介苗接种效果及影响因素研究

目的了解常州市不同等级的2所医院新生儿卡介苗接种效果及其影响因素,为提高接种质量和人群免疫水平提供依据.方法 选择1个市级医院,1个县级医院作为哨点,监测2013年1~12月不同批次菌苗对符合条件新生儿的接种情况,3个月后进行结核菌素试验试验(PPD),观察硬结纵横径和直径,评价接种效果;采用Logistic回归模型,对接种效果进行多因素回归分析. 结果共接种卡介苗新生儿2254例,接种成功2090人,接种成功率92.7%.单因素分析显示,不同单位,季节,疫苗批次卡介苗接种成功率差异有统计学意义(P<0.05);金坛市人民医院接种成功率为95.15%,明显大于市妇幼保健院90.17%,差异有统计学意义(P < 0.05); 经组间比较,秋季接种成功率明显高于冬季(χ²=14.080, P = 0.000).疫苗批号201003a015-1接种成功率明显低于其他各批号,批号201003a012-2接种成功率明显低于批号201101a004-1和201012a083-2,差异均有统计学意义(均P = 0.000).多因素logistic回归分析,疫苗批号(OR=1.754,95%CI:1.477~2.084)是卡介苗接种成功的影响因素. 结论常州市市县不同等级医院新生儿卡介苗接种成功率均较高,疫苗不同批次是影响接种成功的影响因素.     

Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa

OBJECTIVE: To evaluate the safety of the intradermal Copenhagen BCG vaccine in neonates at different levels of delivery and neonatal units of the Durban Functional Region and surrounding regions. METHODS: A prospective study was carried out over a two-year period between July 1997 and June 1999. All neonates who had been vaccinated with the intradermal vaccine were evaluated at immunization clinics six weeks after immunization, or earlier if adverse effects occurred. FINDINGS: In total, 9763 neonates were examined: in 95.4% the vaccination scar had healed and 1.5% had no visible scar. Adverse events occurred in 3.1%. The proportion of neonates with no visible vaccination scars decreased over the study period, as did the number with adverse events. The lowest rate of adverse events and the highest rates of healed vaccination scars were seen in the tertiary hospital and regional and district hospitals that were in close proximity to the academic centre involved in this study. CONCLUSIONS: In the study sites, the transition from the percutaneous to intradermal route of administration of BCG vaccine was successful and took place without incurring unacceptably high rates of adverse events. To minimize adverse events, however, it is essential to continue training health personnel involved in implementing intradermal BCG vaccination programmes.     

Vaccination of white-tailed deer (Odocoileus virginianus) with Mycobacterium bovis bacillus Calmette Guerín

Wildlife reservoirs of Mycobacterium bovis represent serious obstacles to the eradication of tuberculosis in domestic livestock. In Michigan, USA tuberculous white-tailed deer transmit M. bovis to cattle. One approach in dealing with this wildlife reservoir is to vaccinate deer in order to interrupt the cycle of deer to deer and deer to cattle transmission. Thirty-one white-tailed deer were assigned to one of three groups; 2 SC doses of 10(7)CFU of M. bovis BCG (n=11); 1 SC dose of 10(7)CFU of M. bovis BCG (n=10); or unvaccinated deer (n=10). After vaccination, deer were inoculated intratonsilarly with 300 CFU of virulent M. bovis. Gross lesion severity scores of the medial retropharyngeal lymph node were significantly reduced in deer receiving 2 doses of BCG compared to unvaccinated deer. Vaccinated deer had fewer lymph node granulomas than unvaccinated deer, and most notably, fewer late stage granulomas characterized by coalescent caseonecrotic granulomas containing numerous acid-fast bacilli. BCG was isolated from 7/21 vaccinated deer as long as 249 days after vaccination. In one case BCG was transmitted from a vaccinated deer to an unvaccinated deer. In white-tailed deer BCG provides measurable protection against challenge with virulent M. bovis. However, persistence of vaccine within tissues as well as shedding of BCG from vaccinates remain areas for further investigation.     

Safety and reactogenicity of BCG revaccination with isoniazid pretreatment in TST positive adults

Rationale

Global tuberculosis (TB) control may require mass vaccination with a new TB vaccine, such as a recombinant bacille Calmette Guerin (BCG) or attenuated Mycobacterium tuberculosis (MTB). The safety profile of live mycobacterial vaccines in latently infected adults with prior infant BCG vaccination is unknown.

Objectives

Evaluate safety and reactogenicity of BCG revaccination, with or without isoniazid (INH) pretreatment, in adults with latent MTB infection (LTBI).

Methods

Eighty-two healthy, HIV uninfected, South African adults, with a BCG scar and tuberculin skin test (TST) diameter ≥15 mm, were randomized to receive 6 months of INH, starting either before, or 6 months after, intradermal revaccination with BCG Vaccine SSI (Statens Serum Institut, Copenhagen). Safety and reactogenicity data are reported through 3 months post BCG revaccination.

Results

Baseline characteristics were similar between treatment arms. Mean baseline TST diameter was 20 ± 4 mm. Seventy-two subjects received BCG revaccination. Injection site erythema (68%) and induration (86%) peaked 1 week after revaccination. Ulceration (76%) peaked at 2 weeks, and resolved by 3 months in all but 3 subjects. Diameter of ulceration was >10 mm in only 8%, but a residual scar was common (85%). No regional lymphadenitis or serious morbidity related to BCG was seen. Reactogenicity was not affected by INH pretreatment.

Conclusion

BCG revaccination of MTB infected adults is safe, well tolerated, and reactogenicity is similar to that of primary BCG vaccination. Clinical trials of live recombinant BCG or attenuated MTB vaccines may be considered in latently infected adults, with or without INH pretreatment (ClinicalTrials.gov identifier: NCT01119521).     

Loss of anti-mycobacterial efficacy in mice over time following vaccination with Mycobacterium bovis bacillus Calmette-Guérin

Mycobacterium bovis bacillus Calmette-Guérin (BCG) is the most often used vaccine worldwide and sole vaccine against tuberculosis. BCG is protective against severe form of childhood tuberculosis but less or not protective to adult pulmonary tuberculosis. Therefore, improved vaccination strategies and development of new tuberculosis vaccines are urgent demands. For those purposes, appropriate animal models that reflect human are critically useful. However, in animal models, BCG vaccination protects well against subsequent challenge of Mycobacterium tuberculosis. In this study we evaluated the duration of protective efficacy of the BCG vaccination in mice over time and found that efficacy was diminished 40 weeks after vaccination. The aged mice older than 45 weeks are protected sufficiently after the vaccination with BCG, suggesting that loss of its efficacy is not dependent on the age of mice but rather depends on the period from vaccination. The loss of protection occurred in TH1 polarized STAT6 deficient mice despite the maintenance of interferon (IFN)-gamma production activity of lymph node cells and splenic CD4⁺ T cells against M. tuberculosis antigens. Our data suggest that the duration from vaccination may explain the variation in BCG efficacy against adult pulmonary tuberculosis.     

Tuberculous meningitis in children at Zaria, Nigeria:A review of 16 cases

Sixteen children with tuberculous meningitis seen in Zaria between January 1978 and December 1984 were studied. There was absence of neck rigidity in 11 of the 16 cases. Five of 9 patients who had chest X-ray done had either hilar and/or paratracheal lymph node enlargement, while one had miliary spread in the lungs. None of the patients had been vaccinated with BCG in infancy. The overall mortality was 75%. Extension of BCG vaccination of children beyond infancy to include all children aged 4 years and less may further reduce the frequency of tuberculous meningitis in this community.     

Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 2008 and 2009. A report of the Australian Mycobacterium Reference Laboratory Network

There were 886 and 1,062 bacteriologically-confirmed cases of tuberculosis (TB) in 2008 and 2009, representing an annual rate of 4.1 and 4.9 cases per 100,000 population respectively. Over the 2 years, a total of 23 children aged under 10 years (male n = 13, female n = 10) had bacteriologically confirmed tuberculosis, including 3 children with TB meningitis. Results of in vitro drug susceptibility testing were available for 885 of 886 and 1,060 of 1,062 isolates for isoniazid (INH), rifampicin (RIF), ethambutol (EMB), and pyrazinamide (PYZ) in 2008 and 2009 respectively. In 2008, a total of 94 (10.7%) isolates of Mycobacterium tuberculosis complex were resistant to at least one of the anti-tuberculosis agents. Any resistance to INH was noted for 76 (8.7%), 23 (2.6%) for RIF, 10 (1.1%) for EMB and 9 (1.0%) for PYZ. Resistance to at least INH and RIF (defined as multidrug-resistant TB (MDR-TB) was detected in 21 (2.4%) isolates. None of the 21 MDR-TB isolates had resistance to either ofloxacin or the injectable agents. In 2009, a total of 168 (15.9%) were resistant to at least one of the anti-TB agents. Any resistance to INH was noted for 150 (14.2%) isolates, 37 (3.5%) for RIF, 5 (0.5%) for EMB and 13 (1.2%) for PYZ. A total of 31 (2.9%) isolates were MDR-TB. In 2009, there were 2 cases of quinolone resistance in MDR-TB from persons born overseas. Mono-resistance to INH was the most commonly detected resistance with 33 and 80 isolates in 2008 and 2009, respectively. Mono-resistance to RIF was infrequently encountered with 2 and 5 isolates in 2008 and 2009 respectively. There were six and 11 MDR-TB patients from the Papua New Guinea (PNG) - Torres Strait Islands (TSI) cross-border region in 2008 and 2009 respectively. The PNG-TSI zone now contributes a substantial proportion of MDR-TB cases to the database. In addition, there were 24 isolates of Mycobacterium bovis bacille Calmette Guérin (BCG), 15 were cultured from males (4 aged < or = 5 years) and from 9 females (5 aged < or = 5 years). The predominant site of isolation was from vaccination abscess. Eight males (range: 57-87 years) had M. bovis BCG isolated from urine or blood culture.