Systemic BCG reactions after intravesical BCG therapy. A report of four cases

Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. We report four cases of systemic BCG reaction. Although uncommon, this infectious complication of BCG therapy should always be considered in the appropriate clinical setting. The best approach to minimize this complication is a strict compliance with precautions and a close and rigorous surveillance of this drug.     

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.     

Improving the selective neonatal BCG program

OBJECTIVES: The aim of the work was to develop and implement an improved selective neonatal Bacille-Calmette-Guerin (BCG) vaccine program in which neonates are systematically assessed, and those identified as at "high risk of being exposed to tuberculosis" are given neonatal BCG. DESIGN: Service models used in other parts of the country were assessed and their limitations and difficulties were carefully considered. Possible service models for local use were then considered. A selective neonatal BCG program involving universal neonatal screening was implemented. SAMPLE: A program was implemented offering BCG to high-risk neonates. RESULTS: As has been the case with other health trusts, developing a new neonatal BCG service met with obstacles and hurdles. Means of overcoming some of the difficulties are presented. Preliminary findings regarding the service model, including neonatal BCG uptake rates, were positive. CONCLUSION: A successful neonatal BCG program was implemented.     

Intralesional immunotherapy of melanoma with BCG.

Treatment of recurrent cutaneous melanoma nodules with BCG is an effective and relatively nonmorbid method for eliminating these tumor nodules. Injected nodules can be made to disappear about 90 per cent of the time and in about 20 per cent of patients non-injected nodules in the same drainage area may also regress. Subcutaneous melanoma nodules are far more resistant to melanoma injection. Although cutaneous nodules can be made to regress there is no evidence that a systemic effect against disseminated melanoma exists and no responses of distant visceral disease have been seen following intralesional therapy of cutaneous nodules. The regression of cutaneous nodules following BCG injection appears to be an immunologic phenomenon and is related to the immunocompetence of the patient. The molecular mechanisms of this tumor regression are unknown and are the subject of intensive study. Several new approaches such as the use of BCG for the treatment of poor prognosis primary malignant melanomas, as well as the use of nonviable, nonbacteriologic agents for intralesional treatment are under investigation.