Tuberculosis as a Complication of BCG in the Treatment of Bladder Carcinoma Tuberculosis as a Complication of BCG in the Treatment of Bladder Carcinoma
Main Article Content
Keywords
BCG, Extra-pulmonary Tuberculosis, Miliary TB, Bladder carcinoma
Abstract
Bacillus Calmette-Guérin (BCG), is a live attenuated strain of Mycobacterium bovis, and is the essential constituent of the vaccine against tuberculosis (TB) and adjuvant treatment for bladder cancer. This vaccine has a potential pathogenic action; bacilli can cause recorded complications that can be located locally near the site of inoculation and at a distance through blood dissemination root. The BCG-related disease can represent a side effect of anti-TB vaccination in patients with acquired or congenital immunodeficiency or a complication of the therapeutic oncologic schedule in patients with malignancy. Here in we report three cases of BCG-related disease which visited our national tuberculosis Iraqi center in 2022, two of those with locally developed TB and the third presented with disseminated miliary TB.
References
1. World Health Organization.Global tuberculosis report 2022 [Internet]. 2022 [cited 2022December].
2. Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, et al. Urinary tuberculosis: A cohort of 79 adult cases. Renal failure. 2015 Aug 9;37(7):1157–1163. Available from : https://doi.org/10.3109/0886022X.2015.1057460
3. Jayarajah U, Gunawardene M, Willaraarachchi M, Chandrasiri S, Udayakumaran P, Sosai C, et al. Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: An observational study. BMC Infectious Diseases. 2021 Dec 5;21(1):1–9. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
4. Molloy H, Noonan R, Gorsuch T, Brij SO. P10 Miliary tuberculosis: A retrospective review of cases presentedto a UK teaching hospital [Internet]. 2041 MAY 3; Volume 77(1):5-13. Available from : http://dx.doi.org/10.1136/thorax-2022-BTSabstracts.146
5. Colomba C, Rubino R, Mantia G, Guida Marascia F, Abbott M, Gizzi A, Anastasia A, Palermo G, Cascio A. Clinical use of BCG and its complications: a case series. Infez Med. 2021 Mar 1;29(1):123-129.[cited December 2022].
6. Gagneux S, editor. Strain variation in the Mycobacterium tuberculosis complex: Its role in biology, epidemiology, and control. Springer. 2017 Nov 6 .
7. Kulchavenya E, Naber K, Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. European Urology Supplements. 2016 Jul 1;15(4):112–121. Available from : https://doi.org/10.1016/j.eursup.2016.04.001
8. Sadeghi-Shanbestari M, Ansarin K, Maljaei SH, Rafeey M, Pezeshki Z, Baradaran R, et al. Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran. Italian Journal of Pediatrics. 2009 Dec;35(1):1–5.
9. Al Mousa H. An infant with disseminated bacillus Calmette- Guérin infection (BCGitis). Intern J Ped Adolesc Med. 2014; 1(2):89–92. Available from : https://doi.org/10.1016/j.ijpam.2014.11.005
10. Pettenati C, Ingersoll MA. Mechanisms of BCG immunotherapy and its outlook for bladder cancer. Nature Reviews Urology. 2018 Oct;15(10):615–625.
11. Larsen ES, Joensen UN, Poulsen AM, Goletti D, Johansen IS. Bacillus Calmette–Guerin immunotherapy for bladder cancer: A review of immunological aspects, clinical effects and BCG infections. Apmis. 2020 Feb 4;128(2):92–103. Available from :
12. https://doi.org/10.1111/apm.13011
13. Nadasy KA, Patel RS, Emmett M, Murillo RA, Tribble MA, Black RD, et al. Four cases of disseminated Mycobacterium bovis infection following intravesical BCG instillation for treatment of bladder carcinoma. Southern medical journal. 2008 Jan1;101(1):91–95. Available from : 10.1097/smj.0b013e31815d4047
14. Colomba C, Di Carlo P, Guadagnino G, Siracusa L, Trizzino M, Gioè C, et al. A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection. Infectious Agents and Cancer. 2016 Dec 5;11(1):1–3. Available from : https://doi.org/10.1186/s13027-016-0072-y
15. Paterson DL, Patel A. Bacillus Calmette‐Guérin (BCG) immunotherapy for bladder cancer: review of complications and their treatment. Australian and New Zealand Journal of Surgery. 1998 May 8;68(5):340–344. Available from : https://doi.org/10.1111/j.14452197.1998.tb04768.x
16. Lamm DL. Efficacy and safety of bacille Calmette-Guerin immunotherapy in superficial bladder. 2000sep6;31(3):86-90 [cited January 2023]. Available from: https://doi.org/10.1086/314064
17. Grimm, M.O., van der Heijden, A.G., Colombel, M., Muilwijk, T., Martínez-Piñeiro, L., Babjuk, M.M., et al. 2020. Treatment of high-grade non–muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: Results of the European Association of Urology Research Foundation randomised phase III clinical trial“NIMBUS”. EuropeanUrology. 78(5):690–698. Available from : https://doi.org/10.1016/j.eururo.2020.04.066
18. Madentzoglou MS, Nathena D, Sinatkas V, Michalodimitrakis M, Kranioti EF. Lethal BCG-osis, in the context of superficial urothelial bladder carcinoma, diagnosed in autopsy. Egyptian Journal of Forensic Sciences. 2016 Sep 1;6(3):284–288. Available from : https://doi.org/10.1016/j.ejfs.2015.07.007
19. World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. World Health Organization; 2020 Apr 7. [cited April 2023].
20. Gideon HP, Flynn JL. Latent tuberculosis: What the host “sees”?.Immunologic research.2011Aug5;50(2):202–212.Available from : https://doi.org/10.1007/s12026-011-8229-7
21. Sharma SK, Mohanan S, Sharma A. Relevance of latent TB infection in areas of high TB prevalence. Chest. 2012 Sep 1;142(3):761–773. Available from : https://doi.org/10.1378/chest.12-0142
22. Tuberculosis preventive treatment Guideline/NTP/Iraq first edition 2021.
23. WHO. WHO consolidated guideline on tuberculosis.Module1;prevention,Tuberculosis preventive treatment [Internet].2020 [cited February 2023].
24. Fuge O, Vasdev N, Allchorne P, Green JS. Immunotherapy for bladder cancer. Research and reports in urology. 2015 May 4:65–79.
25. Prescott S, Jackson AM, Hawkyard SJ, Alexandroff AB, James K. Mechanisms of action of intravesical bacille Calmette-Guerin: Local immune mechanisms. Clinical infectious diseases. 2000 Sep 1;31(3):S91–93. Available from : https://doi.org/10.1086/314066
26. Nurminen P, Ettala O, Uusitalo‐Seppälä R, Högerman M, Kaipia A, Boström PJ. Clinical presentation of bacille Calmette–Guérin (BCG) infections after BCG instillation therapy. BJU international. 2022 Aug 13;131(3) , Cited January 2023. Available from : https://doi.org/10.1111/bju.15870
27. Liu Y, Lu J, Huang Y, Ma L. Clinical spectrum of complications induced by intravesical immunotherapy of Bacillus Calmette-Guérin for bladder cancer. Journal of Oncology. 2019 Mar 10;. Available from: https://doi.org/10.1155/2019/6230409
28. Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido Á, San Juan R, et al. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: Incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine. 2014 Oct 5;93(17) 236-254.Available from : 10.1097/MD.0000000000000119
29. Alcorn J, Burton R, Topping A. BCG treatment for bladder cancer, from past to present use. International Journal of Urological
2. Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, et al. Urinary tuberculosis: A cohort of 79 adult cases. Renal failure. 2015 Aug 9;37(7):1157–1163. Available from : https://doi.org/10.3109/0886022X.2015.1057460
3. Jayarajah U, Gunawardene M, Willaraarachchi M, Chandrasiri S, Udayakumaran P, Sosai C, et al. Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: An observational study. BMC Infectious Diseases. 2021 Dec 5;21(1):1–9. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
4. Molloy H, Noonan R, Gorsuch T, Brij SO. P10 Miliary tuberculosis: A retrospective review of cases presentedto a UK teaching hospital [Internet]. 2041 MAY 3; Volume 77(1):5-13. Available from : http://dx.doi.org/10.1136/thorax-2022-BTSabstracts.146
5. Colomba C, Rubino R, Mantia G, Guida Marascia F, Abbott M, Gizzi A, Anastasia A, Palermo G, Cascio A. Clinical use of BCG and its complications: a case series. Infez Med. 2021 Mar 1;29(1):123-129.[cited December 2022].
6. Gagneux S, editor. Strain variation in the Mycobacterium tuberculosis complex: Its role in biology, epidemiology, and control. Springer. 2017 Nov 6 .
7. Kulchavenya E, Naber K, Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. European Urology Supplements. 2016 Jul 1;15(4):112–121. Available from : https://doi.org/10.1016/j.eursup.2016.04.001
8. Sadeghi-Shanbestari M, Ansarin K, Maljaei SH, Rafeey M, Pezeshki Z, Baradaran R, et al. Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran. Italian Journal of Pediatrics. 2009 Dec;35(1):1–5.
9. Al Mousa H. An infant with disseminated bacillus Calmette- Guérin infection (BCGitis). Intern J Ped Adolesc Med. 2014; 1(2):89–92. Available from : https://doi.org/10.1016/j.ijpam.2014.11.005
10. Pettenati C, Ingersoll MA. Mechanisms of BCG immunotherapy and its outlook for bladder cancer. Nature Reviews Urology. 2018 Oct;15(10):615–625.
11. Larsen ES, Joensen UN, Poulsen AM, Goletti D, Johansen IS. Bacillus Calmette–Guerin immunotherapy for bladder cancer: A review of immunological aspects, clinical effects and BCG infections. Apmis. 2020 Feb 4;128(2):92–103. Available from :
12. https://doi.org/10.1111/apm.13011
13. Nadasy KA, Patel RS, Emmett M, Murillo RA, Tribble MA, Black RD, et al. Four cases of disseminated Mycobacterium bovis infection following intravesical BCG instillation for treatment of bladder carcinoma. Southern medical journal. 2008 Jan1;101(1):91–95. Available from : 10.1097/smj.0b013e31815d4047
14. Colomba C, Di Carlo P, Guadagnino G, Siracusa L, Trizzino M, Gioè C, et al. A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection. Infectious Agents and Cancer. 2016 Dec 5;11(1):1–3. Available from : https://doi.org/10.1186/s13027-016-0072-y
15. Paterson DL, Patel A. Bacillus Calmette‐Guérin (BCG) immunotherapy for bladder cancer: review of complications and their treatment. Australian and New Zealand Journal of Surgery. 1998 May 8;68(5):340–344. Available from : https://doi.org/10.1111/j.14452197.1998.tb04768.x
16. Lamm DL. Efficacy and safety of bacille Calmette-Guerin immunotherapy in superficial bladder. 2000sep6;31(3):86-90 [cited January 2023]. Available from: https://doi.org/10.1086/314064
17. Grimm, M.O., van der Heijden, A.G., Colombel, M., Muilwijk, T., Martínez-Piñeiro, L., Babjuk, M.M., et al. 2020. Treatment of high-grade non–muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: Results of the European Association of Urology Research Foundation randomised phase III clinical trial“NIMBUS”. EuropeanUrology. 78(5):690–698. Available from : https://doi.org/10.1016/j.eururo.2020.04.066
18. Madentzoglou MS, Nathena D, Sinatkas V, Michalodimitrakis M, Kranioti EF. Lethal BCG-osis, in the context of superficial urothelial bladder carcinoma, diagnosed in autopsy. Egyptian Journal of Forensic Sciences. 2016 Sep 1;6(3):284–288. Available from : https://doi.org/10.1016/j.ejfs.2015.07.007
19. World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. World Health Organization; 2020 Apr 7. [cited April 2023].
20. Gideon HP, Flynn JL. Latent tuberculosis: What the host “sees”?.Immunologic research.2011Aug5;50(2):202–212.Available from : https://doi.org/10.1007/s12026-011-8229-7
21. Sharma SK, Mohanan S, Sharma A. Relevance of latent TB infection in areas of high TB prevalence. Chest. 2012 Sep 1;142(3):761–773. Available from : https://doi.org/10.1378/chest.12-0142
22. Tuberculosis preventive treatment Guideline/NTP/Iraq first edition 2021.
23. WHO. WHO consolidated guideline on tuberculosis.Module1;prevention,Tuberculosis preventive treatment [Internet].2020 [cited February 2023].
24. Fuge O, Vasdev N, Allchorne P, Green JS. Immunotherapy for bladder cancer. Research and reports in urology. 2015 May 4:65–79.
25. Prescott S, Jackson AM, Hawkyard SJ, Alexandroff AB, James K. Mechanisms of action of intravesical bacille Calmette-Guerin: Local immune mechanisms. Clinical infectious diseases. 2000 Sep 1;31(3):S91–93. Available from : https://doi.org/10.1086/314066
26. Nurminen P, Ettala O, Uusitalo‐Seppälä R, Högerman M, Kaipia A, Boström PJ. Clinical presentation of bacille Calmette–Guérin (BCG) infections after BCG instillation therapy. BJU international. 2022 Aug 13;131(3) , Cited January 2023. Available from : https://doi.org/10.1111/bju.15870
27. Liu Y, Lu J, Huang Y, Ma L. Clinical spectrum of complications induced by intravesical immunotherapy of Bacillus Calmette-Guérin for bladder cancer. Journal of Oncology. 2019 Mar 10;. Available from: https://doi.org/10.1155/2019/6230409
28. Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido Á, San Juan R, et al. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: Incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine. 2014 Oct 5;93(17) 236-254.Available from : 10.1097/MD.0000000000000119
29. Alcorn J, Burton R, Topping A. BCG treatment for bladder cancer, from past to present use. International Journal of Urological
Article Sidebar
Published
Jul 15, 2023
Article Details
How to Cite
1.
Tuberculosis as a Complication of BCG in the Treatment of Bladder Carcinoma: Tuberculosis as a Complication of BCG in the Treatment of Bladder Carcinoma. Iraqi Natl J Med [Internet]. 2023 Jul. 15 [cited 2024 Dec. 12];5(2):24-8. Available from: https://iqnjm.com/index.php/homepage/article/view/124
Issue
Section
Original Articles
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.