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Fifteen-minute consultation: Bacillus Calmette–Guérin abscess and lymphadenitis
  1. Andrew Riordan1,
  2. Theresa Cole1,
  3. Claire Broomfield2
  1. 1Department of Paediatric Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  2. 2Infectious Diseases and Immunology, Bristol Royal Hospital for Sick Children, Bristol, UK
  1. Correspondence to Dr A Riordan, Dept of Paediatric Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK; andrew.riordan{at}alderhey.nhs.uk

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Bacillus Calmette–Guérin (BCG) vaccine contains a live attenuated strain of Mycobacterium bovis, which provides 64% efficacy against tuberculous meningitis and 78% efficacy against disseminated tuberculosis.1 A number of local adverse reactions are recognised (abscess, suppurative lymphadentitis, keloid formation). An increased number of local complications were reported in the UK and Ireland since the introduction of a new BCG strain in 2002.2 ,3 It is important to distinguish between a normal vaccine response, a local complication and the very rare cases of systemic BCG infection that occur with immunodeficiency. Antibiotics and/or anti-tuberculous medication are rarely needed, except for systemic BCG infection.

Natural history of BCG site

After intradermal injection, BCG multiplies at the inoculation site, then spreads to regional nodes. A normal reaction is a red indurated area, which progresses to a local lesion that may ulcerate 2–3 weeks after vaccination. A crust is formed around this induration for 3–4 weeks. At 6–10 weeks, the crust falls off, leaving a flat 3 to 7 mm scar. Regional lymphadenopathy <1 cm (95% in the axilla) is considered a normal reaction to the vaccine.4 This ‘simple’ lymphadenitis occurs 63 days (range 16–87) after BCG vaccination5 and resolves spontaneously by 9 months.6 Lymphadenitis may be more common when BCG is given to infants <6 months old compared with older children and adults.5

Complications of BCG

Local complications occur in one in a thousand people given BCG vaccine.3 ,7

Injection site abscess

A local abscess (>1 cm in diameter) can develop at the injection site, 30 days (range 4–65) after BCG vaccination.5 Abscess formation is less common when BCG is given to infants less than 6 months old compared with older children and adults. However, abscesses are more likely in infants aged less than 6 months old immunised by …

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