TY - JOUR T1 - Fifteen-minute consultation: Bacillus Calmette–Guérin abscess and lymphadenitis JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 87 LP - 89 DO - 10.1136/archdischild-2013-304457 VL - 99 IS - 3 AU - Andrew Riordan AU - Theresa Cole AU - Claire Broomfield Y1 - 2014/06/01 UR - http://ep.bmj.com/content/99/3/87.abstract N2 - 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. 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 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 … ER -