• Zafar Nazir
  • Saqib Hamid Qazi


Background: Bacillus Calmette-Guérin (BCG) vaccination is performed as a part of expandedProgramme of Immunization (EPI). Suppurative lymphadenitis is the common complication of BCGvaccination. The optimum treatment for this complication is debated. Methods: All cases of BCGlymphadenitis presenting to pediatric surgical service over a 17-year study period were reviewed todetermine the optimum treatment for this problem. Results: Sixty children were referred for themanagement of BCG lymphadenitis during the study period. Most patients (n=43) presented during1988 and 1990. Children were healthy and received BCG (Pasteur strain) vaccination at EPI duringfirst 2 months of life. Initially all the patients received medical treatment with anti-tuberculous drugsfor one to nine months. Fifty-two children who presented with large (~ 3cm) fluctuant lymph nodes,required a surgical procedure to avoid spontaneous rapture and sinus formation (Group A), whereasmedical treatment was effective in five out of eight patients presenting with small (~1 cm) nodes(Group B). Conclusions: Medical treatment with antituberculous drugs is not effective to treat BCGlymphadenitis, when the involved lymph nodes are around 3.0 cm and have developed fluctuation andinflammation of over lying skin.Keywords: Vaccination, BCG vaccine, Lymph node, Lymphadenitis


Milstien JB, Gibson JJ. Quality control of BCG vaccine by

WHO: a review of factors that may influence vaccine

effectiveness and safety. Bulletin of the World Health

organization 1990; 68:93-108.

Bannon MJ. BCG and tuberculosis. Arch Dis Child 1999; 80:


Karnak I, Senocak ME, Buyukpamukcu N, Gocmen A. Is BCG

vaccine innocent? Pediatr Surg Int 1997; 12: 220-223.

Sadeghi E, Kumar PV. Eczema vaccinatum and post BCG

adenitis. Tubercle 1990; 71:145-6.

Peltola H, Salmi I, Vahvanen V. BCG vaccination as a cause of

osteomyelitis and subcutaneous abscess. Arch Dis Child 1984;


Kroger L, Brander E, Korppi M, Wasz-Hockert O, Backman A,

Kroger H et al. Osteitis after newborn vaccination with three

different Bacillus Calmette- Guerin vaccines: twenty-nine years

of experience. Pediatr Infect Dis J 1994;12:113-6.

Aggarwal NP, Kallan BM, Grover PS, Aggarwal M. ClinicoExcisional study of lymphadenitis following BCG vaccination.

Indian J Pediatr 1990;57:585-6.

Merry C, Fitzgerald RJ. Regional lymphadenitis following BCG

vaccination. Pediatr Surg Int 1996;11:269-71.

Praveen KN, Smikle MF, Prabhakar P, Pande D, Johnson B,

Ashley D. Outbreak of Bacillus Calmette-Guerin Associated

lymphadenitis and abscesses in Jamaican children. Pediatr Infect

Dis J 1990;9:890-3.

Hengster P, Solder B, Fille M, Menardi G. Surgical treatment

of Bacillus Calmette Guerin Lymphadenitis. World J Surg 1997;


Hengster P, Schnapka J, Fille M, Menardi G. Occurrence of

suppurative lymphadenitis after a change of BCG vaccine. Arch

Dis Child 1992;67:952-5.

Close GC, Nasiiro R. Management of BCG adenitis in infancy.

J Trop Pediatr 1985;31:286-9.

Murphy PM, Mayers DL, Brock NF, Wagner KF. Cure of

Bacilli Calmette - Guerin vaccination abscess with

erythromycin. Rev Infect Dis 1989; 11:335-7.

Hanley SP, Gumb J, Macfarlane JT. Comparison of

Erythromycin and Isoniazid in treatment of adverse reaction to

BCG vaccination. Br Med J 1985; 290:970-3.

Caglayan S, Yegin O, Kayran K, Timocin N, Kasirga, Gun M.

Is medical therapy effective for regional lymphadenitis

following BCG vaccination? AJDC 1987; 141:1213-4.

Caglayan S, Arikan A, Yaprak I, Aksoz K, Kansoy S.

Management of suppuration in regional lymph nodes secondary

to BCG vaccination. Acta Paediatr Jpn 1991; 33: 699-702.

Banani SA, Alborzi A. Needle aspiration for suppurative postBCG adenitis. Arch Dis child 1994; 71: 446-7.

Rafi S, Ahmed A, Ramazan M, Billo AG. BCG lymphadenitis:

A study of knowledge, attitude and practice of mothers

including effect on completion vaccination schedule. J Coll

Physicians Surg Pakistan 1994; 4: 80-2.