Quality control of BCG vaccine by WHO: a review of factors that may influence vaccine effectiveness and safety

WHO oversees the quality control of BCG vaccine via a system that includes regular testing of products by in vitro methods and clinical trials. Three parent strains of BCG (Glaxo-1077, Tokyo-172, and Pasteur-1173P2) account for over 90% of the vaccines currently in use worldwide. Important characteristics of the vaccine preparations are summarized here, along with their physical-chemical properties. In instances where diagnostic criteria for tuberculosis are stringent, there is no evidence that when administered to newborns different preparations of BCG vaccine exhibit different efficacies; however, the incidence of BCG-associated adverse reactions does correlate with the type of preparation. Other factors, including dose, administration technique, and recipient characteristics are also important in determining vaccine-associated reactions.

In vivo administration of interleukin 1 elicits increased Ia antigen expression on B cells through the induction of interleukin 4

The effects of the in vivo administration of interleukin 1 (IL 1) on lymphocytes from lymph node and spleen were analyzed. Mice received five daily subcutaneous (s.c.) injections of various doses of human recombinant IL 1 beta. Either 1 or 7 days after IL 1 treatment, spleens, popliteal and inguinal lymph nodes were collected. Lymphadenosis and splenomegaly were observed in the IL 1-treated animals. Lymph nodes from IL 1-treated mice contained a higher percentage of B cells than controls, and B cells from IL 1-treated mice expressed dramatically increased levels of Ia antigen. Lymphadenosis and splenomegaly, as well as the changes in subset distributions and Ia expression were transient. Concomitant treatment of mice with IL 1 and anti-IL 4 monoclonal antibody suppressed IL 1 effects on B cell Ia expression, but not on the B/T cell ratio. In situ hybridization analyses revealed that IL 1 treatment induced the expression of mRNA for IL 4, interferon-gamma, and IL 2 in lymph node and spleen cells. The distribution of cells expressing the various cytokine mRNA was markedly different between the spleens and lymph nodes.

[Dermatopathic lymphadenopathy caused by amalgam allergy. A case report]

A case of a dermatopathic lymphadenopathia is introduced where by we show that this disease can be released without a dermatosis, but only by a disease of the mucous membrane of the mouth. The macroscopic alterations can be very small as described in our case although there is a distinct sensitisation to mercury as allergen.

[Rare side effects of gold]

Rare side-effects of parenterally administered gold salts in rheumatoid arthritis are reported: metallic gold deposition in the teeth; reversible lymphadenopathies of the neck; IgA loss under gold treatment; gold-induced appearance of ANA and DNA-antibodies and gold deposition in the skin.

Limitations of clofazimine in the treatment of lepra reactions

Eight out of 30 cases of Borderline Lepromatous and Lepromatous Leprosy suffering with chronic recurrent lepra reactions failed to respond to clofazimine therapy. Three of the eight were steroid dependent. All the eight patients are doing well after weaning off the clofazimine. Lymphadenitis in post clofazimine reactional status was presenting feature in present retrospective study.

Side effects of systemic cyclosporine in patients not undergoing transplantation

Twenty-six patients with ocular inflammatory disorders of presumed autoimmune origin were treated with oral cyclosporine. Cyclosporine is a potent T cell regulatory agent that has been utilized extensively in organ transplantation. In general, the patients in this study did not have chronic debilitating illnesses that are observed in organ transplant recipients, did not receive corticosteroids in addition to cyclosporine, and did not undergo any surgical procedure during their treatment. This study describes the observed adverse reactions in this group of patients not undergoing transplantation. The reported side effects of cyclosporine in organ transplant recipients have included nephrotoxicity, hepatotoxicity, infections, lymphoma, hirsutism, gingivitis, and central nervous system toxicity. Side effects were observed that were similar to those in previous reports, but the severity of the nephrotoxicity and hepatotoxicity appeared to be less. Nephrotoxicity occurred in eight patients and hepatotoxicity occurred in one patient. No lymphomas were seen. Hypertension and anemia each were observed in six patients. In addition, previously unreported effects of hyperuricemia, elevated sedimentation rate, and hidradenitis were observed. However, the overall severity of the side effects did not seriously affect the usage of cyclosporine in the patients in this study. Cyclosporine may be useful in the treatment of other autoimmune diseases.

Caseating regional lymphadenitis complicating BCG vaccination: a report of 6 cases

Six infants had caseating regional lymphadenitis complicating BCG vaccination. There was a delayed onset and a lack of immediate vaccination complications. Three infants had frank abscesses. Additional affected nodes undetected clinically were found at operation in all cases. All lymph nodes contained tubercles, 3 showing acid-fast bacilli, 2 of which grew Mycobacterium bovis. Complete excision followed by antiuberculous chemotherapy produced satisfactory results.

Phenytoin-induced lymphadenopathy appearing as a nasopharyngeal malignant neoplasm

A case of phenytoin sodium-induced lymphadenopathy appeared as a nasopharyngeal malignant neoplasm with regional metastases. Cervical lymphadenopathy is a lesser-known drug reaction that is produced by anticonvulsant therapy; under some circumstances, this condition may be confused with head and neck malignant neoplasms. To date, phenytoin-induced nasopharyngeal lymphadenopathy has not previously been reported in the literature. A review of the medical literature provides some interesting facts about the syndrome. A familiarity with this potential complication of anticonvulsant therapy may expedite early diagnosis and appropriate patient treatment.

[Regional adenitis following BCG vaccination (author's transl)]

During a period of time close to four years, 239 children with regional lymphadenopathy following BCG vaccination have been treated. Early neonatal vaccination, individual sensitivity and possible mistakes in the dose of vaccine administered may all influence the development of pathological regional lymphadenopathy. In advanced cases, surgery is proposed as the most effective treatment for a rapid recovery. No cases of recurrence or fistulization appeared in our series.

[Lymphadenopathy in phenytoin treatment]

The authors report on a 20-year-old patient who developed hydantoin lymphadenopathy during treatment with diphenylhydantoin. The problems associated with clinical and histological delimination from malignant lymphomata are described by reference to the literature. Hydantoin lymphadenopathy is regarded as a drug-induced allergic and toxic process.

Angio-immunoblastic lymphadenitis: remarks about two cases

Two patients with clinical and pathological symptoms of so-called angioimmunoblastic lymphadenitis are presented. Both patients were over 50, with multiple lymphadenopathies, fever, pruritus and hyperglobulinemia. The lymph node changes exhibited a characteristic histological triad consisting of diffuse lymphoid proliferation, small arborizing vessels proliferation and paraamyloid-like amorphous material deposition. As previous authors suggested, the disease seems to be the expression of a prolonged hyperimmune response induced by the hypersensitivity to certain factors.

Comparative trial of three heterologous anti-tetanus sera

The three heterologous anti-sera currently provided for tetanus prophylaxis have been compared with reference to the production of untoward reactions in 498 patients, and to the blood antitoxin concentrations produced in 76 patients. Equine serum, although giving rise to more reactions, was the only effective agent in terms of the levels and duration of serum antitoxin concentration produced. The local response to a test dose of any of the three sera is not a reliable guide to immediate or late general reactions.

Lymph node enlargement after a single massive infusion of iron dextran

Painful lymphadenopathy developed in eight female patients after massive infusions of iron dextran for sideropaenic anaemia. Fever, arthralgias, and malaise were also features of the clinical picture. The histology of one lymph node is described and changes in it are discussed in relation to the pathogenesis of the syndrome reported.