Observations on an epidemic of cutaneous and lymphatic tuberculosis which followed the use of anti-typhoid vaccine

Sepsis, parenteral vaccination and skin disinfection

ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like 'clean' surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost.

Tuberculous cold abscess

A tubercular cold abscess secondary to adjoining bone involvement is a well-known entity. However, a primary cold abscess with no bony involvement in children is very rare. We present such a case.