Genetic and Clinical Profiles of Disseminated Bacillus Calmette-Guérin Disease and Chronic Granulomatous Disease in China

• Published in: Frontiers in immunology 2019-01, Vol.10, p.73-73
• Main Authors: Li, Tao, Zhou, Xian, Ling, Yun, Jiang, Ning, Ai, Jingwen, Wu, Jing, Chen, Jiazhen, Chen, Li, Qian, Xiaowen, Liu, Xuhui, Xi, Xiuhong, Xia, Lu, Fan, Xiaoyong, Lu, Shuihua, Zhang, Wen-Hong
• Format: Article
• Language: English
• Subjects: Bacillus Calmette-Guérin; BCG Vaccine - adverse effects; BCGosis; Child; Child, Preschool; China; chronic granulomatous disease; complications; disseminated BCG disease; Female; Follow-Up Studies; Genetic Testing; Genotype; Granulomatous Disease, Chronic - complications; Granulomatous Disease, Chronic - drug therapy; Granulomatous Disease, Chronic - genetics; Hematopoietic Stem Cell Transplantation; Humans; Immunology; Interferon-gamma - therapeutic use; Kaplan-Meier Estimate; Male; Mutation; Mycobacterium bovis - immunology; NADPH Oxidase 2 - genetics; NADPH Oxidases - genetics; Prospective Studies; Rhodamines - analysis; Survival Rate; Treatment Outcome; Tuberculosis - drug therapy; Tuberculosis - etiology; Tuberculosis - genetics; Tuberculosis - mortality; vaccination; Vaccination - adverse effects
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2019.00073

Disseminated Bacillus Calmette-Guérin disease (D-BCG) in children with chronic granulomatous disease (CGD) can be fatal, while its clinical characteristics remain unclear because both diseases are extremely rare. The patients with CGD receive BCG vaccination, because BCG vaccination is usually performed within 24 h after delivery in China. We prospectively followed-up Chinese patients with CGD who developed D-BCG to characterize their clinical and genetic characteristics. The diagnoses were based on the patients' clinical, genetic, and microbiological characteristics. Between September 2009 and September 2016, we identified 23 patients with CGD who developed D-BCG. Their overall 10-year survival rate was 34%. We created a simple dissemination score to evaluate the number of infected organ systems and the survival probabilities after 8 years were 62 and 17% among patients with simple dissemination scores of ≤3 and >3, respectively ( = 0.0424). Survival was not significantly associated with the CGD stimulation index or interferon-γ treatment. Eight patients underwent umbilical cord blood transplantation and 5 of them were successfully treated. The genetic analyses found mutations in (19 patients), (1 patient), (1 patient), and (1 patient). We identified 6 novel highly likely pathogenic mutations, including 4 mutations in and 2 mutations in . D-BCG is a deadly complication of CGD. The extent of BCG spreading is strongly associated with clinical outcomes, and hematopoietic stem cell transplantation may be a therapeutic option for this condition.