REGIONAL LYMPHADENITIS FOLLOWING BCG VACCINATION

A cluster of cases of lymphadenitis occurred in Dublin following vacci nation with a newly introduced Copenhagen 1331 strain of Bacille Calme tte-Guerin (BCG) vaccine during 1989, All cases of BCG lymphadenitis p resenting to paediatric surgical clinics over an Ii-year period were r eviewed to determine the optimum treatment for this problem. Seventeen patients are included, 16 of whom received vaccine in the newborn per iod; 1 received BCG at 8 months. Nine were treated by initial operatio n, 6 with antituberculous drugs, and 2 were observed without specific therapy, All but 1 of the medically treated patients and both patients who received observation only required operation for failure to resol ve or progression of disease. The best results were obtained with exci sion and primary closure. We conclude that although spontaneous resolu tion occurs in a majority of all cases of BCG lymphadenitis in infants , in those patients with more severe disease who require surgical refe rral, a short trial of antimicrobial therapy is indicated. Patients wh o fail to improve or develop complications are then best treated by su rgical excision of the involved nodes.