SURGICAL-TREATMENT OF BACILLUS CALMETTE-GUERIN-LYMPHADENITIS

Although its protective effect is contested and the risk of contractin g tuberculosis is rather low nowadays, BCG vaccination is frequently p erformed. Changes of strain repeatedly led to an increased complicatio n rate. In Austria between 1990 and 1991, of 3386 newborn babies (Stra in Pasteur) 116 developed lymphadenitis 3 to 28 weeks after vaccinatio n. The affected children received four types of treatment: nothing spe cific, isoniazid, or surgery with and without isoniazid. Surgical trea tment was found to be necessary in 96 cases. Bacilli were successfully grown in culture in 46% of cases up to week 20 after vaccination; but later than 20 weeks no culture became positive. All cultured bacteria were isoniazid-sensitive. From our data we drew the following conclus ions: Isoniazid therapy did not prove successful when inflamed lymph n odes exceeded a certain size. Suppurative lymphadenitis in lymph nodes exceeding 1.0 to 1.5 cm usually led to infiltration or even perforati on of the skin. Surgery prevents these complications and significantly reduces healing time. Adjuvant isoniazid therapy cannot be recommende d, except for generalized BCG tuberculosis.