Korean J Lab Med.  2011 Jul;31(3):197-200. 10.3343/kjlm.2011.31.3.197.

Mycobacterial Infection after Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer: A Case Report

• Park CH
• Jang MA
• Ahn YH
• Hwang YY
• Ki CS
• Lee NY

• KMID: 1735854
• DOI: http://doi.org/10.3343/kjlm.2011.31.3.197

Abstract

Bacillus Calmette-Guerin (BCG) has been traditionally used as a vaccine against tuberculosis. Further, intravesical administration of BCG has been shown to be effective in treating bladder cancer. Although BCG contains a live attenuated strain of Mycobacterium bovis, complications such as M. bovis BCG infection caused by BCG administration are extremely rare. Here, we report a case of BCG infection occurring after intravesical BCG therapy. A 67-yr-old man presented with azotemia and weight loss. He had been diagnosed with bladder cancer 4 yr back, and had undergone transurethral resection of the bladder tumor and intravesical BCG (Tice strain) therapy at that time. An acid-fast bacterial strain was isolated from his urine sample. We did not detect Mycobacterium tuberculosis protein 64 (MPT-64) antigen in the isolates obtained from his sample, and multiplex PCR and PCR-reverse blot hybridization assay indicated that the isolate was a member of the M. tuberculosis complex, but was not M. tuberculosis. Finally, sequence analysis of 16S ribosomal RNA and DNA gyrase, subunit B (gyrB) suggested that the organism was M. bovis or M. bovis BCG. Although we could not confirm that M. bovis BCG was the causative agent, the results of the 3 molecular methods and the MPT-64 antigen assay suggest this finding. This is an important finding, especially because M. bovis BCG cannot be identified using common commercial molecular genetics tools.

Keyword

BCG; Mycobacterium bovis; Bladder cancer; Multiplex-PCR; Sequence analysis

MeSH Terms

Administration, Intravesical
Aged
BCG Vaccine/administration & dosage/*adverse effects
DNA Gyrase/genetics
Humans
Male
Mycobacterium Infections/*diagnosis/etiology
Mycobacterium bovis/genetics/*isolation & purification
Polymerase Chain Reaction
RNA, Ribosomal, 16S/genetics
Urinary Bladder Neoplasms/*therapy

Figure

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  Fig. 1 Colony morphology on solid medium (A) and cord formation by acid-fast bacillus (B) (Ziehl-Neelsen stain, ×1,000). The presence of cords is known to be a criterion for presumptive identification of the Mycobacterium tuberculosis complex.

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  Fig. 2 Multiplex-PCR to identify the isolate. Products of the multiplex-PCR performed using DNA from the isolates were separated on a 2.0% agarose gel using electrophoresis, and the gel was stained with ethidium bromide. The bands for the isolates (S1-S3 and L1-L3) corresponded to that for NTM. IC, internal control (660 bp); NC, negative control; NTM, control non-tuberculous mycobacteria; MTB, control Mycobacterium tuberculosis; S1-S3, isolates from solid media; L1-L3, isolates from liquid media; M, molecular markers.

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