Pediatr Infect Vaccine.  2018 Dec;25(3):148-155. 10.14776/piv.2018.25.e11.

Clinical Significance of the Bacille Calmette-Guérin Site Reaction in Kawasaki Disease Patients Aged Less than 18 Months

• Park SH
• Yu JJ
• You J
• Kim MJ
• Shin EJ
• Jun HO
• Baek JS
• Kim YH
• Ko JK

• KMID: 2428252
• DOI: http://doi.org/10.14776/piv.2018.25.e11

Abstract

PURPOSE
The purpose of this study was to investigate the clinical significance of Bacille Calmette-Guérin (BCG) site reaction in terms of diagnosis and outcome prediction in young children with Kawasaki disease (KD).
METHODS
The incidence of BCG site reaction in the respective age ranges was investigated in 1,058 patients who were admitted at Asan Medical Center between January 2006 and February 2017. The 416 patients under 18 months of age were enrolled as subjects for the analysis of the association between BCG site reaction and other laboratory and clinical findings. The analysis was performed separately in complete and incomplete KD groups.
RESULTS
The incidence rate of BCG site reaction was peaked at 6-12 months (83%) and decreased with increasing age after 12 months in 1,058 patients (P < 0.001). The incidence rate was above 70% in KD aged less than 18 months and more frequent than those of cervical lymphadenopathy. The logistic regression analyses showed that the principal clinical findings including conjunctivitis (P=0.781), red lips/oral mucosa (P=0.963), rash (P=0.510), cervical lymphadenopathy (P=0.363), changes in extremities (P=0.283) and the coronary artery aneurysm (P=0.776) were not associated with the BCG site reaction.
CONCLUSIONS
The BCG site reaction could be a useful diagnostic tool independent to principal clinical findings in KD developing in children aged < 18 months, who underwent BCG vaccination. Outcome of KD patients was not different between groups with or without the BCG site reaction in both complete KD and incomplete KD.

Keyword

Kawasaki disease; BCG vaccine; Children; Erythema

MeSH Terms

Aneurysm
BCG Vaccine
Child
Chungcheongnam-do
Conjunctivitis
Coronary Vessels
Diagnosis
Erythema
Exanthema
Extremities
Humans
Incidence
Logistic Models
Lymphatic Diseases
Mucocutaneous Lymph Node Syndrome*
Mucous Membrane
Mycobacterium bovis
Vaccination
BCG Vaccine

Figure

• 

  Fig. 1 Age specific proportion of BCG site reaction in 1,058 Kawasaki disease patients. The proportion of the reaction increases until 12 months, then decreases with age. Abbreviations: BCG, Bacille Calmette-Guérin.

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