Post BCG Lymphadenitis in Vaccinated Infants in Yazd, Iran

Objective: Bacille Calmette-Guَerin (BCG) vacination is performed as a part of expanded program of immunization (EPI). Lymphadenitis is the most common complication of BCG vaccination. The aim of this study was to determine the incidence and natural course of BCG lymphadenitis vaccinated in Yazd, Iran.
Methods:I n this analytical prospective follow up study a total of 480 (240 females and 240 males) consecutive newborns received 0.05 ml of BCG vaccine intradermally on right arm within the first week of life during April to July 2003. These babies were followed up when 1.5, 3, 4.5, 6 and 9 months old.
Findings: A total of 26 (5.8%) cases of lymphadenitis were detected. Lymphadenitis occurred as ipsilateral axillary nodes in 24 (92.3%) cases, supraclavicular in one (3.8%) case, and supraclavicular in association with axillary nodes in one case (3.8%). Infants developed lymphadenitis during 4 wks of life in one (3.84%) case, between first and fourth month of life in 14 (53.8%) cases, and between fourth and sixth month of life in 11 (42.3%) cases. All 26 cases of lymphadenitis were followed up for 9 months. Twenty two (84.6%) cases were simple or non-suppurative and 4 (15.4%) cases suppurative lymphadenitis. Eleven (42.3%) cases of non-suppurative lymphadennitis showed spontanous resolution and eleven (42.3%) cases had partial regression without progression or drainage. Four (15.4%) cases developed suppuration with one (3.8%) case of fistulation and drainage.
Conclusion: The greater incidence of lymphadenopathy in our cases can probably be attributed to a more immunogenic vaccine (Pasteur institute, Tehran), young vaccinees (newborn infants), injection in the right arm or improper dilution. Non-suppurative BCG lymphadenitis is a benign condition and regresses spontanously without any treatment.