BCG Adenitis / Lymphadenitis
<p><a href="http://www.hkjpaed.org/pdf/2011;16;85-94.pdf">Management</a></p>
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<p>Lymphadenitis is the most common complication of BCG vaccination, and is of two types – suppurative and non-suppurative</p>
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<p><strong>Normal course post-vaccination</strong>:
Intradermal injection -> local multiplication of vaccine -> transport to lymphatics via lymph glands -> haematogenous dissemination of BCG.</p>
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No clear definition of ‘BCG lymphadenitis,’ proposed definition is when it becomes palpable or concerning for parents.</p>
<p>Can appear as early as two weeks after vaccination, most within 6 months and almost all cases will be within 24 months.
Normally ipsilateral with one or two palpable lymph nodes, but can involve multiple nodes. Normally axillary but can be with cervical/supraclavicular.
<strong>Diagnosis:</strong></p>
<ul>
<li>Isolated lymph node enlargement</li>
<li>BCG vaccination to ipsilateral side</li>
<li>Absence of tenderness or heat to lump</li>
<li>Absence of fever</li>
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<p>Non-suppurative will resolve within a few weeks – this is a normal reaction and most of these are sub-clinical so go unnoticed.
Suppurative involves an enlarging lymph node with fluctuant appearances, edema and erythema. Happens in ’30-80%’ of cases of lymphadenitis. <a href="http://www.paediatricpearls.co.uk/bcg-lymphadenitis/">Read more...</a></p>