Lege Artis Medicinae

[An update on BCG vaccination]

NYERGES Gáborné1, DRINÓCZY Mária1

SEPTEMBER 25, 1991

Lege Artis Medicinae - 1991;1(15)

[Tuberculosis is still a serious and wide-spread disease affecting mainly people living under poor hygienic conditions. Double infections with HIV + M. tuberculosis, however, may worsen the epidemiological situation both in developing and highly developed countries. Since its introduction, BCG vaccine has undergone several changes regarding the production strain and other characteristics. Though, the effectivity of BCG vaccination has been often questioned, it is indisputable that the vaccine protects young children against the disease. In Hungary, lyophilised „Paris" BCG strain has been safely and successfully used for vaccinating new-borns and revaccinating children for 30 years. The tbc incidence of the population under 14 years of age has been very low. Due to the relatively high tbc incidence among adults and the unfavourable tendency in the epidemiology of tbc in the world, however, no changes in the present BCG vaccination schedule are advisable. Moreover revaccination regardless to the tuberculin status should be considered. ]

AFFILIATIONS

  1. Országos "Johan Béla" Közegészségügyi Intézet

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[On pulmonary tuberculosis]

SCHWEIGER Ottó

[The author evaluates the epidemiological conditions of pulmonary tuberculosis in Hungary. The number of new cases decreases year after year. Being the disease infectious afterall, efforts must be continued against it adapted to the new epidemiological situation. This requires the collaboration of all the medical network systems as the pulmonological one is inefficient itself. Though the disease is rare, it cannot be forgotten and in certain cases tuberculosis must be borne in mind as well.]

Lege Artis Medicinae

[The differential diagnosis of pulmonary tuberculosis]

BÖSZÖRMÉNI Miklós

[Since the number of tuberculous patients is constantly decreasing, the diagnosis of pulmonary tuberculosis is a new challenge for physicians. That produces a lifethreatening danger specially for old tuberculous patients. Primary infection – since the clinical tuber culosis of children practically disappeared in Hungary - can be established mostly on young people with general symptoms, who's tuberculin-reaction shows hyperergy. The specific etiology of pleurisy can be determined by the exclusion of other etiologies on young tuberculin-positive people, but a thoracoscopic biopsy may be needed. Tuberculous bronchadenitis is a rarity, but must be differentiated from sarcoidosis or malignant mediastinal lymph nodes. In infiltrative lung diseases, primary and se condary pneumonias (caused in first line by lung cancer) and pulmonary infarctions are much more frequent, than tbc. The most difficult is the differential diagnosis of disseminated pulmonary diseases. The author warns against the too early application of aggressive diagnostic methods (BAL and especially lung biopsy by thoracotomy). He emphasizes in these situations the advantages of an antituberculous treatment without diagnosis (especially in old patients). In coin lesions the very specific transthoracic needle biopsy should be preferated. The author refers to the new researches objecting the rapid detection of BK in the sputum of paucibacillary patients, but is meaning, that the indirect ways of diagnosis mentioned in this paper would be necessary for a long time.]

Lege Artis Medicinae

[The importance of tuberculosis in childhood]

ANDRÁSOFSZKY Barna

[Nowadays tuberculosis has already become a rare disease in childhood in Hungary but the danger of the infection is still present for the several thousand (over 3500) disease manifestations among adults. The main task of the pediatricians is prevention, however the disease should be borne in mind in case of unelucidated chronic cases. In suspicion of meningitis basilaris it is necessary to start the treatment at once. Until now the maintanence of the BCG vaccination by age groups (new-born, 11 and 18 years) was justified, but it needs further restriction due to the advance in epidemic situation.]

Lege Artis Medicinae

[Some problems and characteristics of pulmonary mycobacteriosis in hungary]

KOZMA Dezső, VINCZE Egon, DÁVID Sándor, KISHINDI Katalin, ALEXY György

[360 cases of pulmonary mycobacteriosis caused by atypical mycobacteria were observed between 1980 and 1989. M. xenopi proved to be the most frequent pathogen (in 67% of the cases) followed by M. kansasii and M. avium intracellulare. The disease was common in urban-industrial areas. The yearly incidence of disease has not been increased during the observed period. 86% of patients were male with the mean age of 55 years. Underlying diseases such as pulmonary tuberculosis and chronic obstructive lung disease were found frequently. The symptoms of the disease were uncharacteristic. Thin-wall cavities with the lack of an infiltrate appeared in 24% of the patients. Malignancy and pulmonary aspergillosis were the two more frequent concomitant diseases. The occurence of lung cancer and also other organ cancers were significant higher among these patients than in the normal population between 40–69 years of age. Findings of histopathology were indistinguishable from tuberculosis among M. kansasii cases. A relative lack of caseousiting necrosis, forced fibrosis, foreign body reaction and abortive granuloma formation appeared among M. xenopi and M. avium-intracellulare cases. ]

Lege Artis Medicinae

[Cardiovascular risk factors associated with albuminuria in insulin-dependent diabetic patients]

JERMENDY György, VÖRÖS Péter, STOKUM Éva, KAMMERER László

[The appearance of albuminuria could be associated with increased risk of cardiovascular morbidity and mortality in insulin-dependent diabetic patients. For assessing this relationship 81 insulin-dependent diabetic patients were investigated. Albuminuria was detected by radioimmunoassay and diabetics were classified as having normo, micro- or macroalbuminuria. In macroalbuminuric patients (n = 16) serum creatinine, total cholesterol, triglycerides, uric acid and blood pressure were significantly higher than in normoalbuminuric patients (n = 45). Values of microal buminuric patients (n = 20) were between those of macro- and normoalbuminuric diabetics. Close correlations were found bet ween albumin excretion rate and serum creatinine, cholesterol, triglycerides, uric acid, systolic and diastolic blood pressure. Cardiovascular risk factors are increasingly present in insulin-dependent, non-uraemic diabetic patients with albuminuria playing a possible role in the excess rate of cardiovascular morbidity and mortality. ]

All articles in the issue

Related contents

Clinical Neuroscience

Acute transverse myelitis after inactivated COVID-19 vaccine

ERDEM Şimşek Nazan, DEMIRCI Seden, ÖZEL Tuğba , MAMADOVA Khalida, KARAALI Kamil , ÇELIK Tuğba Havva , USLU Ilgen Ferda, ÖZKAYNAK Sibel Sehür

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

Clinical Neuroscience

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopharynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially devastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006-2015 every year between 34 and 70 were the numbers of the registered invasive disease because of Neisseria meningitis, the morbidity rate was 0.2-0.7⁰⁄₀₀₀₀. Half of the diseases (50.7%) were caused by B serotype N. meningitidis, 23.2% were C serotype. In this article the authors summarise what you must do and must not do as primary care physician when suddenly meeting a young patients suspected of having meningococcus infection. ]

Lege Artis Medicinae

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]

Lege Artis Medicinae

[Vaccinations in the world the expanded programme on immunization]

LELKES Miklós, VEDRES István

[The Expanded Programme on Immunization (EPI) began in 1974 as a WHO-programme, later joining the UNICEF and other organizations. The original target diseases of EPI were tuberculosis, diphtheria, pertussis, tetanus and neonatal tetanus and morbilli. The WHO advises that yellow fever vaccine should be incorporated into EPI and routinely adminis tered to children in all countries at risk for yellow fever. The EPI is dealing now already with the problem of hepatitis B and rubella (congenital rubella syndrome) also. A great achievement of EPI for 1990 of 80% immunization coverage among infants world wide with BCG and measles vaccine and the third dose of DPT and of oral poliovirus vaccines. Some short term goals of EPl: global eradication of poliomyelitis by the year 2000, reduction of measles death by 95% by 1995 and reduction of measles cases world wide by 90% compared to pre-immunization levels as a major step towards the global eradication of measles. Also by 1995, case fatality rates from measles should be reduced to less than 1% in all countries. The WHO European Region has adopted the target of no indigenous measles by the year 2000. Concerning the EPI diseases, the epidemiological situation in Europe including Hungary is generally favourable. ]

Lege Artis Medicinae

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[In this article, based on a short case report, the authors summarise what you must do and must not do as a primary care physician when suddenly meeting a young patient suspected of having meningococcus infection. Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopha-rynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially de­vastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006 and 2015 every year there were 34 to 70 cases of the registered invasive disease caused by Neisseria meningitidis, the morbidity rate being 0.02-0.07‱. Half of the diseases (50.7%) were caused by serotype B N. meningitidis, 23.2% were serotype C. ]