Bcg Adenitis

Introduction

This is a simple but not very uncommon phenomenon occurring in young infants of 3 months or more. BCG vaccine is administered at or soon after birth in India today. This comes up about 6 weeks after the injection.

Left axillary swelling following BCG injection

Injection BCG is given to all children soon after birth, and one thing that all parents must understand is that this does not prevent tuberculosis. Parents have a notion that once BCG is given to their child, he/she will never get tuberculosis life long. Actually, this vaccine only gives the body the ability to fight tuberculous germs, and hence major complications from tubercular infection may be avoided or decreased. As a reaction to this injection of BCG, the nearest draining lymph nodes are the axillary (armpit) or the supraclavicular(neck) may catch the weakened germs and get infected and enlarge. The swelling comes up within a maximum of 3 months of having taken the BCG injection. And is no cause for alarm. When the swelling appears, it must be shown to your doctor to look whether it is a solid enlargement or has it already begun a process of necrosis(caseation) and turned into liquid pus(cold abscess). As long as there is no softening indicating a cold abscess – no intervention is required. A single anti-tubercular drug is started for a period of 6 weeks. A regular watch is kept on the swelling. If it decreases and disappears nothing needs to be done other than close follow-up. If it softens and forms a cold abscess – it has to be drained by surgical means and followed by regular alternate day dressings. However, if it remains the same size or increases in spite of the single drug regime, then it requires to be removed completely and the mass is sent for microscopic examination to confirm the etiology of the swelling. Lymphadenitis does not mean that the child is suffering from active tuberculosis, but, this is a reaction to the attenuated germs given to the child through the vaccine. Surgery for the cold abscess is to incise and drain the pus totally. This is done as a daycare surgery with no overnight stay in the hospital.

Another child with BCG Adenitis

Thick pus being drained out from the axillary swelling