Mycobacterium bovis (BCG strain)

Background

• Intravesicular instillation of Mycobacterium bovis BCG strain is sometimes used to treat bladder cancer
• It can occasionally cause infections, sometimes referred to as BCGitis

Clinical Manifestations

• Median time from instillation to onset of symptoms is 169 days1 (range 3 months to many years)
• Disease can disseminate to liver, lungs, bone marrow, bones, joints (in descending order of frequency)
• Localized disease can cause cystitis, bladder contractures, granulomatous prostatitis, prostate abscess, epididymo-orchitis, testicular abscess, pyelonephritis, renal abscess, ureteral stricture, penile granuloma
  • Common symptoms are localized bladder irritation (dysuria, frequency, hematuria), with low-grade fevers and malaise
• Systemic spread can cause a sepsis syndrome, pulmonary disease (miliary or interstitial disease), granulomatous hepatitis, osteomyelitis (most commonly the spine), psoas abscess, and (very rarely) vascular complications including arteritis or vasa vasorum or contiguous spread from local infection to the adjacent arteries

Local Post-Instillation Reaction

• Can have malaise, myalgias, nausea, chills, and low-grade fevers that resolve within 48 hours

Management

• Induction with isoniazid, rifampin, and ethambutol, followed by consolidation with isoniazid and rifampin
• Sometimes needs surgery