scholarly journals Beware of Drug Interactions Treating Iatrogenic Mycobacterium bovis Endocarditis from Intravesical BCG Instillation

2021 ◽  
Author(s):  
Francesca Curri ◽  
Andrea Da Porto ◽  
Viviana Casarsa ◽  
Daria Albini ◽  
Giorgio Minen ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Bacillus Calmette Guerin ◽  
Antituberculous Therapy ◽  
Intravesical Bcg ◽  
Prosthetic Mitral Valve ◽  
Intravesical Instillations ◽  
Echocardiographic Evidence ◽  
Bcg Instillation

We report a case of mechanical mitral valve endocarditis associated with miliary disseminated bacillus Calmette-Guerin (BCG) infection following intravesical instillations for minimally invasive bladder cancer in a 65-year-old man. The diagnosis was established by echocardiographic evidence of vegetation on the prosthetic mitral valve, miliary lesions in the lungs and evidence of bloodstream infection sustained by Mycobacterium. We successfully treated the patient with the classical regimen of quadruple antituberculous therapy.

scholarly journals Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Yuqing Liu ◽  
Jian Lu ◽  
Yi Huang ◽  
Lulin Ma
Keyword(s):  
Bladder Cancer ◽  
Adverse Reactions ◽  
Clinical Manifestations ◽  
Bacillus Calmette Guerin ◽  
Bcg Immunotherapy ◽  
Bcg Therapy ◽  
Intravesical Bcg ◽  
Proven Efficacy ◽  
Bcg Instillation ◽  
Early Establishment

Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.

scholarly journals Disseminated Granulomatous Disease from Intravesical Instillation of Bacillus Calmette-Guerin

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Sayed Ab. Reshad Ghafouri ◽  
Alexander Brun ◽  
Rohit Bhalla ◽  
Craig Margulies ◽  
Kevin Skole
Keyword(s):  
Bladder Cancer ◽  
Drug Toxicity ◽  
Standard Treatment ◽  
Superficial Bladder Cancer ◽  
Treatment Options ◽  
Intravesical Instillation ◽  
Granulomatous Disease ◽  
Bacillus Calmette Guerin ◽  
Intravesical Bcg ◽  
Bcg Instillation

Intravesical instillation of Bacillus Calmette-Guerin is one of the standard treatment options for superficial bladder cancer. While Bacillus Calmette-Guerin therapy is usually well tolerated with most patients experiencing only cystitis, in rare cases, it can lead to disseminated granulomatous disease. We present a case of a 72-year-old man with disseminated granulomatous disease from intravesical BCG instillation whose treatment was complicated by antimycobacterial drug toxicity.

scholarly journals Disseminated Bacillus Calmette–Guérin (BCG) infection and acute exacerbation of interstitial pneumonitis: an autopsy case report and literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Gen Shimizu ◽  
Ryota Amano ◽  
Itaru Nakamura ◽  
Akane Wada ◽  
Masanobu Kitagawa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bladder Cancer ◽  
Acute Exacerbation ◽  
Interstitial Pneumonitis ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Bacillus Calmette Guerin ◽  
Antituberculosis Drugs ◽  
First Case ◽  
Intravesical Bcg

Abstract Background Intravesical administration of Bacillus Calmette–Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. Case presentation A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. Conclusions We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.

scholarly journals Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Medicine ◽  
2014 ◽  
Vol 93 (17) ◽  
pp. 236-254 ◽  
Author(s):  
María Asunción Pérez-Jacoiste Asín ◽  
Mario Fernández-Ruiz ◽  
Francisco López-Medrano ◽  
Carlos Lumbreras ◽  
Ángel Tejido ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Adjunctive Therapy ◽  
Bacillus Calmette Guerin ◽  
Intravesical Bcg

scholarly journals Miliary pulmonary tuberculosis after the first dose of intravesical BCG instillation in a patient with high-grade bladder cancer

2020 ◽  
Vol 88 (6) ◽  
pp. 628-629
Author(s):  
Adam Stępień ◽  
Michał Brudło ◽  
Tomasz Stachura ◽  
Paulina Marcinek ◽  
Jerzy Soja ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Pulmonary Tuberculosis ◽  
High Grade ◽  
Intravesical Bcg ◽  
Bcg Instillation

scholarly journals BCG instillation versus radical cystectomy for high-risk NMIBC with squamous/glandular histologic variants

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jungyo Suh ◽  
Kyung Chul Moon ◽  
Jae Hyun Jung ◽  
Junghoon Lee ◽  
Won Hoon Song ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Cystectomy ◽  
Bacillus Calmette Guerin ◽  
Large Tumor ◽  
Treatment Groups ◽  
Appropriate Treatment ◽  
Intravesical Bcg ◽  
Risk Patients ◽  
Cystectomy Group ◽  
Bcg Instillation

Abstract This study aims to evaluate the effect of Bacillus Calmette-Guérin (BCG) instillation and radical cystectomy on high-risk NMIBC with squamous or glandular variants. We retrospectively reviewed the data of high-risk (T1 or CIS or HG or TaG1/G2 with multiple, recurrent, large tumor) NMIBC patients from January 2000 to December 2017. Comparative analysis of radical cystectomy, intravesical BCG, and observation groups was conducted in high-risk NMIBC with squamous or glandular histologic variants. Among the 1263 high-risk NMIBC patient, 62 (4.9%) were reported squamous or glandular histologic variants. Thirty patients underwent BCG instillation and 15 patients were subjected to radical cystectomy. Statistically significant differences were found between the three treatment groups in terms of underlying hypertension (p = 0.031), T stage (p = 0.022) and tumor multiplicity (p = 0.019). Similar 5-year OS (p = 0.893) and CSS (p = 0.811) were observed in each of BCG instillation and radical cystectomy group. BCG instillation showed survival benefit in both OS (p = 0.019) and CSS (p = 0.038) than in the observation group. In high-risk patients diagnosed with NMIBC bladder cancer with squamous or glandular histologic variants, both intravesical BCG and radical cystectomy showed survival gain. In conclusion, BCG instillation represents an appropriate treatment option in high-risk NMIBC with squamous or glandular histologic variant.

scholarly journals Assessing the Feasibility of Replacing Standard-Dose Bacillus Calmette–Guérin Immunotherapy with Other Intravesical Instillation Therapies in Bladder Cancer Patients: A Network Meta-Analysis

2017 ◽  
Vol 41 (4) ◽  
pp. 1298-1312 ◽  
Author(s):  
Cheng Wu ◽  
Xunrong Zhou ◽  
Chunqing Miao ◽  
Jianzhong Zhang ◽  
Qingsheng Tang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Tumor Recurrence ◽  
Standard Dose ◽  
Meta Analysis ◽  
Intravesical Instillation ◽  
Bacillus Calmette Guerin ◽  
Odds Ratios ◽  
Significant Difference ◽  
Intravesical Bcg ◽  
Equivalent Efficacy

Background: Bacillus Calmette–Guérin (BCG) immunotherapy plays a key role in patients with bladder cancer. The shortage of intravesical BCG has motivated researchers to seek alternatives with equivalent efficacy If other alternative intravesical agents have equivalent efficacy compared to BCG, then it may be feasible to replace standard BCG with alternative options. Methods: We searched all relevant evidence in multiple sources and key data was extracted from included studies. Conventional and network meta-analysis were conducted so that pooled odds ratios (ORs) for the event of tumor recurrence and progression can be computed. The relative efficacy of different intravesical instillation procedures was computed by pooled odds ratios and their 95% confidence or creditable intervals. Besides, several key model assumptions were evaluated in our analysis. Results: Three intravesical instillation procedures have the potential for preventing tumor recurrence: standard-dose BCG (BCG_SD), Epirubicin (EPI) and Mitomycin C (MMC) (ORs < 1). Patients with BCG SD also exhibited a decreased risk of tumor recurrence and progression compared to those with EPI. No significant difference in the risk of tumor recurrence or progression was detected between patients treated with BCG_ SD and those with low-dose BCG (BCG_LD). Results of SUCRA indicated that BCG_EPI, BCG_ MMC and BCG SD had higher rankings with respect to tumor recurrence and progression. Conclusions: BCG SD, EPI and MMC exhibited established efficacy for preventing tumor recurrence in postoperative BC patients. The efficacy of BCG may not be significantly reduced if standard dose was reduced to a lower level. However, there is no consensus suggesting that intravesical BCG with standard dose can be replaced by alternating or sequentially combined intravesical instillation therapies.

Additional Extension of the Mathematical Model for BCG Immunotherapy of Bladder Cancer and Its Validation by Auxiliary Tool

2019 ◽  
Vol 20 (6) ◽  
pp. 675-689 ◽  
Author(s):  
Ekaterina Guzev ◽  
Sarel Halachmi ◽  
Svetlana Bunimovich-Mendrazitsky
Keyword(s):  
Bladder Cancer ◽  
Superficial Bladder Cancer ◽  
Treatment Protocol ◽  
Bacillus Calmette Guerin ◽  
Cancer Cell Growth ◽  
Model Improvement ◽  
Unnecessary Death ◽  
Clinical Potential ◽  
The Mathematical Model ◽  
Bcg Instillation

AbstractImmunotherapy with bacillus Calmette–Guérin (BCG) is a classic treatment for superficial bladder cancer. Although BCG instillation is a well-established protocol, some patients do not respond to this treatment. To model improvement of this protocol, Bunimovich-Mendrazitsky (B-M) et al. provided a platform for in silico testing of modified protocols of BCG instillation and combination with IL-2. The purpose of this work is to improve and further develop this BCG model describing the tumor–immune interactions occurring in the bladder in response to BCG and IL-2 therapies, based on novel clinical data.To validate this BCG model, we used the results of BCG treatment of 10 patients with bladder cancer 3-5 years ago. Individual data for each patient was entered to simulate the model. As a result, a treatment protocol was obtained which coincided with the protocol assigned by the doctor. In addition, cancer cell growth graphs were obtained from the model simulations, which coincided with the clinical conclusions of the patient’s treatment outcome. Moreover, the program provides a more optimal treatment protocol for each patient.We show that calculated protocols from the model can prevent excess side effects of immunotherapy and even of unnecessary death for some patients, informing the clinical potential of our model.

scholarly journals A Case of Acquired Rifampin Resistance inMycobacterium bovisBacillus Calmette-Guérin-Induced Cystitis: Necessity for Treatment Guidelines

2006 ◽  
Vol 17 (3) ◽  
pp. 183-185 ◽  
Author(s):  
Joyce N Wolfe ◽  
Kym S Blackwood-Antonation ◽  
Meenu K Sharma ◽  
Victoria J Cook
Keyword(s):  
Drug Resistance ◽  
Target Gene ◽  
Treatment Guidelines ◽  
Transitional Cell ◽  
Bacillus Calmette Guerin ◽  
Acquired Drug Resistance ◽  
Elderly Female ◽  
Intravesical Bcg ◽  
Rifampin Resistance ◽  
Bcg Instillation

A case of presumed bacillus Calmette-Guérin (BCG) cystitis in an elderly female patient following direct intravesical BCG instillation treatment for papillary transitional cell carcinoma is reported. The organism cultured from urine samples was eventually identified as a rifampin-resistantMycobacterium bovisBCG isolate. Because the patient had received rifampin monotherapy during the course of treatment for presumed BCG disease, the clinical picture favoured acquired rifampin resistance. Sequencing of the target gene for rifampin (rpoB) confirmed a known mutation responsible for conferring high levels of resistance to both rifampin and rifabutin (Ser531Tyr). To the authors' knowledge, this is the first reported case ofM bovisBCG disease in a non-HIV patient where the organism had acquired drug resistance to rifampin, and the second reported case ofM bovisBCG that had acquired drug resistance. The present case demonstrates the necessity to re-evaluate appropriate guidelines for the effective treatment of BCG disease.

scholarly journals Intravesical Bacillus Calmette–Guérin Treatment for T1 High-Grade Non-Muscle Invasive Bladder Cancer with Divergent Differentiation or Variant Morphologies

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2615
Author(s):  
Makito Miyake ◽  
Nobutaka Nishimura ◽  
Kota Iida ◽  
Tomomi Fujii ◽  
Ryoma Nishikawa ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cox Regression ◽  
World Health ◽  
High Grade ◽  
Bacillus Calmette Guerin ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Divergent Differentiation ◽  
Intravesical Bcg ◽  
The Impact

The 2016 World Health Organization classification newly described infiltrating urothelial carcinoma (UC) with divergent differentiation (DD) or variant morphologies (VMs). Data comparing oncological outcomes after bladder-preservation therapy using intravesical Bacillus Calmette–Guérin (BCG) treatment among T1 bladder pure UC (pUC), UC with DD (UC-DD), and UC with VMs (UC-VM) are limited. We evaluated 1490 patients with T1 high-grade bladder UC who received intravesical BCG during 2000–2019. They were classified into three groups: 93.6% with pUC, 4.4% with UC-DD, and 2.0% with UC-VM. Recurrence-free, progression-free, and cancer-specific survival following intravesical BCG were compared among the groups using multivariate Cox regression analysis, also used to estimate inverse probability of treatment weighting-adjusted hazard ratio and 95% confidence interval for the outcomes. Glandular differentiation and micropapillary variant were the most common forms in the UC-DD and UC-VM groups, respectively. Of 1490 patients, 31% and 13% experienced recurrence and progression, respectively, and 5.0% died of bladder cancer. Survival analyses revealed the impact of concomitant VMs was significant for cancer-specific survival, but not recurrence-free and progression-free survival compared with that of pUC. Our analysis clearly demonstrated that concomitant VMs were associated with aggressive behavior in contrast to concomitant DD in patients treated with intravesical BCG.

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