Classification:
(1) local disease
(2) regional disease
(3) distant disease
(4) disseminated disease
(5) other BCG syndrome, probably immune-based
Local disease:
(1) limited to the site of vaccination
(2) may include an injection site abscess or scar ulceration
Regional disease:
(1) any regional lymph node ipsilateral to and beyond the vaccination site (axillary, cervical, etc.), with enlargement, suppuration and/or fistula
(2) any other regional lesion ipsilateral to vaccination site
Distant disease:
(1) involvement of 1 site NOT local or regional ipsilateral
(2) BCG isolated from 1 or more sites distant from the vaccination site (tracheal aspirate, gastric aspirate, CSF, urine, osteitis, skin)
(3) does not meet criteria for disseminated disease
(4) systemic symptoms (fever) are helpful for diagnosis but may be absent or nonspecific in an immunocompromised patient
Disseminated disease:
(1) 2 or more remote sites AND
(2) at least 1 blood or bone marrow culture positive
(3) systemic symptoms (fever) are helpful for diagnosis but may be absent or nonspecific in an immunocompromised patient
Other BCG syndromes include uveitis or keloid formation, with no organisms isolated on culture.
Need to exclude other disease, especially if immunocompromised.
