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Author: Stela Kulciţkaia Degree: doctor of medicine Speciality:  14.00.26 - Phtisiopneumology Year: 2007 Scientific adviser: Constantin Iavorschi doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc" Scientific consultant: Serghei Ghindă doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc" Institution: Scientific council:

Status The thesis was presented on the 29 May, 2007 Approved by NCAA on the 14 June, 2007 Abstract – 0.35 Mb / in romanian Thesis CZU 616-002.5:576.8.097.3 1.00 Mb / in romanian 123 pages

Keywords

Summary

There were supervised 611 children suffering with BCG postvaccinal complications. There were 332 boys (54.3%) and 279 girls (45.7%). 212 patients (34.7%) were from urban area and 399 patients (65.3 %) were from rural area.

Researches have demonstrated that the considerable increase of BCG complications, both at vaccination and revaccination, occurred due to changing the vaccine preparation (from 2.1 to 78.1 cases per 100 000 children, consequently in 1994 and 1997). According to the classification of BCG complications, recommended by WHO’s European Bureau, the most frequently diagnosed complications have been in the first category: regional lymphadenitis were (63.5%), cool abscesses (18.9%) and ulcers (12.8%). In the 2nd category of complications there’ve been included ostitis (3.1%) and uveitis (0.7%). Generalized processes from the 3rd category haven’t occured. From the 4th category, cutaneous rashes (0.2%) and cheloid scars (0.8%) have been observed.

The causes of BCG complications’development could be: technical errors, vaccine’s biological properties, the complicated evolution of the vaccinal process, unrespecting contra-indications in immunization. The appearance of post-BCG complications has been also challenged by the concomitantly present diseases. At vaccination, the most frequent simultaneous diseases have been: anaemia (13.0 %), perinative encephalopathy (10.5 %), premature birth (6.5 %). At revaccination there could be mentioned respiratory system’s diseases (5.3%), enterobiosis (6.6%), chronic gastritis (4.5%) and chronic tonsillitis (2.1%).

Post-BCG lymphadenitis more frequently occurs at the left axillary region (76.0%). The process is more often traced out at infiltration stage (79.6%). Tubercular intoxication’s symptoms were present in 21.4% of cases. Diagnosing BCG lymphadenitis and qualitative specific treatment in due time led to recovery during the first three months (90.5%). The majority of the children suffering from BCG lymphadenitis were under 6 years old.

BCG ostite at children under three years old has been fixed late. Tubercular ostite diagnosing is based on: bones destruction, local few pronounced changes, sufficient general state and biopsy hotbed data. The fundamental principle in BCG ostite treatment is complex therapy which inclueds surgeon’s intervention, antituberculous chemotherapy and functional therapy.

In immunological researches there were included 47 children with postvaccinal complications and 65 healthy children of different age. The analysis of specific cellular and humoral sensitizing to tuberculin‘s antigens highlights a regularity. Children suffering from ulcer, with allergic reactions manifested because of the high specific cellular sensitizing to tuberculin, have had the least quantity of antibodies. The patients suffering from abscess, with predominant toxic reactions because of the lowest sensitizing to tuberculin, have had the biggest quantity of antitubercular antibodies. The most well-balanced report of specific cellular and humoral sensitizing is observed at patients suffering with regional lymphadenitis.

Oficial Reviewers

• Vera Onu
  doctor, associate professor (docent)
• Vasile Degteariov
  doctor habilitat, associate professor (docent)

 Theses