The Journal of Pediatric Infectious Diseases and lmmunology Online Journal


The Journal of Pediatric Infectious Diseases and Immunology > Vol.31 No.4 contents > Abstract

Article in Japanese

Analysis of 23 patients suspected Koch's phenomenon after BCG vaccination

Satoshi ABE1), Mizuki SHIBUYA2), Yoshiko IWAMARU2), Maiko IGARASHI2), Tomomi NAITO2), Nao OIKAWA2), Shoichi OYAMA2)

Koch's phenomenon is a valuable opportunity to discover tuberculosis infections in children. 23 patients who visited Saiseikai Kawaguchi Hospital for suspected Koch's phenomenon were included, and their age at the time of first visit were 4 to 8 months old (mean age was 5.8 months). The 23 patients were graded according to the classification of post-vaccination local findings presented in Nagai's flowchart of "responses to Koch's phenomenon", Grade 1 : 2 patients, Grade 2 : 2 patients, Grade 3 : 10 patients, Grade 4 : 8 patients, Grade 5 : 0 patient, and Grade 6 : 1 patient. 14 patients of the 23 patients were suspected as "true" Koch's phenomenon, i.e., existing history of actual tuberculosis infection. As the age become higher, "true" Koch's phenomenon patients get more. For the diagnosis of actual tuberculosis infection, interferon-γ release assay tests (IGRA), chest X-ray, enhanced chest CT (computed tomography) were performed. These tests were negative, 14 patients were diagnosed as latent tuberculosis infection (LTBI). 6 months of LTBI treatment was applied to 13 of the 14 patients, and at the result of the 2-year follow-up observation, no patients experienced the onset of tuberculosis. In this study, we didn't find out actual tuberculosis by Koch's phenomenon. But, there are many high risk countries in Asia, careful observation may be needed.

1) Division of General Internal Medicine, Tokai University School
2) Department of Pediatrics, Saiseikai Kawaguchi hospital

Key words Koch's phenomenon, tuberculosis, LTBI, BCG, IGRA
Received July 24, 2018
Accepted July 25, 2019

31 (4):321─326,2019