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PRIMARY COMPLEX AND BCG VACCINATION |
Kul Bhushan: Souvenir of Shri A.V.Jasani TB Hospital,
Kotharia: 1978, 1-7. |
The article deals with primary complex and BCG
vaccination. Lodgement or implantation of tubercle bacilli, at any
site, in the body of an animal or human being is called primary
infection. The tissue response by accumulation of polymorphonuclear
leucocytes at the site of primary infection is termed as primary
focus. The tubercle bacilli are transported from the primary
focus to the lymph node through lymphatics. The primary focus,
the lymphangitis and regional lymphadenitis together constitute
primary complex. In 95% of cases it occurs in the lung: the initial
polymorphic leucocytic reaction in the primary focus and
the lymph nodes are soon augmented by large monocytes then epitheloid
cells and the Langhans' giant cells. In about 2-4 weeks the
reticuloendothehal system develops cell mediated immunity and tuberculo
hypersensitivity. Most of the primary complexes (lesions) become
innocuous after a short time harbouring the tubercle bacilli with
arrested activity, but live and potentially virulent. There is always
a lurking danger of these bacilli flaring up in the future to progressive
tuberculous disease. BCG vaccination is aimed at establishing a
controlled primary complex by intradermal injection of attenuated
(harmless) live, bovine strain of tubercle bacilli in an attempt
to forestall the infection with virulent tubercle bacilli among
the uninfected persons. At the site of vaccination, the lower half
of the left deltoid region, a primary focus is created from where
some bacilli are transported to axillary lymph node through the
lymphatics and complete the formation of primary complex. In 2-4
weeks time cell mediated immunity and delayed hypersensitivity are
initiated and is completed in about 6-8 weeks time and the vaccinated
persons show positive reaction to tuberculin test. The BCG lesion
heals in 4-6 weeks time.
The advantages of primary complex established
with BCG vaccination prior to a chance of natural infection
are: i) primary tuberculosis disease caused by it can be ruled out;
ii) there is no chance of spread of disease to adjoining parts i.e.,
haematogenous dissemination of disease leading to milliary, meningeal,
bone tuberculosis etc., is prevented; iii) also the danger of future
local flare up and thereby chances of disease after infection are
reduced. To obtain maximum advantage from the BCG vaccination, it
should be given at the earliest possible time in life of an individual.
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KEY WORDS: PRIMARY COMPLEX, BCG VACCINATION. |