ReviewAnnals of medicine2026
Genetic and immunologic determinants of BCG disease: from mechanism to prevention.
Review in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBacillus Calmette-Guérin (BCG) infection, a disseminated infection triggered in immunocompromised hosts by the administration of the attenuated BCG vaccine, is characterized by a pathogenic mechanism that involves the synergistic interaction between host immune deficiencies and strain-specific genetic mutations.
methodsThis review synthesizes published multi-omics and proteomics findings from the past decade, along with reported results from
resultsThe study revealed the following findings: 1) The occurrence of BCG disease follows the "dual-hit model," where defects in the host interferon-gamma/interleukin-12 (IFN-γ/IL-12) signaling pathway (in 70% of cases) synergize with genetic mutations in BCG strains (such as pks12 and mma3), leading to immune evasion and disseminated infection; 2) Compared to Mtb, BCG strains exhibit reduced virulence due to the loss of the RD1 region, but strain heterogeneity leads to differences in cell wall lipid metabolism, which induces atypical systemic symptoms in immunocompromised hosts; 3) Some BCG strains display low-level resistance to isoniazid and rifampicin, with resistance linked to mma3 mutations (resulting in increased MIC for isoniazid) and inactivation of pncA (resulting in resistance to pyrazinamide); 4) Genetic modifications of strains (such as BCGΔBCG1419c vaccine), delayed vaccination, and individualized immune monitoring can effectively reduce the infection risk in immunocompromised hosts. T-cell receptor excision circles (TREC)/K-cell receptor excision circles (KREC) screening improves the identification rate of immunocompromised hosts.
conclusionBCG disease represents a typical case of host-pathogen interaction imbalance. Its prevention and control require an integrated approach combining molecular mechanisms and clinical practice improvements.
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