Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge

Abstract

Atypical mycobacteriosis (AM) is a rare disease, which is caused by an infection with mycobacteria other than tuberculosis (MOTT). In children, the cervical lymph nodes are frequently affected. MOTT are a pathogen or facultative pathogen environmental germs, which can affect otherwise healthy individuals. The diagnostic and therapeutic management is often challenging. Currently, there are only few data published about the systematic investigation and therapy of children with AM. In a retrospective study, 29 children with AM were evaluated. The clinical records of these patients were reviewed and analyzed along with the results of histopathological and microbiological findings. The clinical parameters were correlated to patients' therapy and clinical follow-up. 29 otherwise healthy and immunocompetent children (18 girls, 11 boys, average age of 3.5 years, range 1.5-9.5 years) with AM of the head and neck region have been evaluated. Clinically, all patients were admitted with a swelling of cervical lymph nodes and discoloration of the overlaying skin. In five patients, an abscess formation of the lymph nodes occurred. Ultrasound examinations typically revealed a hypoechoic mass with central necrosis and intralesional septa. Histologically, epithelioid granuloma with caseating necrosis was described in any case. Germ identification by either microbiological culture or PCR was successful in 20 cases, with Mycobacterium avium and Mycobacterium intercellulare being the most frequent germs. In all patients, lymph nodes were surgically removed. In a clinical follow-up of at least 18 months, a recurrence occurred in five cases. Diagnosis of atypical mycobacteriosis is often difficult and challenging, since clinical appearance is unspecific and MOTT can only be identified microbiologically or by PCR in about two-thirds of cases. Therefore, a close cooperation between clinician, pathologist, and microbiologist is required. Therapeutically excision of all affected lymph nodes is recommended. Alternative or concomitant medical treatment with tuberculostatics is indicated in particular cases, i.e., recurrence, persistence or systemically lymph node involvement.

Cutaneous Mycobacterium avium‐intracellulare infection masquerading as sarcoidosis

“…Cutaneous manifestations of MAC infection are rare and may include pustules, papules, erythematous plaques, painless yellow plaques, painful nodules, granulomas, abscesses, verrucous ulcers, ulcerations, and panniculitis and are most commonly localized to the head and neck. [4][5][6] The variable presentation of MAC infections and the difficulty of culture and proper identification of the organism on hematoxylin and eosin staining can pose a diagnostic challenge, as well as the histopathological findings that may mimic other conditions such as sarcoidosis, as in our case. In fact, several reports in the literature describe cases where mycobacterial cutaneous lesions were initially misdiagnosed as sarcoidosis.…”

Late recurrence in surgically managed pediatric atypical mycobacterial lymphadenitis: A case report and review of the literature

“…The patient in this study was initially treated in a combination method with complete excision followed by 12 months of rifabutin. At the time of recurrence this patient was treated with a 10‐month regime of clarithromycin, rifabutin, and ethambutol 13 . All studies described treating recurrence in a broad variety of ways.…”

“…Neven et al described that 54% ( n = 7) of cases treated with incomplete excision in their cohort required a second surgical intervention for complete excision due to persistent infection or recurrence occurring between 18 days and 25 months after the initial intervention 7 . Many of the included papers discussed the trend of initial complete excision being associated with lower rates of recurrence 1,7,9,13,14,18,22 . Another frequent discussion was the association between previous biopsy (incision and drainage or FNA) being associated with higher rates of recurrence, even after complete excision 7,16 .…”

“…7 Many of the included papers discussed the trend of initial complete excision being associated with | 361 lower rates of recurrence. 1,7,9,13,14,18,22 Another frequent discussion was the association between previous biopsy (incision and drainage or FNA)…”

Zervikale Lymphadenitis durch atypische Mykobakterien bei Kindern mit unterschiedlichem Wohnsitz

“…Luong et al haben in ihrer Studie eine Kombination aus Clarithromycin und Ethambutol oder Rifampicin sowie aus Rifampicin und Isoniazid mit oder ohne Clarithromycin vorgezogen [20]. Lindeboom et al [21] haben eine Therapie mit der Kombination Clarithromycin-Rifabutin und Deichmueller et al [18] eine Monotherapie mit Clarithromycin oder eine Kombination von Clarithromycin mit entweder Rifampicin oder Rifabutin durchgeführt. Generell zeigt sich in der Literatur eine große Heterogenität bezüglich der verabreichten antibiotischen Schemata, die möglicherweise vom Zeitpunkt der Studie und der lokalen Therapieprotokolle abhängig sind.…”