Cervicofacial Lymphadenitis Due to Atypical Mycobacteria: A Surgical Disease

Abstract

Despite the increasing prevalence of cervicofacial lymphadenitis due to atypical mycobacteria (AMB) in children, the true nature of AMB infection in clinical practice is poorly understood. The purpose of our study was to define the most common signs and symptoms, and to establish a workable scheme of diagnosis and treatment. Patients fulfilling the criteria of AMB infection (i.e., clinical signs, positive cultures or polymerase chain reaction, histologic features) were included in the study. All children underwent a standard surgical procedure, depending on pretreatment and the course of the disease. Sixteen infants presented with characteristic unilateral lymphadenopathy predominantly involving the submandibular area (13/16). Eight children had been initially treated at various institutions by fine-needle puncture or incision, and 7 of the 16 patients had received antituberculous multidrug treatment for a varying length of time. Complete excision of the affected lymph nodes was the definitive treatment in all patients. Three children had transient marginal mandibular nerve paralysis that resolved within a few months in all cases. Recognition of the characteristic features of AMB adenitis may permit early diagnosis and appropriate surgical treatment.

Analysis of the interleukin-12/interferon-γ pathway in children with non-tuberculous mycobacterial cervical lymphadenitis

“…Submandibular involvement was found to be the most frequent location of the disease in most of the reports [30,32,35]. In contrast, the site of lymph node enlargement in our patients was mainly cervical.…”

“…Usually, PPD tuberculin test reacts weakly (5-15 mm) or negatively in NTM infection, whereas M. tuberculosis infection induces a strong positive reaction [20,30,32,35,38]. An induration of 5-15 mm was found in 12 of our patients while the remaining 2 had a strong reaction of more than 30 mm without any evidence of TB infection.…”

“…Children with NTM cervical lymph node involvement usually have few systemic signs at presentation such as fever (5/14, 35.7%) or respiratory tract infections [35,38]. Submandibular involvement was found to be the most frequent location of the disease in most of the reports [30,32,35].…”

“…Human NTM infection is usually acquired from contact with the environment rather than by person-to-person spread. Children aged 1-5 years are most commonly affected by contaminated objects in their mouth, and the most frequent manifestation of NTM infection is generally limited to lymphadenitis of the superior anterior cervical or submandibular nodes [30,35,43]. Cutaneous disease and pulmonary infections are the most frequent forms of NTM infection in adults, but are uncommon in children.…”

Tropical Skin Diseases in Children: A Review—Part II

“…This is a commonly encountered complex causing submandibular or preauricular lymphadenitis in children 1 to 5 years old (87% of cases are pediatric) affects both sexes equally (Table ) .…”