Intrathoracic Mycobacterium avium Complex Infection in Immunocompetent Children: Case Report and Review

Abstract

Mycobacterium avium complex (MAC) infection is a rarely recognized cause of intrathoracic infection in immunocompetent children. The incidence of this disease is unknown but is likely underestimated among children in whom MAC infection is not usually considered. An increase in the number of cases of MAC infection in adults has been noted since the late 1970s. The number of these cases in children with AIDS has also increased. There are currently no guidelines for the treatment of these children. We describe a previously healthy 14-month-old boy with a mediastinal mass for whom tuberculosis was initially diagnosed; subsequently, biopsy-proven infection with MAC was demonstrated. He received no specific therapy after surgical excision of his intrathoracic mass and has done well since. We reviewed eight additional cases of intrathoracic nontuberculous mycobacteria infection in children that were reported from 1979 to 1994 and found excellent outcomes for seven immunocompetent children who received diverse methods of treatment.

A foreign body alternative

“…This is demonstrated by this case, where definitive excision of the lesions has been delayed in favour of a symptom‐based surgical approach, due to the risks posed to vital structures. Medical regimens are extrapolated from the treatment of HIV affected children and adults, in whom there is more extensive experience 6 . Usually a combination of three drugs is recommended, one of which should be clarithromycin or azithromycin.…”

“…Many cases are treated with a combination of surgical resection and then medical therapy to treat residual disease. Occasional cases have been treated with surgical excision of the affected nodes alone 6 . Regardless of the therapy used, close observation of the patient during and after treatment is important to monitor for recurrence.…”

“…Medical regimens are extrapolated from the treatment of HIV affected children and adults, in whom there is more extensive experience. 6 Usually a combination of three drugs is recommended, one of which should be clarithromycin or azithromycin. Other adjunctive agents are ciprofloxacin, isoniazid, rifabutin, rifampicin, amikacin, and ethambutol.…”

A toddler with a cough and wheeze refractory to treatment

“…Only 3/43 patients suffered relapse of their disease. Fergie et al 6 reviewed eight cases of intrathoracic NTM infection, seven of which were in immunocompetent patients and one patient with acquired hypogammoglobulinaemia. In the seven immunocompetent patients, all were cured, after they received a variety of treatments involving two to three antibiotics used for 2–14 months.…”

Intrathoracic nontuberculous mycobacterial infections in otherwise healthy children

“…[5][6][7][8] There have been several reports in recent years of isolated thoracic mycobacterial disease in apparently immunocompetent children without evidence of CF. [9][10][11][12][13] Disease has been limited to endobronchial lesions or hilar adenopathy, as opposed to pulmonary NTM disease in immunocompetent adults, which tends to be parenchymal. Adult lung disease due to NTM occurs in older smokers or older Caucasian women often associated with CFTR mutations.…”