Lymphadenitis by non‐tuberculous mycobacteria in children

Abstract

Background Non‐tuberculous mycobacteria (NTM) constitute an important cause of cervical lymphadenitis in immunocompetent children. The aims of this study were to estimate the incidence of lymphadenitis due to NTM in children in Cyprus and to describe the characteristics, diagnostic approach, management and outcome of such infections. Methods Children aged 1–5 years old, evaluated at Archbishop Makarios III Hospital, Nicosia, Cyprus, from 1 January 2007 to 31 December 2016 for lymphadenopathy, were included in the study. All children had positive lymph node culture for NTM. Results A total of 22 cases of culture‐positive lymphadenitis caused by NTM were reviewed. Patient age ranged from 16 to 55 months. Tuberculin skin test produced an induration in 81.0% of cases (diameter, 4–17 mm). Mycobacterium avium was isolated in 17 cases (77.3%), M. intracellulare in three (13.6%), M. paraffinicum in one (4.5%) and M. kansasii in one case (4.5%). All 22 patients underwent surgical excision of affected nodes. Additional anti‐mycobacterial treatment was given when complete excision was not achieved or for post‐surgical recurrence. Complications were few and included scar in three children and one case of transient facial nerve palsy. Conclusion Surgical excision of NTM‐infected lymph nodes is an effective diagnostic and therapeutic approach. When total surgical excision is not feasible, a combination of partial excision with a clarithromycin‐including drug regimen appears safe, effective and causes milder and fewer complications than surgery alone.

Non-Tuberculous Mycobacterial Diseases in Children

“…In population-based surveillance studies, estimates of the annual incidence of NTMs in children range widely from 0.8/100,000 children < 15 years in Australia to 3.1/100,000 children < 15 years or 11.3/100,000 children < 5 years in Germany and 0.8/100,000 children < 18 years in the Netherlands [14]. In children, NTM infection typically affects cervicofacial lymph nodes and manifests itself with an enlarged lymph node in the laterocervical region that appears as a painless lump that can spontaneously drain within weeks/months.…”

“…Surgery is the gold standard treatment for cervical lymphadenitis. Many authors have shown that surgery is effective, having an 81-100% cure rate with primary excision versus 45% for incision and drainage [1,13,14,16]. Then, the advantage of surgery is to allow histological and microbiological diagnosis.…”

Long-Term Outcome of Surgical Treatments for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

“…25 In a retrospective study by Loizos et al , 22 patients with confirmed NTM infections were treated with excisions. 26 However, in 12 cases, recurrences were observed. Five of these occurred in the first 2 months after surgery and required a second operation.…”

Ethambutol-resistant Mycobacterium kansasii cervical lymphadenitis in an immunocompetent adult patient: A case report and literature review

“…Ours is the 6th reported case of M. kansasii extrapulmonary lymphadenitis in immunocompetent adults; 5 cases in children under 18 have also been reported. (Table 1) [6], [7], [8], [9], [10], [11], [12], [13], [14]. Sites of dissemination included cervical and mediastinal lymph nodes, skin, brain, soft tissue, joint, and peritoneum.…”