Lymphadenitis Due to Nontuberculous Mycobacteria in Children: Presentation and Response to Therapy

Abstract

The most common manifestation of infection due to nontuberculous mycobacteria (NTM) in children is cervical lymphadenitis in an otherwise healthy patient. We identified and reviewed 19 cases of proven or presumptive lymphadenitis due to NTM seen at our hospital over the course of 13 months. Nine patients underwent initial surgical excision of involved lymph nodes. Ten children did not have involved lymph nodes excised initially and were treated with macrolide-containing antibiotic regimens. Of these patients, five required subsequent surgical excision and five were cured with combination chemotherapy. Six patients underwent radiographic imaging of the head and neck that revealed asymmetrical adenopathy with ring-enhancing masses but minimal inflammatory stranding of the subcutaneous fat, a finding that may distinguish adenitis caused by NTM from staphylococcal and streptococcal adenitis. Our data suggest that if surgical excision is not considered feasible, antimicrobial therapy for adenitis due to NTM may be beneficial for some patients.

Novel Mycobacterium Related to Mycobacterium triplex as a Cause of Cervical Lymphadenitis

“…Surgical excision achieves a high cure rate, but complete excision is often not feasible. Antibiotic therapy may be of benefit in some cases (12,13).…”

Granulomatous cervicofacial lymphadenitis in children: a nine-year study in Singapore

“…Four large, retrospective studies have demonstrated that surgical excision of infected nodes has a cure rate between 81% and 92%, which rises to 95% if there is early surgical intervention. (19)(20)(21)(22) A recent, well-conducted trial in which 100 children were randomised to either undergo surgical excision or receive at least 12 weeks of therapy with clarithromycin and rifabutin has shown surgery to be more effective than antibiotic therapy, with cure rates of 96% and 66%, respectively. (23) However, there was a reported complication rate of 28% in children who underwent surgery, which included secondary staphylococcal infection and transient or permanent facial nerve damage.…”

Mycobacterium fortuitum–induced persistent parotitis: Successful therapy with clarithromycin and ciprofloxacin

“…10,11 Contrastenhanced CT scan typically demonstrates asymmetrical cervical lymphadenitis and contiguous low-density, necrotic, ring-enhancing masses but with minimal inflammatory stranding of the subcutaneous fat, a finding that may distinguish lymphadenitis caused by NTM from other conventional bacteria. 12,13 Among NTM, M. fortuitum is an extremely rare cause of isolated lymphadenitis or neck abscess. 4,10,11,13 A history of dental procedures or defects in the immune system such as human immunodeficiency virus infection may provide insight to the cause of such an infection.…”

“…12,13 Among NTM, M. fortuitum is an extremely rare cause of isolated lymphadenitis or neck abscess. 4,10,11,13 A history of dental procedures or defects in the immune system such as human immunodeficiency virus infection may provide insight to the cause of such an infection. 4 However, in the present case, she was neither an immunocompromised patient nor receiving any dental procedure; CT scan ruled out cervical lymphadenitis.…”

“…In the past, NTM generally have shown poor in vitro susceptibility to standard antituberculous drugs, 14 and many authors have recommended surgical interventions including partial or total parotidectomies for NTM infection of the parotid gland lymph nodes. 13,15,16 Conversely, many studies show that clarithromycin, amikacin, cefoxitin, fluoroquinolones (ciprofloxacin and ofloxacin), doxycycline, imipenem, and sulfonamides have good in vitro activity against M. fortuitum. 17,18 A combina- tion of 2 or more agents should always be utilized, as with all mycobacterial infections, to avoid drug resistance.…”