Nontuberculous Mycobacterial Adenitis of the Head and Neck in Children: Experience From a Tertiary Care Pediatric Center

Abstract

Surgical excision is the treatment of choice of NTM adenitis because of the high cure rate with a single procedure, the excellent cosmetic result, and the low complication rate. NTM skin tests are safe and could be useful in early diagnosis of the infection but further investigation is needed.

Clinicopathological profile of cervicofacial masses in pediatric patients

“…Only 10 patients needed surgical excision. This is not in accordance with most of the authors [2]. High percentage of cure rates with conservative treatment can be attributed to seratiopeptidase which allows good penetration of antibiotics into the affected nodes.…”

Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections

“…Surgical excision of the infected lymph nodes is considered by experts to be the most effective treatment, especially for extensive cases, but it could be complicated by the anatomical site of infection and the proximity to important vessels and nerves [17,21,[24][25][26][36][37][38][39].…”

“…Their clinical course could vary from spontaneous cure to progression and spontaneous fistulisation; the latter situation is usually due to the liquefying process of the affected lymph node, which turns into a fluctuant lesion with necrosis in the granulomatous centre and with a characteristic changing in its overlying skin to a purple colour [18,19]. 80% of the patients presenting to a head and neck surgeon are at this stage [20,21].…”

“…So far, the proportion of infected lymph nodes with spontaneous recovery is unknown and, despite many reports available in literature have published about this item, the epidemiology and treatment of NTM lymphadenitis are still not well documented. Although surgical excision has been widely suggested as the treatment of choice for NTM cervical lymphadenitis [20,21,[24][25][26], with a reported complete resolution of the disease ranging from 80% to 96% of the cases, recent trials support the combined approach of surgery followed by antibiotic therapy [26][27][28]. In contrast, there are an increasing numbers of investigators reporting successful conservative treatment with antibiotics, in particular prolonged course of macrolides and rifampicin and/or ethambutol [16,[29][30][31][32].…”

Management of Infection With Nontuberculosis Mycobacteria

“…Optimal treatment of this condition is surgical excision, which has a lower reoperation rate than incision and drainage, curettage, or aspiration (17). Relapse and sinus formation are rare, occurring in less than 5% of cases (16,52). Antimicrobial chemotherapy appears to be unnecessary (2), although there are reports of successful management with clarithromycin monotherapy (53).…”