Childhood nontuberculous mycobacterial lymphadenitis-observation alone is a good alternative to surgery

Int J Pediatr Otorhinolaryngol. 2020 Feb:129:109778. doi: 10.1016/j.ijporl.2019.109778. Epub 2019 Nov 12.

Abstract

Objective: Cervicofacial lymphadenitis caused by nontuberculous mycobacteria (NTM) is commonly treated with surgery or antimicrobial therapy. The aim of this study was to analyze the utility of our new blood-based diagnostic method and the treatment protocol, surgery or observation alone, in NTM lymphadenitis in children.

Methods: All patients under 16 years of age with cervicofacial NTM lymphadenitis diagnosed and treated at Children's Hospital or at the Department of Otorhinolaryngology, Helsinki University Hospital (Helsinki, Finland) in 2007-2017 were retrospectively reviewed.

Results: Fifty-two patients, 33 (63%) of whom were girls, were included in the study. The median age at initial presentation of the NTM lymphadenitis was 2.9 years. The novel blood-test had been performed on 49 (94%) of the patients and in all of them it was indicative of NTM infection. A sample for mycobacterial culture was available from 34 patients, and Mycobacterium avium was the most common species detected. Most patients (n = 33, 63%) were treated conservatively with observation alone. Of these, nine patients (27%) did not develop a skin fistula, and the lymphadenitis resolved without drainage.

Conclusions: The novel blood test is clinically feasible method for diagnosing childhood cervicofacial NTM lymphadenitis noninvasively. Observation alone is a good alternative to surgery, without the risk of complications.

Keywords: Children; Lymphadenitis; Non-tuberculous mycobacteria.

MeSH terms

  • Child
  • Child, Preschool
  • Drainage
  • Face
  • Female
  • Humans
  • Infant
  • Lymphadenitis / microbiology
  • Lymphadenitis / therapy*
  • Male
  • Mycobacterium Infections, Nontuberculous / blood
  • Mycobacterium Infections, Nontuberculous / complications
  • Mycobacterium Infections, Nontuberculous / diagnosis*
  • Mycobacterium Infections, Nontuberculous / therapy*
  • Neck
  • Retrospective Studies
  • Watchful Waiting*