Management of non-tuberculous mycobacterial lymphadenitis in children
Abstract number: S278
The spectrum of clinical manifestations caused by nontuberculous mycobacteria (NTM) in immunocompetent individuals comprises three major categories: lymphadenitis, pulmonary infections and skin/soft tissue infections. Lymphadenitis due to NTM strikes mainly young children whereas pulmonary and skin/soft tissue infections are common in adults. The frequency of NTM lymphadenitis has increased over the past few decades. Diagnosis is based on clinical presentation, PPD skin test and bacterial isolation from nodal aspiration or incision. Mycobacterium scrofulaceum was the most common cause in the 1970s, replaced by M. avium-intracellulare complex (MAC) and M. haemophilum in last two decades. Management options are surgery, antibiotics or "observation only". Complete excision of the infected lymph node has been considered the optimal therapy by most researchers, however, it is associated with various side effects such as unacceptable scarring with or without keloid formation, wound breakdown, secondary staphylococcal infection and facial nerve paresis. Most facial nerve damage is transient, although in approximately 2% permanent palsy developed. Incision and drainage is performed when the lesions are too large to be excised. Few retrospective case series have demonstrated superiority of complete excision over incision and drainage. Pharmacologic therapy with clarithromycin alone, or combined with other antimycobacterial agents such as rifampicin, rifabutin, or ethanbutol have been reported. On the other hand, there are no controlled clinical trials showing the efficacy of chemotherapy versus placebo. Very few cases of "observation only" in children with NTM lymphadenitis were reported in the past. A recently published study described the natural history of 92 immunocompetent children with cervical NTM lymphadenitis. In most cases, the skin over affected lymph nodes underwent violaceous changes, with discharge of purulent material for 38 weeks. Total resolution was achieved within 6 months in 71% of the patients, and within 912 months in the remainder. No complications were observed, and at 2 years follow-up, a skin-colored flat scar in the region of the drainage was noted.
In conclusion, The optimal therapy for this condition is still controversial. Nevertheless, it seems that antibiotics are not very effective in treating immunocompetent children. A randomized, controlled trial examining surgical excision versus spontaneous healing is warranted.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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