Cervicofacial nontuberculous mycobacterial lymphadenitis in children.

INTRODUCTION

Nontuberculous mycobacteria are ubiquitous organisms readily isolated from natural waters, drinking water systems and soil. They form a continuous challenge to the human immune system which becomes apparent in patients with impaired immunity. However, most infections occur in seemingly healthy children. The clinical presentation consists of a unilateral, non-tender, persistent, cervical lymphadenopathy without systemic illness. Fistula formation may occur.

MATERIAL AND

METHODS

Patients were included if one or more of the following were positive; 1) mycobacterial culture, 2) acid-fast microscopy, 3) polymerase chain reaction and/or 4) granulomatous inflammation.

RESULTS

On the basis of operative management, two distinct groups were established. Group 1 had an excision of all pathological tissue performed and Group 2 was treated with incision and drainage. There was a difference between the two groups in regard to the risk of developing a postoperative fistula. In Group 1, 50% developed a fistula compared with 91% in Group 2 (p = 0.06).

CONCLUSION

Surgical treatment is generally advocated as the treatment of choice. Antibiotic treatment is associated with adverse effects and avoidance of surgery does not justify the inferior results related to antibiotics. A watch-and-wait strategy or antibiotic therapy may be considered when surgical excision carries a high risk of facial nerve injury. Although the lymph nodes may persist for months, spontaneous regression may occur and the children remain systemically well.

FUNDING: not relevant.

TRIAL REGISTRATION: not relevant.