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Shah KV, Peraza LR, Wiedermann JP. Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population. Curr Opin Otolaryngol Head Neck Surg 2023; 31:388-396. [PMID: 37712822 DOI: 10.1097/moo.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to analyze and consolidate recently published literature to provide updated guidelines on the diagnosis and management of nontuberculous mycobacterial lymphadenitis (NTM LAD) in the pediatric population and to suggest areas of further research. RECENT FINDINGS Diagnosis of NTM LAD relies on a detailed clinical history, physical examination, laboratory tests, and imaging techniques. Treatment strategies vary widely, with a shift towards complete surgical excision being observed due to its higher cure rate, improved aesthetic outcomes, and lower recurrence rates. However, patient-specific factors must be considered. The role of genetic factors, such as Mendelian susceptibility to mycobacterial disease (MSMD), is being increasingly recognized and could lead to targeted therapies. SUMMARY Despite strides in the understanding and management of NTM LAD, substantial gaps remain in key areas such as the role of diagnostic imaging, optimal treatment parameters, postoperative care, and surveillance strategies. In this article, we explain our approach to NTM using the most relevant evidence-based medicine while offering directions for future work.
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Affiliation(s)
- Keshav V Shah
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lazaro R Peraza
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua P Wiedermann
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Roy CF, Balakrishnan K, Boudewyns A, Cheng A, Chun RH, Daniel SJ, Fayoux P, Hart C, Hemansson A, Hewitt R, Hsu WC, Kuo M, Liu C, Maddalozzo J, Messner AH, Pransky S, Rahbar R, Rickert S, Roy S, Russell J, Rutter MJ, Sie KCY, Sidell D, Smith R, Soma M, Spratley J, Watters K, White DR, Wolter N, Zalzal G, Yeung JC. International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of non-tuberculous mycobacterial cervicofacial lymphadenitis. Int J Pediatr Otorhinolaryngol 2023; 166:111469. [PMID: 36764081 DOI: 10.1016/j.ijporl.2023.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. OBJECTIVES This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. METHODS A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. SETTING Multinational, multi-institutional, tertiary pediatric hospitals. RESULTS Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. CONCLUSION The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation.
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Affiliation(s)
- Catherine F Roy
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sam J Daniel
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Lille, F-59000, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ann Hemansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Richard Hewitt
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wei-Chung Hsu
- Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Michael Kuo
- Department of Pediatric Otolaryngology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Christopher Liu
- Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Dallas, TX, USA
| | - John Maddalozzo
- Department of Otolaryngology/Head and Neck Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Anna H Messner
- Department of Otolaryngology/Head & Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Seth Pransky
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - Reza Rahbar
- Department of Pediatric Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA
| | - Soham Roy
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - John Russell
- Department of Pediatric Otorhinolaryngology, Children's Health Ireland (Crumlin), Dublin, Ireland
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, USA
| | - Douglas Sidell
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Richard Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal
| | - Karen Watters
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - David R White
- Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Nikolaus Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George Zalzal
- Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Jeffrey C Yeung
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada.
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Al Bulushi Y, Saint-Martin C, Muthukrishnan N, Maleki F, Reinhold C, Forghani R. Radiomics and machine learning for the diagnosis of pediatric cervical non-tuberculous mycobacterial lymphadenitis. Sci Rep 2022; 12:2962. [PMID: 35194075 PMCID: PMC8863781 DOI: 10.1038/s41598-022-06884-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Non-tuberculous mycobacterial (NTM) infection is an emerging infectious entity that often presents as lymphadenitis in the pediatric age group. Current practice involves invasive testing and excisional biopsy to diagnose NTM lymphadenitis. In this study, we performed a retrospective analysis of 249 lymph nodes selected from 143 CT scans of pediatric patients presenting with lymphadenopathy at the Montreal Children’s Hospital between 2005 and 2018. A Random Forest classifier was trained on the ten most discriminative features from a set of 1231 radiomic features. The model classifying nodes as pyogenic, NTM, reactive, or proliferative lymphadenopathy achieved an accuracy of 72%, a precision of 68%, and a recall of 70%. Between NTM and all other causes of lymphadenopathy, the model achieved an area under the curve (AUC) of 89%. Between NTM and pyogenic lymphadenitis, the model achieved an AUC of 90%. Between NTM and the reactive and proliferative lymphadenopathy groups, the model achieved an AUC of 93%. These results indicate that radiomics can achieve a high accuracy for classification of NTM lymphadenitis. Such a non-invasive highly accurate diagnostic approach has the potential to reduce the need for invasive procedures in the pediatric population.
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Affiliation(s)
- Yarab Al Bulushi
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Montréal, QC, H4A 3S9, Canada.,Department of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.,Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Christine Saint-Martin
- Department of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Nikesh Muthukrishnan
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Montréal, QC, H4A 3S9, Canada
| | - Farhad Maleki
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Montréal, QC, H4A 3S9, Canada
| | - Caroline Reinhold
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Montréal, QC, H4A 3S9, Canada.,Department of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Reza Forghani
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Montréal, QC, H4A 3S9, Canada. .,Department of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada. .,Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and Division of Medical Physics, University of Florida, PO Box 100374, Gainesville, FL, 32610-0374, USA.
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Martínez-Planas A, Baquero-Artigao F, Santiago B, Fortuny C, Méndez-Echevarría A, Del Rosal T, Bustillo-Alonso M, Gale I, Guerrero C, Blázquez-Gamero D, Canet A, Lillo M, Calavia O, Núñez Cuadros E, Falcón-Neyra L, Soriano-Arandes A, Van Ingen J, Tebruegge M, Noguera-Julian A. Interferon-Gamma Release Assays Differentiate between Mycobacterium avium Complex and Tuberculous Lymphadenitis in Children. J Pediatr 2021; 236:211-218.e2. [PMID: 33984332 DOI: 10.1016/j.jpeds.2021.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis. STUDY DESIGN Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database. RESULTS Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P < .001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P < .001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P < .001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ = 0.017), but good in TB cases (95.6%; κ = 0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis. CONCLUSIONS In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.
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Affiliation(s)
- Aina Martínez-Planas
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Fernando Baquero-Artigao
- Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz, Madrid, Spain; Fundación IdiPaz, Madrid, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Begoña Santiago
- Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain; Department of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute, Madrid, Spain
| | - Clàudia Fortuny
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain
| | - Ana Méndez-Echevarría
- Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz, Madrid, Spain; Fundación IdiPaz, Madrid, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Teresa Del Rosal
- Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz, Madrid, Spain; Fundación IdiPaz, Madrid, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | | | - Inés Gale
- Pediatrics Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Carmelo Guerrero
- Pediatrics Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Daniel Blázquez-Gamero
- Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain; Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain; Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Anna Canet
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Lillo
- Pediatrics Department, Hospital General Universitario de Albacete, Albacete, Spain
| | - Olga Calavia
- Pediatrics Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Esmeralda Núñez Cuadros
- Division of Pediatric Rheumatology, Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, Spain
| | - Lola Falcón-Neyra
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Infection in the Immunocompromissed Child Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jakko Van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Department of Pediatrics, The University of Melbourne, Parkville, Australia; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain.
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Willemse SH, Karssemakers LHE, Oomens MAEM, Schreuder WH, Lindeboom JA, van Wijk AJ, de Lange J. Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal. Int J Oral Maxillofac Surg 2020; 49:1392-1396. [PMID: 32371179 DOI: 10.1016/j.ijom.2020.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0-15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case-control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04-1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13-8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.
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Affiliation(s)
- S H Willemse
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
| | - L H E Karssemakers
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M A E M Oomens
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J A Lindeboom
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Amstelland Hospital, Amstelveen, The Netherlands
| | - A J van Wijk
- Department of Social Dentistry, ACTA, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - J de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
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Gallois Y, Cogo H, Debuisson C, Guet-Revillet H, Brehin C, Baladi B, Calmels MN. Nontuberculous lymphadenitis in children: What management strategy? Int J Pediatr Otorhinolaryngol 2019; 122:196-202. [PMID: 31039497 DOI: 10.1016/j.ijporl.2019.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a "wait-and-see" approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. METHODS Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as "proven diagnosis" (NTM detected), "highly probable" (suggestive clinical and anatomopathological aspect) or "possible" infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. RESULTS Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85-3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20-13.43]). We found 17 "proven diagnosis" (58.62%), 5 "highly probable" (17.24%) and 7 "possible" infections (24.14%). "Proven" infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17-7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. CONCLUSION Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of "wait-and-see" attitude in the literature make excision surgery a second line treatment.
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Affiliation(s)
- Yohan Gallois
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France.
| | - Haude Cogo
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Cécile Debuisson
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Guet-Revillet
- Bacteriology and Hygiene Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
| | - Camille Brehin
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Blandine Baladi
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
| | - Marie-Noëlle Calmels
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
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7
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Della Bella C, Venturini E, Devente S, Piccini P, Tapinassi S, Bianchi L, Grassi A, Benagiano M, Alnwaisri HFM, Montagnani C, Chiappini E, Bitter W, D’Elios MM, de Martino M, Galli L. Role of Mycobacterium avium lysate INF-γ, IL-17, and IL-2 ELISPOT assays in diagnosing nontuberculous mycobacteria lymphadenitis in children. Eur J Clin Microbiol Infect Dis 2019; 38:1113-1122. [DOI: 10.1007/s10096-019-03506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
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Marsicek SM, Odom B, Woodard A, Hopkins A. Time for a Time-out: The Value of a Diagnostic Time-out in Prolonged Fever and Lymphadenopathy. Hosp Pediatr 2019; 9:139-141. [PMID: 30700501 DOI: 10.1542/hpeds.2018-0176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sarah M Marsicek
- Office of Medical Education, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Brittany Odom
- Office of Medical Education, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Alyssa Woodard
- Office of Medical Education, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Akshata Hopkins
- Office of Medical Education, Johns Hopkins All Children's Hospital, St Petersburg, Florida
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9
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Emergence of Nontuberculous Mycobacterial Lymphadenitis in Children After the Discontinuation of Mandatory Bacillus Calmette and GuÉrin Immunization in France. Pediatr Infect Dis J 2018; 37:e257-e260. [PMID: 29570591 DOI: 10.1097/inf.0000000000001977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eighty-five children were diagnosed with culture-confirmed nontuberculous mycobacterial cervical lymphadenitis within the MYCOMED surveillance network from 2004 to 2013. The mean incidence sharply increased from 0.57 to 3.7 per 100,000 children per year, after the discontinuation of mandatory bacillus Calmette and Guérin immunization in 2007. Cases were documented as Mycobacterium avium (62.3%), Mycobacterium intracellulare (15.3%) and Mycobacterium lentiflavum (12.9%). Outcome was favorable in all, with or without surgery or antimycobacterial treatment.
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10
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Willemse SH, Oomens MAEM, De Lange J, Karssemakers LHE. Diagnosing nontuberculous mycobacterial cervicofacial lymphadenitis in children: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 112:48-54. [PMID: 30055739 DOI: 10.1016/j.ijporl.2018.06.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Widespread controversy exists regarding correct diagnosing nontuberculous mycobacterial cervicofacial (NTM) lymphadenitis. This study intends to gather the available evidence with respect to diagnosing NTM cervicofacial lymphadenitis. METHODS A review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-statement (www.prisma-statement.org). A comprehensive search was performed in the bibliographic databases PubMed, Embase.com and Wiley/Cochrane Library. 10 Articles fulfilled the inclusion criteria and were included in the review. Assessing risk of bias of the articles was done using the revised Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. RESULTS This systematic review shows that diagnostic studies of high methodological quality are scarce. Diagnostic accuracy of polymerase chain reaction (PCR), culture, skin testing, auramine staining, Ziehl-Neelsen staining, and immunodiagnostic assays was studied. Culture sensitivity proved to be 41,8%, while polymerase chain reaction has a sensitivity of 71,6%. Both methods showed a specificity of 100%. Sensitivity of Immunodiagnostic assays ranged between 87,5% and 100% and specificity between 81% and 100%. Overall sensitivity of skin tests containing purified protein derivative (PPD-S) was 70% (95% CI [62%-78%]) with an overall specificity of 94% (95% CI [88%-100%]). CONCLUSIONS In patients with a high clinical suspicion for NTM cervicofacial lymphadenitis, a positive PPD-S skin is indicative for the diagnosis of NTM cervicofacial lymphadenitis. Either PCR or culture is necessary to confirm the diagnosis. Interferon-γ release assays with purified protein derivative stimulation appear to provide good sensitivity and specificity as a non-invasive pre-operative test, but the evidence is weak. More studies of high methodological quality are needed to validate the results of this systematic review.
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Affiliation(s)
- S H Willemse
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A E M Oomens
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - J De Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - L H E Karssemakers
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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11
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Kavookjian H, Jones JW, Shah S, Escobar H, Swanson D, Nicklaus P. Endobronchial Non-Tuberculosis Mycobacterium Infection Presenting in a Healthy Child. Ann Otol Rhinol Laryngol 2018; 127:726-730. [PMID: 29962232 DOI: 10.1177/0003489418784970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a safe and effective treatment for endobronchial Mycobacterium avium complex. METHODS Case report and literature review. RESULTS We present a case of endobronchial M. avium complex in a healthy child treated with serial carbon-dioxide laser excisions and antibiotic triple therapy using azithromycin, rifampin, and ethambutol. No current guideline for the treatment of these lesions in the pediatric population exists. CONCLUSIONS In patients with airway impingement, serial endoscopic surgical resection combined with antibiotics can provide safe and effective management.
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Affiliation(s)
- Hannah Kavookjian
- 1 Department of Otolaryngology Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joel W Jones
- 1 Department of Otolaryngology Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sweeti Shah
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Hugo Escobar
- 3 Department of Pulmonology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Douglas Swanson
- 4 Department of Infectious Disease, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Pamela Nicklaus
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
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12
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Sigg N, Bailleul S, Turmel JM, Legrand G, Kettani S, Martin L. [Non-tuberculous mycobacterial cervical adenitis in children: 2 cases]. Ann Dermatol Venereol 2018; 145:505-511. [PMID: 29773279 DOI: 10.1016/j.annder.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 01/07/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management. PATIENTS AND METHODS We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision. DISCUSSION NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve. CONCLUSION Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.
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Affiliation(s)
- N Sigg
- Service de dermatologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
| | - S Bailleul
- Service d'ORL, clinique de l'Anjou, 9, rue de l'Hirondelle, 49000 Angers, France
| | - J-M Turmel
- Service des maladies infectieuses et tropicales, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - G Legrand
- Service d'ORL, clinique de l'Anjou, 9, rue de l'Hirondelle, 49000 Angers, France
| | - S Kettani
- Centre de pathologie de l'Ouest, 2, rue de l'Appentis, 49000 Angers, France
| | - L Martin
- Service de dermatologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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13
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Spinelli G, Mannelli G, Arcuri F, Venturini E, Chiappini E, Galli L. Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections. Int J Pediatr Otorhinolaryngol 2018; 108:137-142. [PMID: 29605343 DOI: 10.1016/j.ijporl.2018.02.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-tuberculous mycobacteria are the most frequent cause of chronic lymphadenitis in children. We reviewed treatment and outcomes of paediatric patients with chronic cervical lymphadenitis, to better understand their differential diagnosis, surgical indication, complication and recover. METHODS A retrospective study was carried out on children who underwent surgery from 2013 to 2016 at Meyer Children's University Hospital, Florence, Italy. Time to cure, type of surgery, and complications rate were determined and etiologic agents were identified and correlated to their clinical presentation. RESULTS 275 children were evaluated. Nearly 98% of the patients were cured regardless of which therapeutic option was used and surgery was necessary in 38.2% of children. Complete excisional biopsy ensured recover in 97.7% of patients compared with the non-excisional surgical group 88.2% (p = 0.06). Re-interventions were needed in the 2.3% of complete excision group and in two cases of the incision and drainage group; all of them developed fistula and were caused by Mycobacterium avium complex. Excision followed by adjunctive antibiotic therapy was favoured in the majority of the patients (80.1%, n = 71). CONCLUSION In cases of non-tuberculous mycobacteria lymphadenitis, surgery is the treatment of choice and it is closely related to a favourable prognosis.
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Affiliation(s)
| | - Giuditta Mannelli
- Clinic of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy.
| | | | - Elisabetta Venturini
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - Elena Chiappini
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
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14
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Naselli A, Losurdo G, Avanzini S, Tarantino V, Cristina E, Bondi E, Castagnola E. Management of nontuberculous mycobacterial lymphadenitis in a tertiary care children's hospital: A 20year experience. J Pediatr Surg 2017; 52:593-597. [PMID: 27614809 DOI: 10.1016/j.jpedsurg.2016.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/27/2016] [Accepted: 08/13/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Nontuberculous mycobacteria are uncommon cause of chronic cervicofacial lymphadenitis in healthy children. We describe clinical features and management strategies of cervicofacial nontuberculous mycobacterium lymphadenitis in a tertiary pediatric hospital. METHODS Retrospective analysis of medical records of children discharged from 1992 to 2014 with a diagnosis of cervicofacial nontuberculous mycobacterium was made. Diagnosis certainty was based on microhistological investigations. Clinical stage was evaluated according to lymph node size and presence of fistulas. Successful therapy was defined by the regression of the lymph node enlargement (>75%) or complete surgical excision without relapse. RESULTS Cervicofacial nontuberculous mycobacterium was diagnosed in 33 patients. Complete excision was performed in 73% of cases primarily observed in our hospital, while 83% of those referred from other hospitals required further surgical treatment. No case of relapse was observed after one year of follow-up. CONCLUSIONS We recommend surgical approach as the first therapeutic option in the management of cervicofacial nontuberculous mycobacterium lymphadenitis. LEVELS OF EVIDENCE Prognosis and Retrospective Study - Level II.
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Affiliation(s)
- Aldo Naselli
- Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Giuseppe Losurdo
- Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Stefano Avanzini
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Vincenzo Tarantino
- Otorhinolaryngology Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Emilio Cristina
- Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Elisabetta Bondi
- Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy.
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Ruiz del Olmo Izuzquiza I, Bustillo Alonso M, Monforte Cirac ML, Burgués Prades P, Guerrero Laleona C. Lymphadenitis due to non-tuberculous mycobacteria: Experience over 15 years. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Ruiz Del Olmo Izuzquiza I, Bustillo Alonso M, Monforte Cirac ML, Burgués Prades P, Guerrero Laleona C. [Lymphadenitis due to non-tuberculous mycobacteria: Experience over 15 years]. An Pediatr (Barc) 2016; 86:115-121. [PMID: 27052399 DOI: 10.1016/j.anpedi.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). MATERIAL AND METHODS A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. INCLUSION CRITERIA patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. RESULTS Twenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months-8 years). The mean time between the symptoms onset and first consultation was 1.7±1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96±1.26cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. CONCLUSIONS The most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients.
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Affiliation(s)
| | - Matilde Bustillo Alonso
- Unidad de Infectología, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | | | - Pedro Burgués Prades
- Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - Carmelo Guerrero Laleona
- Unidad de Infectología, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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17
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Dovriki E, Gerogianni I, Petinaki E, Hadjichristodoulou C, Papaioannou A, Gourgoulianis K. Isolation and identification of nontuberculous mycobacteria from hospitalized patients and drinking water samples--examination of their correlation by chemometrics. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:247. [PMID: 27021690 DOI: 10.1007/s10661-016-5258-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
Nontuberculous mycobacteria (NTM) have been found to be widely dispersed in the environment and are being considered potentially pathogenic for humans and animals, while reports of their human to human transmission are absent. Water and aerosols are potential transmission modes of NTM to humans. Hospitalized patients with NTM infections were studied together with drinking water samples from their respective residence areas during 2003-2013. Cluster analysis and factor analysis were used to analyze the data matrix. A total of 367 hospitalized patients living in 30 localities in the Prefecture of Larissa were tested positive for NTM. The most frequently isolated NTM species of the 383 NTM isolates from the clinical specimens were Mycobacterium fortuitum (n = 118, 30.8 %), M. gordonae (n = 87, 22.7 %), M. peregrinum (n = 46, 12.0 %), M. chelonae (n = 11, 2.9 %), M. avium (n = 8, 2.1 %), and M. intracellulare (n = 7, 1.8 %), while 88 (23.0 %) of these isolates were not identified. It is noted that in 8 patients, M. tuberculosis was isolated simultaneously with one NTM, in 15 patients, together with two types of NTM, while in 1 patient, it was found at the same time as three different NTM. In addition, 3360 drinking water samples were collected from 30 localities and analyzed during 2010 to 2013; they were found 11.2 % NTM positive. Cluster analysis and factor analysis results confirm that NTM strains are correlated to each other in both isolated samples from patients and drinking water, while the strength of their correlation varied from weak to moderate (e.g., factor loadings ranged from 0.69 to 0.74 when all data are considered). These results provide indications that drinking water could be linked with NTM cases in humans.
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Affiliation(s)
- Eleni Dovriki
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece.
| | - Irini Gerogianni
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Efi Petinaki
- Department of Microbiology, Medical School, University of Larissa, Larissa, Greece
| | | | - Agelos Papaioannou
- Department of Medical Laboratories, Technological Education Institution of Thessaly, Larissa, Greece
| | - Kostas Gourgoulianis
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
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18
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Mahadevan M, Neeff M, Van Der Meer G, Baguley C, Wong WK, Gruber M. Non-tuberculous mycobacterial head and neck infections in children: Analysis of results and complications for various treatment modalities. Int J Pediatr Otorhinolaryngol 2016; 82:102-6. [PMID: 26857325 DOI: 10.1016/j.ijporl.2015.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Analyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications. METHODS Retrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive. RESULTS 104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n=48, 46%), cervical (n=40, 38%), parotid (n=18, 17%) and submental (n=4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p<0.01) versus incisional interventions (44%, p<0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p<0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula. CONCLUSIONS Excision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.
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Affiliation(s)
- M Mahadevan
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand.
| | - M Neeff
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand
| | - G Van Der Meer
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand
| | - C Baguley
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand
| | - W K Wong
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand
| | - M Gruber
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Starship Children's Hospital, Private bag 9204, Auckland 1142, New Zealand
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19
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Melenotte C, Edouard S, Lepidi H, Raoult D. [Diagnosis of infectious lymphadenitis]. Rev Med Interne 2015; 36:668-76. [PMID: 26021493 DOI: 10.1016/j.revmed.2015.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 01/15/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
Adenitis is a common disorder requesting numerous medical specialties. Etiologies are dominated by viral and bacterial infections, and more rarely parasitic, or by neoplastic and inflammatory diseases. Nevertheless, etiology remains often unknown and invasive tests may be required. On nodal tissue sample, histological examination, culture and polymerase chain reaction (PCR) are realized. PCR has revolutionized the diagnostic approach and consequently, knowledge of infectious lymphadenopathy. Previously, staphylococcus, streptococcus and mycobacterium were the main infectious agents identified in lymph nodes. Since its use, new emergent microorganisms responsible of lymphadenitis have been identified. Bartonella henselae, responsible of cat scratch disease, is to date the infectious agent most often encountered in adenitis. Mycobacterium avium subsp. hominisuis has been recently described as responsible of children lymphadenitis. PCR has become an essential tool in the diagnostic process of infectious lymphadenitis. Here, we propose a literature review on infectious adenitis and we emphasize the diagnostic strategy of adenitis.
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Affiliation(s)
- C Melenotte
- Faculté de médecine, URMITE, UM63, CNRS 7278, IRD198, Inserm 1095, Aix Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - S Edouard
- Faculté de médecine, URMITE, UM63, CNRS 7278, IRD198, Inserm 1095, Aix Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - H Lepidi
- Faculté de médecine, URMITE, UM63, CNRS 7278, IRD198, Inserm 1095, Aix Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - D Raoult
- Faculté de médecine, URMITE, UM63, CNRS 7278, IRD198, Inserm 1095, Aix Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
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20
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Non-tuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis. THE LANCET RESPIRATORY MEDICINE 2015; 3:244-56. [DOI: 10.1016/s2213-2600(15)00062-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
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Lang S, Kansy B. Cervical lymph node diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc08. [PMID: 25587368 PMCID: PMC4273169 DOI: 10.3205/cto000111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation. Such an approach is described in the following paper.
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Affiliation(s)
- Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Kansy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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22
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Abstract
PURPOSE OF REVIEW Skin and soft tissues infections (SSTIs) caused by nontuberculous mycobacteria (NTM) are underrecognized and difficult to treat. Controversies exist for optimal medical management and the role of surgery. Defining the epidemiology in the environment, in animals and in healthcare aids disease prevention. This review focuses on recent advances in epidemiology, risk factors, diagnostics and therapy. RECENT FINDINGS The increasing consumer appetite for cosmetic and body-modifying procedures (e.g. tattooing, mesotherapy, liposuction) has been associated with rises in sporadic cases and outbreaks of NTM SSTIs. In mainstream healthcare, recent epidemiological studies have helped to quantify the increased risk of NTM infection related to anti-tumour necrosis factor-α monoclonal antibody therapy. Cervicofacial lymphadenitis in children poses management dilemmas, but recent studies and resultant algorithms have simplified decision-making. Molecular studies have led to a better understanding of the epidemiology, therapy and course of Mycobacterium ulcerans infection (Buruli ulcer) that remains prevalent in many areas including sub-Saharan Africa and southeastern Australia. Apart from molecular methods, the widespread adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry by routine laboratories has potential to simplify and expedite the laboratory identification of NTMs. SUMMARY An improved understanding of the epidemiology of NTM SSTIs indicates a need to apply effective infection control and ensure regulation of cosmetic and related procedures associated with nonsterile fluids. Broader access to newer diagnostic methods will continue to improve recognition of NTM disease. Along with a paucity of therapeutic agents, there is need for more reliable methods to assess susceptibility and selection of effective combination therapy.
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23
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[Surgical treatment of children with nontuberculous mycobacteria cervical lymphadenitis]. HNO 2014; 62:570-4. [PMID: 25008272 DOI: 10.1007/s00106-014-2881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Persistent cervical lymphadenopathy is the typical clinical manifestation of nontuberculous mycobacterial (NTM) infection in otherwise healthy children 1-5 years of age. A positive NTM culture or PCR is necessary to proof the diagnosis. In the case of localized disease, cervical lymphadenectomy simultaneously serves both diagnosis and therapy. A typical complication of surgical treatment, i.e. incision, puncture or excision, is the formation of a fistula, which then requires further surgical intervention. In the case of an unconfirmed diagnosis, the extent of the initial surgical intervention remains unclear. PATIENTS AND METHODS On the basis of this diagnosis, 17 operations were performed in 10 children under the age of 7 years (8 female, 2 male; age 17 months to 5 years, median 36 months) in the Charité ENT clinics between 2009 and 2012. Clinical course and diagnostics, as well as the results of therapies and treatments were retrospectively analysed. RESULTS Duration of anamnesis prior to initial surgery was 2-30 weeks (mean 10.4 weeks). A second intervention was performed in 7 out of 10 patients. No patient developed recurrent disease after selective cervical lymphadenectomy. The clinical course of 1 patient was complicated by a cefuroxime-responsive Staph. aureus superinfection. A second patient experienced transient accessory nerve paresis after lymphadenectomy, which resolved 2 months after the second surgery. CONCLUSION In case of persistent cervical lymphadenopathy a complete diagnostic workup is necessary. If lymphadenopathy continues to persist 1 month after a 10-day course of broad-spectrum antibiotics, a selective cervical lymphadenectomy should be performed. In order to avoid the development of fistulae and avoid secondary surgical procedures, incision, drainage and puncture should be deferred.
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Perdikogianni C, Galanakis E. Non-tuberculous mycobacterial cervical lymphadenitis in the immunocompetent child: diagnostic and treatment approach. Expert Rev Anti Infect Ther 2014; 12:959-65. [DOI: 10.1586/14787210.2014.920691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Management of cervicofacial nontuberculous lymphadenitis in children. Curr Opin Otolaryngol Head Neck Surg 2013; 21:581-7. [PMID: 24152916 DOI: 10.1097/moo.0000000000000005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the body of literature on the treatment options for nontuberculous cervicofacial lymphadenitis in children, focusing on the most recent reports describing outcomes utilizing either observation alone, medical therapy or various forms of surgical intervention. RECENT FINDINGS Large studies have defined the time course of the disease and the safety and efficacy in treating nontuberculosis cervicofacial lymphadenitis with a wait-and-see approach. SUMMARY Nontuberculosis cervicofacial lymphadenitis is a disease with several stages that provides for various treatment options. All treatment regimens--wait-and-see approach, medical therapy, and surgical excision--have their risks and benefits. The current body of literature allows the otolaryngologist an assortment of treatment choices that permits him to tailor the treatment with an individualized approach for each family's preferences.
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Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. Int J Pediatr Otorhinolaryngol 2013; 77:817-20. [PMID: 23531371 DOI: 10.1016/j.ijporl.2013.02.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/09/2013] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute cervical lymphadenitis is a common condition often times requiring antibiotic therapy and possible surgical drainage. The objective of this study was to describe the clinical characteristics, diagnostic and therapeutic management of children requiring surgical drainage for acute cervical lymphadenitis. METHODS A retrospective, descriptive study was performed at a Midwestern US tertiary-care children's hospital on all immunocompetent children who underwent an incision and drainage procedure of cervical lymphadenitis from January 1999 to July 2009. RESULTS A total of 277 patients were identified. Males represented 51% and the median age was 28 months (IQR: 13-59). Lymphadenitis was unilateral in 243 (87.7%) cases and bilateral in 19 (6.9%). Median length of hospital stay was 4 days (IQR: 3-5). Aerobic, anaerobic, acid fast bacillus (AFB), and fungal cultures were obtained intraoperatively in 99%, 98%, 82%, and 78% of cases, respectively. However no fungal cultures were positive and only 1% of anaerobic and 2% of AFB cultures were positive. The most common bacterial etiology was Staphylococcus aureus (35.7%) and Streptococcus pyogenes (18.8%). Of all cultures, 32% were negative. Overall, 22% were positive for methicillin susceptible S. aureus (MSSA) and 13.7% for methicillin resistant S. aureus (MRSA), with 96% MSSA and 100% MRSA susceptible to clindamycin. Median duration of discharge antibiotics prescribed was 10 days (IQR: 7-11). Only 12 (4.5%) patients required a repeat incision and drainage within 3 months. CONCLUSIONS A single antibiotic that treats S. pyogenes and S. aureus should be the empiric antibiotic for cervical lymphadenitis requiring incision and drain. We recommend sending only aerobic cultures intraoperatively as a routine practice as other pathogens are rare.
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Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre el diagnóstico y tratamiento de las adenitis por micobacterias no tuberculosas. An Pediatr (Barc) 2012; 77:208.e1-208.e12. [DOI: 10.1016/j.anpedi.2012.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 12/28/2022] Open
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