Mycobacterial cervical lymphadenitis in children: clinical and laboratory factors of importance for differential diagnosis.

Abstract

The role of epidemiological and clinical features for the early differential diagnosis between Mycobacterium tuberculosis (MTB) complex and non-tuberculous mycobacterial (NTM) cervical lymphadenitis in children was examined in this study. From 1982 to 1997, 24 MTB complex cases and 26 NTM cases were diagnosed, of which 75% and 25%, respectively, presented during the first half of the study period. Epidemiological and lymph-node features and anatomical areas were not helpful in the differential diagnosis between the 2 groups. Fulfilment of 2 out of 3 criteria (positive tuberculin skin test reaction, abnormal chest radiograph, contact with a person with infectious tuberculosis) was associated with 92% sensitivity for the diagnosis of MTB lymphadenitis. 37.5% of the MTB cases and 88.5% of the NTM cases were culture-confirmed; all inconclusive cultures concerned patients with spontaneous drainage and fistula. Surgical intervention was required in 67% of the MTB cases. All NTM cases were managed by surgery alone. Fistulae or cheloids occurred in all patients in whom incision and drainage were applied instead of total excision. Excellent aesthetic results were achieved in patients who presented within 1 month following the onset of lymphadenitis. The spectrum of mycobacterial cervical lymphadenitis in children in Greece has changed during the 1990s. Early and prompt treatment contributes to the diagnosis and response.