Nontuberculous Mycobacterial Infections in Children.

Abstract

1. Jyotsna Bhattacharya, MD* 2. Sindhu Mohandas, MBBS* 3. David L. Goldman, MD† 1. *Department of Pediatric Infectious Diseases and 2. †Department of Pediatrics and Microbiology and Immunology, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY * Abbreviations: AFB: : acid-fast bacillus CF: : cystic fibrosis HAART: : highly active antiretroviral therapy HIV: : human immunodeficiency virus IFN-γ: : interferon-γ IGRA: : interferon-γ release assay IRIS: : immune reconstitution inflammatory syndrome MAC: : Mycobacterium avium complex MALDI-TOF: : matrix-assisted laser desorption/ionization–time of flight NTM: : nontuberculous mycobacteria RGM: : rapidly growing mycobacteria SGM: : slowly growing mycobacteria SSTI: : skin and soft tissue infection After completing this article, readers should be able to: 1. Recognize the major clinical features associated with nontuberculous mycobacteria (NTM) infections in children. 2. Recognize that NTM infections are a potential risk related to medical tourism for cosmetic surgery. 3. Understand the strengths and weaknesses of currently available diagnostic methods. 4. Plan the appropriate management of NTM infections based on the specific clinical presentation and mycobacterial species. Nontuberculous mycobacteria (NTM) include all mycobacteria other than Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium leprae . Children are constantly exposed to NTM, yet clinical signs of infection are unusual. NTM exist primarily in the environment, causing human disease as opportunistic pathogens in the appropriate clinical context. Lymphadenitis is far and away the most common manifestation of NTM disease in children. Other, less common, manifestations include skin and soft tissue infections (SSTIs), lung infections, and disseminated disease. Since the last review of NTM disease in Pediatrics in Review , (3) several important developments have occurred, including changes in the epidemiology and treatment, which are reviewed herein. Currently there are more than 170 recognized NTM species, although a limited number of species cause human disease. It survives inside amoeba, and the traits that promote this process may also allow for successful macrophage infection. (4 …