Cause Of Cervical Lymphadenitis Research Articles

Lymphadenitis by non-tuberculous mycobacteria in children.

Non-tuberculous mycobacteria (NTM) constitute an important cause of cervical lymphadenitis in immunocompetent children. The aims of this study were to estimate the incidence of lymphadenitis due to NTM in children in Cyprus and to describe the characteristics, diagnostic approach, management and outcome of such infections. Children aged 1-5years old, evaluated at Archbishop Makarios III Hospital, Nicosia, Cyprus, from 1 January 2007 to 31 December 2016 for lymphadenopathy, were included in the study. All children had positive lymph node culture for NTM. A total of 22 cases of culture-positive lymphadenitis caused by NTM were reviewed. Patient age ranged from 16 to 55months. Tuberculin skin test produced an induration in 81.0% of cases (diameter, 4-17mm). Mycobacterium avium was isolated in 17 cases (77.3%), M.intracellulare in three (13.6%), M.paraffinicum in one (4.5%) and M.kansasii in one case (4.5%). All 22 patients underwent surgical excision of affected nodes. Additional anti-mycobacterial treatment was given when complete excision was not achieved or for post-surgical recurrence. Complications were few and included scar in three children and one case of transient facial nerve palsy. Surgical excision of NTM-infected lymph nodes is an effective diagnostic and therapeutic approach. When total surgical excision is not feasible, a combination of partial excision with a clarithromycin-including drug regimen appears safe, effective and causes milder and fewer complications than surgery alone.

Mycobacterium lentiflavum as the main cause of lymphadenitis in pediatric population

IntroductionCervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5 years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. MethodsA restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lymphadenitis at the Niño Jesús Hospital in Madrid during 2009–2016. ResultsDuring the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17.85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30.8 months and all cases showed a satisfactory evolution. ConclusionWe propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population.

Mycobacterium lentiflavum como causa principal de linfadenitis en población pediátrica

IntroductionCervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. MethodsA restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lympahdenitis at the Niño Jesús Hospital in Madrid during 2009-2016. ResultsDuring the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17,85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30,8 months and all cases showed a satisfactory evolution. ConclusionWe propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population.

Management der zervikalen atypischen Mykobakteriose im Kindesalter

Atypical mycobacteriosis is a rare cause of cervical lymphadenitis that most frequently affects immunoincompetent children between the ages of 12months and 5years. The typical clinical manifestation is a painless unilateral cervical mass. The nonspecific clinical symptoms and laboratory parameters complicate diagnosis and, therefore, therapeutic management. Various therapeutic options, including surgery, antimycobacterial drug therapy and wait-and-scan approaches are discussed in the literature. Complete surgical excision has become the established treatment of choice. However, controlled randomized studies that clearly demonstrate the benefits of a particular type of therapy are lacking.

Atypical mycobacterial cervical lymphadenitis with extensive local spread: a surgical disease

Atypical (nontuberculous) mycobacterium is an uncommon cause of cervical lymphadenitis in immunocompetent children. Rarely, this disease progresses to locoregional destruction of the deep structures of the neck including salivary glands. Recent reports suggest medical monotherapy as an effective treatment of this disease. We report three cases of children who experienced progression to locoregional disease while on appropriate antibiotics. We suggest that the patient population to benefit from medical monotherapy has yet to be adequately defined. In our experience, surgical therapy is the only effective treatment for locoregional disease.

Kikuchi’s disease: A rare cause of cervical lymphadenitis and fever

Cervical lymphadenitis and fever are common in patients presenting to the Emergency Department (ED). Kikuchi’s disease is a rare, self-limited cause of fever and cervical lymphadenitis often misdiagnosed as lymphoma or lupus and inappropriately treated, potentially causing numerous ED visits for unrelieved symptoms. The case described is that of a 29-year-old with persistent fever and cervical lymphadenitis who presented to the ED with a suspected allergic reaction to an antibiotic. The diagnosis of Kikuchi’s disease was made in association with nasopharyngeal carcinoma and partial hydatidiform mole. The case highlights the clinical features, diagnosis, and treatment of Kikuchi’s disease.

Health impacts of environmental mycobacteria.

Environmental mycobacteria are emerging pathogens causing opportunistic infections in humans and animals. The health impacts of human-mycobacterial interactions are complex and likely much broader than currently recognized. Environmental mycobacteria preferentially survive chlorination in municipal water, using it as a vector to infect humans. Widespread chlorination of water has likely selected more resistant environmental mycobacteria species and potentially explains the shift from M. scrofulaceum to M. avium as a cause of cervical lymphadenitis in children. Thus, human activities have affected mycobacterial ecology. While the slow growth and hydrophobicity of environmental mycobacteria appear to be disadvantages, the unique cell wall architecture also grants high biocide and antibiotic resistance, while hydrophobicity facilitates nutrient acquisition, biofilm formation, and spread by aerosolization. The remarkable stress tolerance of environmental mycobacteria is the major reason they are human pathogens. Environmental mycobacteria invade protozoans, exhibiting parasitic and symbiotic relationships. The molecular mechanisms of mycobacterial intracellular pathogenesis in animals likely evolved from similar mechanisms facilitating survival in protozoans. In addition to outright infection, environmental mycobacteria may also play a role in chronic bowl diseases, allergies, immunity to other pulmonary infections, and the efficacy of bacillus Calmette-Guerin vaccination.

Subclassification of Localized Leishmania Lymphadenitis in Fine Needle Aspiration Smears

To describe the cytologic findings of localized Leishmania lymphadenitis and discuss the differential diagnosis. The study group consisted of 133 cases. All of them were diagnosed by fine needle aspiration (FNA) study. The ages ranged between 3 and 80 years, 102 were male and 31 female. Seventy lymph nodes were excised. The FNA smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, giant cells, abnormal plasma cells and tingible body macrophages. Leishman-Donovan (LD) bodies were identified in all cases, but their number differed from case to case. Granulomas, dendritic cells, mast cells and lymphoglandular bodies were identified in a substantial number of cases. Depending upon the presence of characteristic cytologic findings, the cases were divided into five major groups: acute inflammation with giant cells, histiocytic granulomas, epithelioid cell granulomas, plasma cell type and mixed histioplasmacytic type. Leishmaniasis is an uncommon cause of cervical lymphadenitis but should be considered in the differential diagnosis of unexplained lymphadenopathy in endemic countries. Demonstration of LD bodies is necessary for the diagnosis of this self-limited condition, for which no treatment is required.

Intrathoracic Disease Associated With Mycobacterium avium-intracellulare Complex in Otherwise Healthy Children: Diagnostic and Therapeutic Considerations

Mycobacterium tuberculosis (MTB) is a well described human pathogen.1 Less commonly, atypical or nontuberculous mycobacteria (NTM) can cause disease in humans. Recent studies report that NTM account for one-third of all pathogenic mycobacterial isolates in the United States.2 Mycobacterium avium-intracellulare complex (MAI) is the most common NTM causing human disease.2 It is also the most common mycobacterial cause of cervical lymphadenitis in children in areas with low endemic rates of MTB infection.3 MAI/NTM infection other than cervical adenitis is unusual in children, except in those that are immunosuppressed.4 Rarely, MAI presents as mediastinal or endobronchial disease in otherwise healthy children.