Nontuberculous Mycobacterial Lymphadenitis Research Articles

Atypical mycobacterial cervical lymphadenitis associated with Sweet's syndrome.

We report the case of a 52-year-old woman with a non-tuberculous (atypical) mycobacterial cervical lymphadenitis, caused by Mycobacterium fortuitum, in association with Sweet's syndrome. The cervical lymphadenitis was resistant to medical treatment, and the Sweet's syndrome occurred intermittently. Systemic steroid treatment was required to control the cutaneous symptoms.

Mycobacterial Lymphadenitis in Children: A Prospective Study of 105 Nontuberculous Cases with Long-Term Follow-Up

Cases of nontuberculous mycobacterial lymphadenitis were analyzed in a prospective study spanning 32 years, from 1958 to 1990. The results are based on personal observations and long-term follow-up. There were 105 cases, all of which occurred in children aged 9 1/2 months to 12 years (median age, 2.92 years). The patients were predominantly female, and the cases occurred more often in the winter and spring. The cervical or facial nodes were involved in 96 cases. An abrupt change in the predominant etiologic agent (from Mycobacterium scrofulaceum to Mycobacterium avium complex) was noted in the 1970s. Positive tuberculin skin tests were the rule, and reactivity was long lasting. Complications included a prolonged initial phase of infection (n = 6) and recurrences 3 1/2 months to 7 years later (n = 5). Resection during the early stage of infection produced the most satisfactory healing.

Cervical lymphadenitis due to mycobacteria other than tuberculosis--an emerging problem in children?

Therapy with antituberculosis drugs is not indicated in patients with isolated cervical lymph node infection due to mycobacteria other than tuberculosis (MOTT); resectional surgery is the treatment of choice in these cases. The reason for this study was a striking increase in the incidence of this disease in children referred to the University Hospital in Aachen. In the period from 1987 to 1990, we saw only 1 case of nontuberculous mycobacterial cervical lymphadenitis among 77 cultured specimens; in contrast to this, out of 85 specimens examined between 1991 and March 1993 were positive, with an increasing tendency. The patients were treated surgically by adequate conservative neck dissection. The outcome was excellent in all cases.

A case of non‐tuberculous mycobacterial lymphadenitis diagnosed with new skin tests and PCR

Non-tuberculous mycobacterial (NTM) cervical lymphadenitis has been rarely reported in Japan. We report on a case of a 15 month old child with NTM cervical lymphadenitis who was diagnosed with new skin tests containing NTM antigens and a polymerase chain reaction (PCR) method. These two diagnostic methods were highly useful in the present case, therefore we anticipate they will become available to other Japanese physicians to expedite the diagnosis of NTM lymphadenitis.

Evaluation of lymphadenopathy in children

This chapter provides an approach to the evaluation of lymphadenopathy in children. Malignant etiologies, including HIV-associated malignancies are reviewed. In discussing infectious agents or causes of lymphadenopathy, particular emphasis is placed on chronic regional lymphadenopathy with a focus on new advances in cat-scratch disease and tuberculous and non-tuberculous mycobacterial lymphadenitis. After a suggested preliminary set of laboratory tests, biopsy is often necessary both for histologic and cultural investigation. Therapy must be specific and must follow an accurate diagnosis.

Diagnostic and therapeutic management of atypical mycobacterial infections in children.

A series of 12 children (9 girls, 3 boys) with non-tuberculous mycobacterial lymphadenitis was reviewed to define the most frequent presenting features, helpful diagnostic measures and optimal management. The mean age at diagnosis was 42 months and cervical nodes in the submandibular region were most commonly affected. In most of the children the diagnosis was made on the basis of a positive intradermal skin test with specific antigens for atypical mycobacteria. The diagnosis was confirmed in all but one case by histopathologic examination. Total excision of the affected gland was recommended as the therapy of choice in the patients treated.

Lymphocyte production of gamma-interferon as a test for non-tuberculous mycobacterial lymphadenitis in childhood

Infection with Mycobacterium avium, M. intracellulare and M. scrofulaceum (MAIS) organisms in normal children may result in cervical lymphadenopathy. There is a poor response to anti-tuberculous therapy and surgical excision of infected nodes is necessary. The diagnosis therefore requires consideration in children with cervical lymphadenopathy. A simple in vitro assay is described which may be useful for diagnosis prior to excision. Whole blood is cultured with M. avium purified protein derivative. After 24 h the plasma is removed and the concentration of gamma interferon (IFN-gamma) quantified by a radioimmunometric assay. In a prospective study of 38 children with neck lesions, 16 showed MAIS organisms isolated from cultures of excised tissue. The level of IFN-gamma produced by peripheral blood lymphocytes from children in the MAIS group was significantly greater when compared with children having operations for neck lesions that were not due to MAIS organisms (P < 0.001).

Mycobacterial lymphadenitis in Western Australia

The records of 172 patients with culture-positive mycobacterial lymphadenitis in Western Australia between January 1972 and December 1989 inclusive have been reviewed. Of the 118 children under 7 years of age, the disease was caused by M. tuberculosis in 4%, the M. avium complex in 74% and M. scrofulaceum in 20%, whereas in the 54 adults aged 15 years and over, the same organisms were responsible for 89%, 2% and 4% respectively of their diseases. Tuberculous (TBC) lymphadenitis affected mainly adult Asian migrants (71%), while non-tuberculous mycobacterial (NTM) lymphadenitis predominantly affected non-Aboriginal Australian children (92%). The two conditions differed significantly in their distribution of disease in the lymph nodes ( P < 0.001). Patients with the TBC disease had a longer ( P < 0.001) duration of symptoms before diagnosis but less common ( P < 0.02) local complications at presentation than those with the NTM disease. The response of TBC lymphadenitis to medical treatment was excellent with no failure or relapse in the 43 patients followed up to 12 months. Total excision was curative for NTM lymphadenitis although in 10% a second excision was needed because of relapse or residual disease. In a selected group of children, the double Mantoux test was shown to have a 79% sensitivity and a 69% specificity in the diagnosis of the NTM disease. Over the last decade, the prevalence of NTM lymphadenitis in Western Australia decreased while that of TBC lymphadenitis remained steady.

Non-tuberculous mycobacterial lymphadenitis in children.

Eighty-six children (44 males, 42 females) were identified as having non-tuberculous mycobacterial lymphadenitis. The diagnostic criteria were either culture of the organism from the affected lymph node (n = 68), or, when culture was negative, a positive skin test with non-tuberculous mycobacterial antigens and negative skin test responses to tuberculin purified protein derivative (PPD) in association with typical histological features (n = 18). All children had histopathological findings of granulomatous inflammation with caseation and/or acid-fast bacilli. Eighty-two percent of the children were under 5 years of age at presentation and 30% were less than 2 years old. Most (79%) were city dwellers. Lymph node enlargement had been present for less than 6 months in almost all children (97.5%) and was almost exclusively in the face and neck region (97%). Disease was confined to the involved lymph nodes in 56% but had extended beyond the confines of the infected node to form a collar stud abscess in 38% and 6% presented with a skin sinus. Extranodal extension did not show any statistically significant association with the duration of lymphadenopathy. The duration of lymphadenopathy had been greater in those children in whom an organism was not isolated on culture resected tissue (chi 2 = 10.07, P less than 0.01). All children were treated surgically, and recurrence occurred in five patients. This study describes the clinical and demographic characteristics of non-tuberculous mycobacterial lymphadenopathy in children in a population in which tuberculous adenitis is rare. Recognition of these features may allow earlier diagnosis and appropriate surgical therapy.

Non-tuberculous mycobacterial lymphadenitis.

Most cases of mycobacterial lymphadenitis in children are caused by non-tuberculous mycobacteria, previously called the atypical mycobacteria. It is important to differentiate non-tuberculous mycobacterial lymphadenitis from tuberculous lymphadenitis as the treatment is different. We reviewed 19 children (12 girls and seven boys) with non-tuberculous mycobacterial lymphadenitis to define likely presenting features, helpful diagnostic measurements, and optimum management. Mean age at diagnosis was 5.2 years. Most had no systemic upset and clear chest x ray films. Cervical nodes were the commonest affected, and enlargement was usually unilateral. Mean duration of swelling was 6.6 weeks, and 63% of the nodes had an appearance suggestive of cold abscess. Routine haematology was unhelpful, and standard tuberculin testing performed in 47% yielded negative results in two thirds. Differential Mantoux testing with human purified protein derivative and an avium-intracellular antigen may be more useful. Antituberculous drugs were ineffective. The organism was usually highly resistant. Total excision is the treatment of choice. Antituberculous drugs are unnecessary.