Non-tuberculous Mycobacterial Lymphadenitis In Children Research Articles

TB or Not TB: Role of Interferon-Gamma Release Assays

Research Article| August 01 2021 TB or Not TB: Role of Interferon-Gamma Release Assays AAP Grand Rounds (2021) 46 (2): 19. https://doi.org/10.1542/gr.46-2-19 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation TB or Not TB: Role of Interferon-Gamma Release Assays. AAP Grand Rounds August 2021; 46 (2): 19. https://doi.org/10.1542/gr.46-2-19 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: interferon type ii, tuberculosis, interferon gamma release assay, lymphadenitis Source: Martínez-Planas A, Baquero-Artigao F, Santiago B, et al. On behalf of the Spanish Pediatric TB Research Network (pTBred) and the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) study. Interferon-gamma release assays differentiate between Mycobacterium avium complex and tuberculous lymphadenitis in children [published online ahead of print May 10, 2021]. J Pediatr. doi. https://doi.org/10.1016/j.jpeds.2021.05.008 Investigators from multiple institutions conducted a study to assess the utility of interferon-gamma release assays (IGRAs) to differentiate tuberculosis (TB) from Mycobacterium avium complex (MAC) as the etiology of subacute/chronic submandibular/cervical lymphadenitis in children. Patients <18 years old with TB lymphadenitis who were included in the Spanish Network for the Study of Pediatric TB (pTBred) database between 2013 and 2018 were eligible for the current study. pTBred is a collaborative network of healthcare professionals in Spain; a central database includes demographic, laboratory test, and clinical data on children with TB.... You do not currently have access to this content.

Diagnosis of nontuberculous mycobacterial lymphadenitis: the role of fine-needle aspiration.

Nontuberculous mycobacterial lymphadenitis often presents a diagnostic challenge. This study aimed to evaluate the role of fine-needle aspiration cytology in the diagnosis of nontuberculous mycobacterial lymphadenitis in children. We conducted a retrospective review of fine-needle aspiration cytology performed in patients < 17year-old with subacute lymphadenitis from 2003 to 2016 in a tertiary hospital in Spain. Confirmed nontuberculous mycobacterial lymphadenitis (isolation of nontuberculous mycobacterial in culture from fine-needle aspiration cytology or biopsy samples) and probable nontuberculous mycobacterial lymphadenitis ("granulomatous inflammation" in cytopathologic examinations from fine-needle aspiration cytology or biopsy and clinical-epidemiological history compatible with nontuberculous mycobacterial) were selected. Forty-one patients with nontuberculous mycobacterial lymphadenitis were included: 14 confirmed and 27 probable. Fine-needle aspiration cytology was done in all of them. For 34 patients with excised lymphadenopathy, cytopathology from fine-needle aspiration cytology was concordant with biopsy in 100% cases. Culture results were available from 78.0% (32/41) of patients with fine-needle aspiration cytology and from 85.3% (29/34) with excisional biopsy. Among 22 patients with microbiological results from fine-needle aspiration cytology and biopsy, fine-needle aspiration cytology allowed advanced results in concordance with biopsy or with positive isolation not found in biopsy in 90.1% (20/22) of patients. Sensitivity of nontuberculous mycobacterial cultures obtained by fine-needle aspiration cytology compared to biopsy was 45.5% vs. 36.4% (p = 0.07). Two patients with previous skin alterations presented fistulas after fine-needle aspiration cytology (4.9%); no other complications were described.Conclusion: Fine-needle aspiration cytology provides quick cytopathologic information and is an accurate and safe technique for the diagnosis of nontuberculous mycobacterial lymphadenitis, especially in cases with challenging work-up. What is Known: • Nontuberculous mycobacterial (NTM) infection is an important cause of subacute lymphadenitis in children. • Fine-needle aspiration cytology (FNAC) is an available technique for the diagnosis of lymphadenitis of unknown etiology. What is New: • FNAC is an accurate and safe technique for the diagnosis of NTM lymphadenitis in children. • FNAC can provide reliable samples for cytopathological studies and even a better sensitivity for microbiological culture than excisional biopsy in the study of suspected NTM lymphadenitis.

Use of the facelift incision for excision of non-tuberculous mycobacterial lymphadenitis in children

ObjectivesTo present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision. MethodsRetrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018. ResultsThe series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage. ConclusionThe facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.

Emergence of Nontuberculous Mycobacterial Lymphadenitis in Children After the Discontinuation of Mandatory Bacillus Calmette and GuÉrin Immunization in France.

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.

Surgical treatment of non-tuberculous mycobacterial lymphadenitis in children: Our experience and a narrative review.

Non-tuberculous mycobacterial lymphadenitis (NTML) accounts for about 95% of the cases of head-and-neck mycobacterial lymphadenitis, and its prevalence has been increasing in the Western world. The diagnostic work-up can be challenging, and differential diagnoses such as tuberculous and suppurative lymphadenitis need to be considered. It may, therefore, not be diagnosed until the disease is in a late stage, by which time it becomes locally destructive and is characterized by a chronically discharging sinus. The treatment options include a medical approach, a wait-and-see policy, and surgery, with the last being considered the treatment of choice despite the high risk of iatrogenic nerve lesions. The aim of this article is to provide an overview of pediatric, head-and-neck NTML based on the literature and our own experience, with particular emphasis on the impact and limitations of surgery.

Risk factors of non-tuberculous mycobacterial lymphadenitis in children: a case-control study.

M. avium is still the predominant bacteria causing NTM lymphadenitis in children of our region. Contact with hens has been the only risk factor for NTM lymphadenitis detected in the present study. What is Known: • M. avium is the predominant bacteria causing NTM lymphadenitis in children of our region. • There is no consensus on which environmental factors are associated with NTM lymphadenitis in children. What is New: • The only risk factor for NTM lymphadenitis found in the present study was regular contact with hens. Contact with other farm animals was not associated to NTM lymphadenitis.

Treatment outcome in children with nontuberculous mycobacterial lymphadenitis: A retrospective follow-up study.

Information on the long-term treatment outcome following nontuberculous mycobacterial (NTM) lymphadenitis is very limited. We performed a study to (a) compare cure rates following different initial treatment courses, (b) describe subsequent treatment courses and their outcomes, and (c) determine the occurrence of late sequelae in immunocompetent children with NTM lymphadenitis. In 2011, we conducted a retrospective follow-up study in 71 parents whose children had been hospitalized with NTM disease 2002-2005. A telephone survey was performed using a standardized questionnaire to collect information on the therapeutic management and treatment outcome. Of 61 children with NTM lymphadenitis, 33 (54%) children were cured after the initial treatment. We found no significant difference in cure rates following surgical intervention only (45%, 13/29 children) and a combination of surgical intervention and chemotherapy (61%, 19/31 children). In 7 out of 11 children, the cure rate following complete lymph node excision was 64%. Subsequent courses of treatment including repeated surgical intervention, combination therapy, chemotherapy only, and wait-and-see strategy in children where initial therapy failed resulted in the cure of all 61 children. In four children (7%), recurrences were observed up to 5 years later. Our study showed that recurrent NTM lymphadenitis might be observed several years after initial resolution of disease. The cure rate following complete lymph node excision was lower than reported in other studies. Subsequent treatment courses were necessary in half of the children. Physicians and parents need to be aware that NTM lymphadenitis in children requires careful choice of intervention and active follow-up.

Nerve dysfunction following surgical treatment of cervical non‐tuberculous mycobacterial lymphadenitis in children

To present our experience of nerve dysfunction following surgical treatment among 126 children with microbiologically verified non-tuberculous mycobacterial (NTM) lymphadenitis. We retrieved data from medical records, and a questionnaire with an invitation to a clinical follow-up was returned by 88 families. The time from onset of symptoms to diagnosis was more than 3 months in 24% of subjects. Mycobacterium avium complex was isolated from 105, Mycobacterium malmoense from 12 and Mycobacterium scrofulaceum from one cervical lymph node. A total of 89% of the children underwent surgery and were examined in particular with regard to cranial motor nerve functions. Major persisting nerve dysfunction occurred in 3/51 (6%) children who underwent radical surgery, and minor dysfunction in seven (14%). In nine children, the marginal mandibular branch of the facial nerve was affected, and the accessory nerve was affected in one child. There were no neurological signs in 25 children treated with incision and drainage alone or in 12 followed with observation alone. Healing took >6 months in 2/76 (3%) surgically treated and 3/12 (25%) non-surgically treated children. Considering the risk of nerve dysfunction following extirpation, incision with drainage and observation alone should both be included among the management options for cervical NTM lymphadenitis in children.

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.