Penn Renee, Steehler Matthew K, Sokohl Alex, Harley Earl H
Department of Otolaryngology - Head and Neck Surgery, South Pasadena Cancer Center, 209 Fair Oaks Avenue, South Pasadena, CA 91030, United States.
Int J Pediatr Otorhinolaryngol. 2011 Dec;75(12):1599-603. doi: 10.1016/j.ijporl.2011.09.018. Epub 2011 Oct 19.
To describe a clinical staging system for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis that has both diagnostic and therapeutic implications.
A Medline database search was performed using key words "nontuberculous mycobacteria". All articles pertaining to nontuberculous mycobacterial cervicofacial lymphadenitis were reviewed for data evaluation regarding diagnosis and treatment methodologies.
Nontuberculous cervicofacial lymphadenitis infections pass through distinctly segmented clinical phases. In Stage I, a painless mass presents with notable increase in vascularity. Stage II is characterized by liquefaction of the affected lymph node, causing the mass to appear fluctuant. Significant skin changes characterize Stage III, whereby overlying skin may develop violaceous discoloration and become notably thinner, or parchment-like, with a "shiny" appearance. During Stage IV, the lesion fistulizes to the skin surface causing a draining wound.
While nontuberculous mycobacterial cervicofacial lymphadenitis has typically been thought of as a surgical disease, further characterization is warranted. We present a new classification system for appraising the clinical stages of nontuberculous mycobacterial cervicofacial lymphadenitis that may be used as part of a greater approach to disease management: (1) after other causes have been ruled out, the possibility of a tuberculous scrofula must be eliminated, and the degree of diagnostic suspicion must be categorized; (2) the clinical stage of the infection can be determined using the classification system described; and (3) a stage-specific treatment may be chosen based on the individual patient.
描述一种对非结核分枝杆菌（NTM）颈面部淋巴结炎具有诊断和治疗意义的临床分期系统。
使用关键词“非结核分枝杆菌”对Medline数据库进行检索。对所有与非结核分枝杆菌颈面部淋巴结炎相关的文章进行综述，以评估有关诊断和治疗方法的数据。
非结核分枝杆菌颈面部淋巴结炎感染经历明显的临床分期。在I期，出现无痛性肿块，血管明显增多。II期的特征是受累淋巴结液化，导致肿块出现波动感。III期有明显的皮肤变化，即覆盖其上的皮肤可能出现紫蓝色变色，并明显变薄，呈羊皮纸样，外观“发亮”。在IV期，病变形成通向皮肤表面的瘘管，导致引流伤口。
虽然非结核分枝杆菌颈面部淋巴结炎通常被认为是一种外科疾病，但仍需要进一步明确其特征。我们提出了一种新的分类系统，用于评估非结核分枝杆菌颈面部淋巴结炎的临床分期，该系统可作为疾病管理更全面方法的一部分：（1）在排除其他病因后，必须排除结核性瘰疬的可能性，并对诊断怀疑程度进行分类；（2）可使用所述分类系统确定感染的临床分期；（3）可根据个体患者情况选择特定阶段的治疗方法。
