Deichmueller C M C, Emmanouil K, Welkoborsky H-J
Department of Otorhinolaryngology, Children's Hospital auf der Bult, Hannover, Germany,
Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2425-31. doi: 10.1007/s00405-014-3160-x. Epub 2014 Jul 3.
Atypical mycobacteriosis (AM) is a rare disease, which is caused by an infection with mycobacteria other than tuberculosis (MOTT). In children, the cervical lymph nodes are frequently affected. MOTT are a pathogen or facultative pathogen environmental germs, which can affect otherwise healthy individuals. The diagnostic and therapeutic management is often challenging. Currently, there are only few data published about the systematic investigation and therapy of children with AM. In a retrospective study, 29 children with AM were evaluated. The clinical records of these patients were reviewed and analyzed along with the results of histopathological and microbiological findings. The clinical parameters were correlated to patients' therapy and clinical follow-up. 29 otherwise healthy and immunocompetent children (18 girls, 11 boys, average age of 3.5 years, range 1.5-9.5 years) with AM of the head and neck region have been evaluated. Clinically, all patients were admitted with a swelling of cervical lymph nodes and discoloration of the overlaying skin. In five patients, an abscess formation of the lymph nodes occurred. Ultrasound examinations typically revealed a hypoechoic mass with central necrosis and intralesional septa. Histologically, epithelioid granuloma with caseating necrosis was described in any case. Germ identification by either microbiological culture or PCR was successful in 20 cases, with Mycobacterium avium and Mycobacterium intercellulare being the most frequent germs. In all patients, lymph nodes were surgically removed. In a clinical follow-up of at least 18 months, a recurrence occurred in five cases. Diagnosis of atypical mycobacteriosis is often difficult and challenging, since clinical appearance is unspecific and MOTT can only be identified microbiologically or by PCR in about two-thirds of cases. Therefore, a close cooperation between clinician, pathologist, and microbiologist is required. Therapeutically excision of all affected lymph nodes is recommended. Alternative or concomitant medical treatment with tuberculostatics is indicated in particular cases, i.e., recurrence, persistence or systemically lymph node involvement.
非典型分枝杆菌病（AM）是一种罕见疾病，由结核分枝杆菌以外的分枝杆菌（非结核分枝杆菌，MOTT）感染引起。在儿童中，颈部淋巴结常受影响。MOTT是一种病原体或兼性病原体环境细菌，可感染原本健康的个体。其诊断和治疗管理通常具有挑战性。目前，关于AM患儿的系统研究和治疗的公开数据很少。在一项回顾性研究中，对29例AM患儿进行了评估。回顾并分析了这些患者的临床记录以及组织病理学和微生物学检查结果。将临床参数与患者的治疗及临床随访情况进行了关联分析。对29例原本健康且免疫功能正常、患有头颈部区域AM的儿童（18名女孩，11名男孩，平均年龄3.5岁，范围1.5 - 9.5岁）进行了评估。临床上，所有患者均因颈部淋巴结肿大及覆盖皮肤变色入院。5例患者出现淋巴结脓肿形成。超声检查通常显示为低回声肿块，伴有中央坏死和病灶内分隔。组织学上，所有病例均描述为伴有干酪样坏死的上皮样肉芽肿。通过微生物培养或PCR进行病原菌鉴定，20例成功，其中鸟分枝杆菌和胞内分枝杆菌是最常见的病原菌。所有患者均接受了淋巴结手术切除。在至少18个月的临床随访中，5例出现复发。非典型分枝杆菌病的诊断通常困难且具有挑战性，因为临床表现不具特异性，且在约三分之二的病例中，MOTT只能通过微生物学或PCR鉴定。因此，临床医生、病理学家和微生物学家之间需要密切合作。治疗上，建议切除所有受累淋巴结。在特定情况下，即复发、持续存在或系统性淋巴结受累时，可选择或联合使用抗结核药物进行药物治疗。
