Reuss Annicka, Drzymala Sarah, Hauer Barbara, von Kries Rüdiger, Haas Walter
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig Maximilian University of Munich, Munich, Germany.
Int J Mycobacteriol. 2017 Jan-Mar;6(1):76-82. doi: 10.4103/2212-5531.201898.
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.
关于非结核分枝杆菌（NTM）淋巴结炎的长期治疗结果的信息非常有限。我们开展了一项研究，以（a）比较不同初始治疗疗程后的治愈率，（b）描述后续治疗疗程及其结果，以及（c）确定免疫功能正常的NTM淋巴结炎患儿后期后遗症的发生情况。
2011年，我们对71名家长进行了一项回顾性随访研究，这些家长的孩子在2002年至2005年期间因NTM疾病住院。使用标准化问卷进行电话调查，以收集有关治疗管理和治疗结果的信息。
在61例NTM淋巴结炎患儿中，33例（54%）在初始治疗后治愈。我们发现仅手术干预后的治愈率（45%，29例中的13例）与手术干预和化疗联合后的治愈率（61%，31例中的19例）无显著差异。在11例患儿中的7例中，完全切除淋巴结后的治愈率为64%。后续治疗疗程包括重复手术干预、联合治疗、单纯化疗以及对初始治疗失败患儿采取的观察等待策略，最终所有61例患儿均治愈。在4例患儿（7%）中，观察到疾病在5年后复发。
我们的研究表明，NTM淋巴结炎在疾病初始缓解数年后可能会复发。完全切除淋巴结后的治愈率低于其他研究报告。一半的患儿需要后续治疗疗程。医生和家长需要意识到，儿童NTM淋巴结炎需要谨慎选择干预措施并积极随访。
