Zhukhovitskaya A, Chang D T, Huoh K C, Pham N S, Singh J, Ahuja G S
University of California - Irvine, Department of Otolaryngology, Orange, CA, USA; CHOC Children's Hospital, Orange, CA, USA.
CHOC Children's Hospital, Orange, CA, USA.
Int J Pediatr Otorhinolaryngol. 2020 Apr;131:109882. doi: 10.1016/j.ijporl.2020.109882. Epub 2020 Jan 15.
We report on our experience with surgical management of nosocomial Mycobacterium abscessus cervical lymphadenitis in the setting of an epidemic linked to a dental practice in the community.
This is an observational case series of children who required surgical treatment of cervical lymphadenitis as part of multidisciplinary management of nosocomial M. abscessus infections. We describe the criteria for surgical management of cervical lymphadenitis as well as patient characteristics and outcomes.
Over 1000 children undergoing pulpectomies and pulpotomies at a local dental practice with a contaminated water source were identified as potentially susceptible to atypical mycobacteria infection, identified as M. abscessus. Between August 2016 and May 2017 108 children underwent inpatient evaluation at our institution by general pediatricians and pediatric infectious disease specialists. 90 children required at least 1 surgical intervention by pediatric otolaryngology and/or oral and maxillofacial surgery (OMFS). Children were evaluated by the Pediatric Otolaryngology service if computer tomography (CT) scan of the neck demonstrated lymph nodes of at least 1.5 cm in shortest dimension or lymph nodes with central hypolucencies suspicious for infection with central necrosis. Pediatric Otolaryngology intervened on 11 patients all of whom required selective cervical lymphadenectomy with or without curettage. These patients ranged in age from 3 to 8 years; 8 were male, 6 had concurrent pulmonary nodules. Two patients underwent curettage in addition to lymphadenectomy. Five patients required at least 2 surgical interventions by Pediatric Otolaryngology.
We found M. abscessus to be an aggressive infection requiring early cervical lymphadenectomy in select patients.
我们报告了在社区中与一家牙科诊所相关的疫情背景下，对医院内脓肿分枝杆菌性颈淋巴结炎进行外科治疗的经验。
这是一个观察性病例系列，纳入了因医院内脓肿分枝杆菌感染的多学科管理而需要对颈淋巴结炎进行外科治疗的儿童。我们描述了颈淋巴结炎外科治疗的标准以及患者特征和治疗结果。
在当地一家水源受污染的牙科诊所接受牙髓摘除术和牙髓切断术的1000多名儿童被确定为可能易患非典型分枝杆菌感染，经鉴定为脓肿分枝杆菌。2016年8月至2017年5月期间，108名儿童在我们机构接受了普通儿科医生和儿科传染病专家的住院评估。90名儿童需要儿科耳鼻喉科和/或口腔颌面外科（OMFS）至少进行1次手术干预。如果颈部计算机断层扫描（CT）显示最短径至少为1.5厘米的淋巴结或有中央低密度影可疑感染伴中央坏死的淋巴结，则由儿科耳鼻喉科服务进行评估。儿科耳鼻喉科对11名患者进行了干预，所有患者均需要进行选择性颈淋巴结清扫术，可伴有或不伴有刮除术。这些患者年龄在3至8岁之间；8名男性，6名同时患有肺结节。2名患者除淋巴结清扫术外还接受了刮除术。5名患者需要儿科耳鼻喉科至少进行2次手术干预。
我们发现脓肿分枝杆菌是一种侵袭性感染，在部分患者中需要早期进行颈淋巴结清扫术。
