Childhood lymphadenitis in a harsh northern climate due to atypical mycobacteria.

Between 1979 and 1983, 16 patients under 15 years of age living within 480 km of Edmonton, Alberta (latitude 53 degrees 34' N) were seen with cervical lymphadenitis caused by atypical mycobacteria. During this period only 4 cases of cervical lymphadenitis from Mycobacterium tuberculosis occurred in the same age and geographical grouping. Young children age 1-4 years accounted for most cases (14/16). The onset showed no seasonal preponderance and the nodal enlargement was either asymptomatic (8/16) or associated with only minor systemic symptoms. M. avium intracellulare scrofulaceum (6 cases) or M. avium intracellulare (4 cases) were identified on cultures from the infected node. In the remaining cases characteristic histopathology and acid fast bacilli were seen on biopsy specimens but no organisms could be cultured. Surgery was employed in all cases either for diagnosis or for therapy. This series demonstrates that atypical mycobacteria may cause childhood lymphadenitis throughout the year in a harsh inland Northern climate. The etiological pathogen can be difficult to culture but complete surgical excision of the infected node is usually curative.