Division of Paediatric Infectious Diseases, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
Department of Otolaryngology-Head and Neck Surgery, National University Health System, Singapore, Singapore.
J Pediatric Infect Dis Soc. 2023 Jul 31;12(7):406-412. doi: 10.1093/jpids/piad043.
Lymphadenitis is the most common manifestation of non-tuberculous mycobacteria (NTM) infection in children. We describe the epidemiology and clinical characteristics of NTM lymphadenitis, determine diagnostic yield from tissue sampling, and review management and outcomes.
This was a 10-year retrospective review of children aged 0-16 years diagnosed with NTM cervicofacial lymphadenitis who were seen in a pediatric infectious disease clinic in a tertiary public hospital. Data relating to patient demographics, clinical features, surgical and antimicrobial treatment, complications, and outcomes were retrieved from patients' electronic medical records and analyzed.
There were 48 episodes of NTM cervicofacial lymphadenitis in 45 children (17 males and 28 females). Of these episodes, 43.7% manifested as a unilateral single node, mostly parotid (39.6%) and submandibular (29.2%). All patients underwent diagnostic fine-needle aspiration or surgery. Surgical excision more frequently yielded positive histological findings (P = .016). NTM was identified in 22/48 episodes (45.8%) via culture or molecular sequencing. Mycobacterium abscessus was most commonly found (47.8%). Thirty-eight children (79.2%) received antibiotics. Outcomes in 43 episodes revealed full resolution in 69.8%, while 25.6% had de novo disease and 4.6% experienced recurrence at the same site. Overlying skin changes and multiple or bilateral nodal diseases were significantly associated with de novo disease or recurrence (P = .034 and .084, respectively). Complications occurred in 11/70 (15.7%) procedures. Antibiotic-associated adverse effects occurred in 14/38 (36.8%) episodes.
NTM lymphadenitis remains a challenging condition. More aggressive management with surgical excision and antibiotics is recommended for those with overlying skin changes and extensive nodal disease.
淋巴结炎是非结核分枝杆菌（NTM）感染儿童中最常见的表现。我们描述了 NTM 淋巴结炎的流行病学和临床特征，确定了组织取样的诊断产量，并回顾了治疗和结局。
这是对在一家三级公立医院的儿科传染病诊所就诊的年龄在 0-16 岁之间的 NTM 颈面部淋巴结炎患儿进行的 10 年回顾性研究。从患者的电子病历中检索并分析了与患者人口统计学、临床特征、手术和抗菌治疗、并发症和结局相关的数据。
45 名儿童中有 48 例 NTM 颈面部淋巴结炎（17 名男性和 28 名女性）。这些病例中，43.7%表现为单侧单个淋巴结，主要位于腮腺（39.6%）和颌下腺（29.2%）。所有患者均接受了诊断性细针抽吸或手术。手术切除更常获得阳性组织学发现（P =.016）。通过培养或分子测序在 22/48 例（45.8%）中确定了 NTM。最常见的是脓肿分枝杆菌（47.8%）。38 名儿童（79.2%）接受了抗生素治疗。43 例的结局显示完全缓解 69.8%，25.6%出现新发疾病，4.6%在同一部位复发。表面皮肤改变和多个或双侧淋巴结疾病与新发疾病或复发显著相关（P =.034 和.084）。70 例中有 11 例（15.7%）发生并发症。38 例中有 14 例（36.8%）出现抗生素相关不良反应。
NTM 淋巴结炎仍然是一种具有挑战性的疾病。对于有表面皮肤改变和广泛淋巴结疾病的患者，建议采用更积极的手术切除和抗生素治疗。
