Paediatric cervicofacial lymphadenitis caused by non-tuberculous mycobacteria: nation-wide overview in the period 2000-2020.

PURPOSE

Cervicofacial lymphadenitis caused by non-tuberculous mycobacteria (NTM) is a rare but increasing infection in children worldwide. The purpose of this study was to analyse and evaluate all microbiologically proven cases of NTM lymphadenitis in children under the age 14 years in Slovenia.

METHODS

Between 2000 and 2020, we retrospectively reviewed laboratory and medical records for basic demographic and microbiological data. Different clinical samples were collected in medical centres and regional hospitals from all over Slovenia.

RESULTS

In the period before mandatory BCG vaccination was discontinued (2000-2005), we did not observe any case of paediatric NTM lymphadenitis. After discontinuation of non-selective BCG vaccination of new-borns (2006-2020), we identified 55 cases of microbiologically confirmed NTM lymphadenitis in BCG-unvaccinated children with median age 26.0 months (range: 15.0-75.0 months). Mean annual incidence of paediatric NTM lymphadenitis accounted for 1.26 (range: 0.35-2.38) per 100,000 children. The main causative agents were Mycobacterium avium (38/55; 69.1%) and M. intracellulare (9/55; 16.4%). We did not find any M. chimaera isolate. Since 2006, each year we microbiologically confirm sporadic cases of paediatric NTM lymphadenitis, a condition not diagnosed before.

CONCLUSIONS

After discontinuation of universal BCG vaccination in March 2005, first cases of paediatric NTM lymphadenitis appeared. Several possible reasons could be attributed to observed trend and further multinational observational studies are warranted to explore possible causal relationships.