Nontuberculous mycobacterial infections in children
Authors:
Nicol Koblásová 1; Jan Mejzlík 1,2; Lukáš Školoudík 1,2; Hubert Vaníček 2,3; Jana Dědková 4; Jan Laco 2,5; Petra Kašparová 2,5; Lenka Ryšková 2,6; Viktor Chrobok 1,2
Authors‘ workplace:
Univerzita Karlova, LF v Hradci Králové
2; Dětská klinika, FN Hradec Králové
3; Radiologická klinika, FN Hradec Králové
4; Fingerlandův ústav patologie, FN Hradec Králové
5; Ústav klinické mikrobio logie, FN Hradec Králové
6
Published in:
Otorinolaryngol Foniatr, 73, 2024, No. 1, pp. 8-15.
Category:
Original Article
doi:
https://doi.org/10.48095/ccorl20248
Overview
Introduction: Nontuberculous mycobacterial (NTM) infection of lymph nodes in young children is a rare disease. The increasing incidence has been observed after termination of vacciation in Czech Republic in November 2010. Aim of the study: To provide an overview of the clinical picture, diagnostic options and therapeutic approach in children with neck lymph nodes affected by non-tuberculous mycobacteria. Methods: Retrospective cohort study of patients with confirmed NTM infection treated at the Clinic of Otorhinolaryngology and Head and Neck Surgery of Faculty Hospital Hradec Kralove from 2010 to 2021. The inclusion criterion was proof of the causative agent of the disease (nontuberculous mycobacteria) by culture or molecular biological technique (PCR). Results: A total of 19 children with an average age of 26 months (range 12–42, SD 7.27) were enrolled. The most frequent pathogen was Mycobacterium avium (N = 16). Culture examination was positive in 84% (N = 16) of cases, PCR was positive in 47% of patients (N = 9). All children from the group underwent both surgical and antibiotic treatment. The most frequently used antibiotics were a combination of a macrolide antibiotic (clarithromycin) with an antituberculotic drug (rifampicin). In 6 children, an incision was made along with drainage of the lesion and for the duration of the inflammation a complete extirpation of the pathological tissue under general anaesthesia followed. A total of 15 children underwent probatory extirpation of the pathological neck lymph node. We performed block dissections of the infected tissue in 7 children for residual inflammation. Conclusion: The most effective treatment of the infection seems to be the exstirpation of all affected lymph nodes with surrounding tissue and combination of antibiotic (macrolide) with antituberculotic agent (rifampicin).
Keywords:
nontuberculous mycobacteria – children – mycobacterial infection – cervical lymphadenitis
Sources
1. Doležalová K, Malá M, Wallenfels J et al. Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003–2018. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164 (3): 1–6. Doi: 10.5507/bp.2020.025.
2. Penn R, Steehler MK, Sokohl A et al. Nontuberculous mycobacterial cervicofacial lympadenitis – a review and proposed classification system. Int J Pediatr Otorhinolaryngol 2011; 75 (12): 1599–1603. Doi: 10.1016/j.ijporl.2011.09.018.
3. Bruijnesteijn van Coppenraet LE, de Haas PE, Lindeboom, JA et al. Lymphadenitis in children is caused by Mycobacterium avium hominissuis and not related to ‘bird tuberculosis’. Eur J Clin Microbiol Infect 2008; 27 (4): 293–299. Doi: 10.1007/s10096-007-0440-z.
4. Fraser L, Moore P, Kubba H. Atypical mycobacterial infection of the head and neck in children: A 5-year retrospective review. Otolaryngol Head Neck Surg 2008; 138 (3): 311–314. Doi: 10.1016/ j.otohns.2007.11.032.
5. Kuchynková Z, Davidová R, Campr V. Mykobakteriální infekce v ORL oblasti. Otorinolaryngol Foniatr 2004; 53 (4): 171–176.
6. Albar RF, Selati SA, Alghamdi AA et al. Atypical mycobacterial infection in pediatric age group: Case report and literature review. Curr Pediatr Res 2017; 21 (1): 186–189.
7. Mortaz E, Moloudizargari M, Varahram M et al. What Immunological Defects Predispose to Non-tuberculosis Mycobacterial Infections? Iran J Allergy Asthma Immunol 2018; 17 (2): 100–109.
8. Orme IM, Collins FM. Prophylactic effect in mice of BCG vaccination against non-tuberculous mycobacterial infection. Tubercle 1985; 66: 117–120.
9. Mandell LD, Wald ER, Michaels MG. Management of Nontuberculous Mycobacterial Cervical Lymphadenitis. Arch Otolaryngol Head and Neck Surg 2003; 129 (3): 341–344. Doi: 10.1001/archotol.129.3.341.
10. Suskind DL, Handler SD, Tom LWC et al. Nontuberculous Mycobacterial Cervical Adenitis. Clin Pediatr 1997; 36 (7): 403–409. Doi: 10.1177/000992289703600705.
11. Robson CD, Hazra R, Barnes PD et al. Nontuberculous Mycobacterial Infection of Head and Neck in Immunonocompetent Children: CT and MR Finfings. AJNR Am J Neuroradiol 1999; 20: 1829–1835.
12. Saggese D, Compadretti GC, Burnelli R. Nontuberculous Mycobacterial Adenitis in Children: Diagnostic and Therapeutic Management. AM J Otolaryngol 2003; 24 (2): 79–84. Doi: 10.1053/ajot.2003.21.
13. Meoli A, Deolmi M, Iannarella R et al. Non-Tuberculous Mycobacterial Diseases in Children. Pathogens 2020; 553 (9): 1–12.
14. Školoudík L, Ryšková L, Hornychová H et al. Netuberkulózní mykobakterióza krčních uzlin. Pediatr praxi 2017; 17 (1): 28–30. Doi: 10.36290/ped.2018.048.
15. Deichmueller CM, Emmanouil K, Welkoborsky HJ. Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge. Eur Arch Otorhinolaryngol 2015; 272 (9): 2425–2431. Doi: 10.1007/s00405-014-3160-x.
16. Kvaerner KJ, Kvestad E, Orth M. Surgery required to verify atypical mycobacterial infections. Int J Pediatr Otorhinolaryngol 2001; 61: 121–128. Doi: 10.1016/s0165-5876 (01) 00558-4.
17. Kennedy TL. Curettage of Nontuberculous Mycobacterial Cervical Lymphadenitis. Arch Otolaryngol Head Neck Surg 1992; 118 (7): 759–762.
18. Rahal A, Abela A, Arcand PH et al. Nontuberculous mycobacterial adenitis of the head and neck in children: experience from a tertiary care pediatric center. Laryngoscope 2001; 111: 1791–1797. Doi: 10.1097/00005537-200110000-00024.
19. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES et al. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a controlled trial. Clin Infect 2007; 44 (8): 1057–1064. Doi: 10.1086/512675.
20. Margileth AM, Chandra R, Altman P. Chronic Lymphadenopathy due to Mycobacterial Infection. Am J Dis Child 1984; 138 (10): 917–922. Doi: 10.1001/archpedi.1984.02140480019007.
21. Flint D, Mahadevan M, Barber C et al. Cervical lymphadenitis due to non-tuberculous mycobacteria: surgical treatment and review. Int J Pediatr Otorhinolaryngol 2000; 53: 187–194.
22. Havlík J. Makrolidová antibiotika v pediatrické praxi. Pediatr praxi 2009; 10 (2): 76–79.
23. Rapp RP, McCreaney SA, Goodman NL et al. New macrolide antibiotics: Usefulness in infections caused by Mycobacteria other than Mycobacterium tuberculosis. Ann Pharmacother 1994; 28: 1255–1264.
24. Tebruegge M, Pantazidou A, MacGregor D et al. Nontuberculous Mycobacterial Disease in Children – Epidemiology, Diagnosis and Management at a Terciary Center. PLoS ONE 2016; 11 (1): 1–14. Doi: 10.1371/journal.pone.0147513.
ORCID autorů
Přijato k recenzi: 14. 12. 2022
Přijato k tisku: 29. 12. 2022
MUDr. Nicol Koblásová
Klinika otorinolaryngologie a chirurgie hlavy a krku
FN Hradec Králové
Sokolská 581
500 05 Hradec Králové
nicol.koblasova@fnhk.cz
Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
2024 Issue 1
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