Nontuberculous mycobacterial infections in children

Abstract

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, dia gnostic options and therapeutic approach in children with neck lymph nodes aff ected by non-tuberculous mycobacteria. Methods: Retrospective cohort study of patients with confi rmed 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 bio logical 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 antibio tic treatment. The most frequently used antibio tics were a combination of a macrolide antibio tic (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 infl ammation 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 infl ammation. Conclusion: The most eff ective treatment of the infection seems to be the exstirpation of all aff ected lymph nodes with surrounding tissue and combination of antibio tic (macrolide) with antituberculotic agent (rifampicin). Key words mycobacterial infection – nontuberculous mycobacteria – cervical lymphadenitis – children