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Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge

  • Head and Neck
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Abstract

Atypical mycobacteriosis (AM) is a rare disease, which is caused by an infection with mycobacteria other than tuberculosis (MOTT). In children, the cervical lymph nodes are frequently affected. MOTT are a pathogen or facultative pathogen environmental germs, which can affect otherwise healthy individuals. The diagnostic and therapeutic management is often challenging. Currently, there are only few data published about the systematic investigation and therapy of children with AM. In a retrospective study, 29 children with AM were evaluated. The clinical records of these patients were reviewed and analyzed along with the results of histopathological and microbiological findings. The clinical parameters were correlated to patients’ therapy and clinical follow-up. 29 otherwise healthy and immunocompetent children (18 girls, 11 boys, average age of 3.5 years, range 1.5–9.5 years) with AM of the head and neck region have been evaluated. Clinically, all patients were admitted with a swelling of cervical lymph nodes and discoloration of the overlaying skin. In five patients, an abscess formation of the lymph nodes occurred. Ultrasound examinations typically revealed a hypoechoic mass with central necrosis and intralesional septa. Histologically, epithelioid granuloma with caseating necrosis was described in any case. Germ identification by either microbiological culture or PCR was successful in 20 cases, with Mycobacterium avium and Mycobacterium intercellulare being the most frequent germs. In all patients, lymph nodes were surgically removed. In a clinical follow-up of at least 18 months, a recurrence occurred in five cases. Diagnosis of atypical mycobacteriosis is often difficult and challenging, since clinical appearance is unspecific and MOTT can only be identified microbiologically or by PCR in about two-thirds of cases. Therefore, a close cooperation between clinician, pathologist, and microbiologist is required. Therapeutically excision of all affected lymph nodes is recommended. Alternative or concomitant medical treatment with tuberculostatics is indicated in particular cases, i.e., recurrence, persistence or systemically lymph node involvement.

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References

  1. Fraser L, Moore P, Kubba H (2008) Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review. Otolaryngol Head Neck Surg 138(3):311–314

    Article  PubMed  Google Scholar 

  2. Munck K, Mandpe AH (2003) Mycobacterial infections of the head and neck. Otolaryngol Clin North Am 36:569–576

    Article  PubMed  Google Scholar 

  3. Schulze-Röbbecke R, Janning B, Fischeder R (1992) Occurence of mycobacteria in biofilm samples. Tuber Lung Dis 73:141–144

    Article  PubMed  Google Scholar 

  4. Falkinham JO (2002) Nontuberculous mycobacteria in the environment. Clin Chest Med 23:529–551

    Article  PubMed  Google Scholar 

  5. Schlossberg D (2006) Tuberculosis and nontuberculous mycobacterial infections. Edition 5. McGraw-Hill Publishing Company

  6. Runyon EH (1959) Anonymous mycobacteria in pulmonary disease. Med Clin North Am 43(1):273–290

    CAS  PubMed  Google Scholar 

  7. Schönfeld N, Haas W, Richter E, Bauer TT, Bös L, Castell S, Hauer B, Magendorf K, Matthiessen W, Mauch H, Reuß A, Rüsch-Gerdes S, Zabel P, Dalhoff K, Schaberg T, Loddenkemper R (2013) Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). Pneumologie 67:605–633

    Article  PubMed  Google Scholar 

  8. Tremblay V, Ayad T, Lapointe A, Giguàre C, Quintal MC, Arcand P, Abela A (2008) Nontuberculous mycobacterial cervicofacial adenitis in children: epidemiologic study. J Otolaryngol Head Neck Surg 37(5):616–622

    PubMed  Google Scholar 

  9. van Ingen J, Haefsloot W, de Lange WC, Magis-Escurra C, Dekhuijzen PN, Boeree MJ, van Soolingen D (2010) Nontuberculous mycobacteria: clinically relevant. Ned Tijdschr Geneeskd 154:A1178

    PubMed  Google Scholar 

  10. Reuss AM, Wiese-Posselt M, Weissmann B, Siedler A, Zuschneid I, der An Heiden M, Claus H, von Kries R, Haas WH (2009) Incidence rate of nontuberculous mycobacterial disease in immunocompetent children: a prospective nationwide surveillance study in Germany. Pediatr Infect Dis J 28(7):642–644

    Article  PubMed  Google Scholar 

  11. Pilkington EF, MacAthur CJ, Beekmann SE, Polgreen PM, Winthrop KL (2010) Treatment patterns of pediatric nontuberculous mycobacterial (NTM) cervical lymphadenitis as reported by nationwide surveys of pediatric otolaryngology and infectious disease societies. Int J Pediatric Otolaryngol 74(4):343–346

    Article  CAS  Google Scholar 

  12. Lindeboom JA (2012) Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children. J Oral Maxillofac Surg 70(2):345–348

    Article  PubMed  Google Scholar 

  13. Méndez Echevarría A, Baquero Artigao F, García Miguel MJ, Romero Gómez MP, Alves Ferreira F, Del Castillo Martín F (2007) Nontuberculous mycobacterial lymphadenitis. An Pediatr (Barc) 66(3):254–259

    Article  Google Scholar 

  14. Welkoborsky H (2013) Ultraschalluntersuchung bei Erkrankunngen der Kopfspeicheldrüsen. In: Welkoborsky HJ, Jecker P, Maurer J, Mann WJ (eds) Ultraschalldiagnostik Kopf-Hals. Thieme, Stuttgart, pp 95–97

    Google Scholar 

  15. Lindeboom JA, Smets AM, Kuliper EJ, van Rijn RR, Prins JM (2006) The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol 36(10):1063–1067

    Article  PubMed  Google Scholar 

  16. Pinder SE, Colville A (1993) Mycobacterial cervical lymphadenitis in children: can histological assessment help differentiate infections caused by non-tuberculous mycobacteria from Mycobacterium tuberculosis? Histopathology 22(1):59–64

    Article  CAS  PubMed  Google Scholar 

  17. Harris RL, Modayil P, Adam J et al (2009) Cervicofacial nontuberculous Mycobacterium lymphadenitis in children: is surgery always necessary? Int J Pediatr Otorhinolaryngol 73(9):1297–1301

    Article  PubMed  Google Scholar 

  18. Goel MM, Budhwar P (2008) Species-specific immunocytochemical localization of Mycobacterium tuberculosis complex in fine needle aspirates of tuberculous lymphadenitis using antibody to 38 kDa immunodominat protein antigen. Acta Cytol 52(4):424–433

    Article  PubMed  Google Scholar 

  19. Mohapatra PR, Janmeja AK (2009) Tuberculous lymphadenitis. J Assoc Physicians India 57:585–590

    PubMed  Google Scholar 

  20. Verma K, Kapila K (2002) Aspiration cytology for diagnosis of tuberculosis—perspectives in India. Indian J Pediatr 69(Suppl 1):39–43

    Google Scholar 

  21. Richter E, Beer J, Diel R et al (2010) MIQ 05:Tuberculose Mycobacteriose. In: Podbielski A, Mauch H, Herrmann N, Kniehl E, Rüssmann H (eds) Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik, 2nd edn. Urban und Fischer, München

    Google Scholar 

  22. DIN 58943-3:2011-03 Medical microbiology—diagnosis of tuberculosis—part 3: detection of microbacterial by culture methods

  23. Wei JL, Bond J, Sykes KJ, Selvarangan R, Jackson MA (2008) Treatment outcomes for nontuberculous mycobacterial cervicofacial lymphadenitis in children based on the type of surgical intervention. Otolaryngol Head Neck Surg 138(5):566–571

    Article  PubMed  Google Scholar 

  24. Losurdo G, Castagnola E, Cristina E, Tasso L, Toma P, Buffa P, Giacchino R (1998) Cervical lymphadenitis caused by nontuberculous mycobacterial in immunocompetent children: clinical and therapeutic experience. Head Neck 20(3):245–249

    Article  CAS  PubMed  Google Scholar 

  25. Luong A, McClay JE, Jafri HS et al (2005) Antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis. Laryngoscope 115(10):1746–1751

    Article  PubMed  Google Scholar 

  26. Nguyen DQ, Righini C, Darouassi Y et al (2011) Nasal infection due to Mycobacterium fortuitum. Eur Ann Otorhinolaryngol Head Neck Dis 128(4):197–199

    Article  PubMed  Google Scholar 

  27. Deutsche Gesellschaft für pädiatrische Infektiologie DGPI (2013) Therapie von Erkrankungen durch NTM. DGPI Handbuch Infektionen bei Kindern und Jugendlichen, 6., vollständig überarbeitete Auflage, Thieme, Stuttgart, pp 568–9

  28. Bayazit YA, Bayazit N, Namiduru M (2004) Mycobacterial cervical lymphadenitis. ORL J Otorhinolaryngol Relat Spec 66(5):275–280

    Article  PubMed  Google Scholar 

  29. Iversen RH, Illum P (2012) Cervicofacial nontuberculous mycobacterial lymphadenitis in children. Dan Med J 59(1):A4349

    PubMed  Google Scholar 

  30. Hogan M, Price D, Burrage K, Pushpanathan C (2005) Atypical mycobacterial cervical lymphadenitis with extensive local spread: a surgical disease. Pediatr Surg Int 21(9):758–760

    Article  CAS  PubMed  Google Scholar 

  31. Núñez Cuadros E, Baquero Artigao F, Grupo de trabajo sobre infección por micobacterias no tuberculosas de la Sociedad Española de Infectología Pediátrica (SEIP) (2012) Recommandations from the Spanish Society of Paediatric Infectious Diseases on the diagnosis and treatment of non-tuberculous mycobacterial cervical lymphadenitis. An Pediatr (Barc) 77(3):208.e1–208.e12

    Article  Google Scholar 

  32. Thavagnanam S, McLoughlin LM, Hill C, Jackson PT (2006) Atypical mycobacterial infections in children: the case for early diagnosis. Ulster Med J 75(3):192–194

    PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Children’s Hospital auf der Bult, Hannover, Germany

    C. M. C. Deichmueller & H.-J. Welkoborsky

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Region Hannover, Nordstadt Clinic, Academic Hospital, Haltenhoffstr. 41, 30167, Hannover, Germany

    C. M. C. Deichmueller, K. Emmanouil & H.-J. Welkoborsky

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  1. C. M. C. Deichmueller
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  2. K. Emmanouil
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  3. H.-J. Welkoborsky
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Correspondence to C. M. C. Deichmueller.

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Deichmueller, C.M.C., Emmanouil, K. & Welkoborsky, HJ. Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge. Eur Arch Otorhinolaryngol 272, 2425–2431 (2015). https://doi.org/10.1007/s00405-014-3160-x

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  • DOI: https://doi.org/10.1007/s00405-014-3160-x

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