European Journal of Pediatrics

, Volume 176, Issue 5, pp 607–613 | Cite as

Risk factors of non-tuberculous mycobacterial lymphadenitis in children: a case–control study

  • Patricia W. Garcia-Marcos
  • Mercedes Plaza-Fornieles
  • Ana Menasalvas-Ruiz
  • Ramon Ruiz-Pruneda
  • Pedro Paredes-Reyes
  • Santiago Alfayate Miguelez
Original Article

Abstract

The aim of the present study is to clarify the association between environmental exposures and non-tuberculous mycobacterial (NTM) lymphadenitis, during the last decade, in a population of children. In children up to 14 years of age in a pediatric tertiary hospital, all cases of NTM lymphadenopathy with a specific microbiological diagnosis, from January 2004 to January 2015, were reviewed. This is a case–control study (1:5 proportion), in which the prevalence of environmental factors between cases and controls was compared by means of a multivariate logistic regression analysis. A total of 24 cases were diagnosed in the aforementioned period, and 18 of them included in the case–control study. Mycobacterium avium-intracellulare was the predominant mycobacterium species isolated (83.3%). Exposure to hens showed a clear trend to be significantly associated with the disease (OR = 4.33; IC95% 0.97–19.41, p = 0.055), with no significant differences for the rest of the risk factors studied.

Conclusion: M. avium is still the predominant bacteria causing NTM lymphadenitis in children of our region. Contact with hens has been the only risk factor for NTM lymphadenitis detected in the present study.

What is Known:

M. avium is the predominant bacteria causing NTM lymphadenitis in children of our region.

There is no consensus on which environmental factors are associated with NTM lymphadenitis in children.

What is New:

The only risk factor for NTM lymphadenitis found in the present study was regular contact with hens. Contact with other farm animals was not associated to NTM lymphadenitis.

Keywords

Non-tuberculous Lymphadenitis Children Risk factors Birds Hens 

Abbreviations

aORs

Adjusted ORs

ED

Emergency department

FNAB

Fine-needle aspiration biopsy

MAC

Mycobacterium intracellular complex

NTM

Non-tuberculous mycobacterial

Notes

Acknowledgements

We are grateful to Mr. Anthony Carlson for his assistance with the English language.

Authors’ contributions

All coauthors have contributed to the study: Dr. Alfayate and Dr. Menasalvas (pediatricians) diagnosed the cases, with the cooperation of Dr. Paredes (microbiologist). Dr. Ruiz Pruneda (pediatric surgeon) was in charge of the surgical therapy. Dr. Plaza and Dr. García-Marcos (pediatricians) interviewed about the risk factors and contributed to the follow-up. They also recruited and interviewed the control group. Dr. Garcia-Marcos wrote the paper, which was corrected and approved in the last version by the rest of the authors.

Compliance with ethical standards

Informed consent was obtained before interviewing all cases and controls.

This article does not contain any studies with human participants performed by any of the authors.

Funding

This work was not supported by any funding source.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bruijnesteijn van Coppenraet LE, de Haas PE, Lindeboom JA, Kuijper EJ, van Soolingen D (2008) Lymphadenitis in children is caused by Mycobacterium avium hominissuis and not related to ‘bird tuberculosis’. Eur J Clin Microbiol Infect Dis 27(4):293–299CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cabria F, Torres MV, Garcia-Cia JI, Dominguez-Garrido MN, Esteban J, Jimenez MS (2002) Cervical lymphadenitis caused by Mycobacterium lentiflavum. Pediatr Infect Dis J 21(6):574–575CrossRefPubMedGoogle Scholar
  3. 3.
    Dvorska L, Matlova L, Bartos M et al (2004) Study of Mycobacterium avium complex strains isolated from cattle in the Czech Republic between 1996 and 2000. Vet Microbiol 99(3–4):239–250CrossRefPubMedGoogle Scholar
  4. 4.
    Fischer OA, Matlova L, Dvorska L et al (2004) Blowflies Calliphora vicina and Lucilia sericata as passive vectors of Mycobacterium avium subsp. avium, M. a. paratuberculosis and M. a. hominissuis. Med Vet Entomol 18(2):116–122CrossRefPubMedGoogle Scholar
  5. 5.
    Gonzalez-Granado LI, Gonzalez-Tome MI, Rojo-Conejo P, Ruiz-Contreras J (2009) Erythema nodosum as a first sign of adenitis due to Mycobacterium lentiflavum. An Pediatr (Barc) 71(4):364–365CrossRefGoogle Scholar
  6. 6.
    Gonzalez-Martin J, Garcia-Garcia JM, Anibarro L et al (2010) Consensus document on the diagnosis, treatment and prevention of tuberculosis. Arch Bronconeumol 46(5):255–274CrossRefPubMedGoogle Scholar
  7. 7.
    Jimenez-Montero B, Baquero-Artigao F, Saavedra-Lozano J et al (2014) Comparison of Mycobacterium lentiflavum and Mycobacterium avium-intracellulare complex lymphadenitis. Pediatr Infect Dis J 33(1):28–34CrossRefPubMedGoogle Scholar
  8. 8.
  9. 9.
    Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Lindeboom R, Prins JM (2007) Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis 44(8):1057–1064CrossRefPubMedGoogle Scholar
  10. 10.
    Marshall HM, Carter R, Torbey MJ et al (2011) Mycobacterium lentiflavum in drinking water supplies. Australia Emerg Infect Dis 17(3):395–402CrossRefPubMedGoogle Scholar
  11. 11.
    Matlova L, Dvorska L, Palecek K, Maurenc L, Bartos M, Pavlik I (2004) Impact of sawdust and wood shavings in bedding on pig tuberculous lesions in lymph nodes, and IS1245 RFLP analysis of Mycobacterium avium subsp. hominissuis of serotypes 6 and 8 isolated from pigs and environment. Vet Microbiol 102(3–4):227–236CrossRefPubMedGoogle Scholar
  12. 12.
    Pham-Huy A, Robinson JL, Tapiero B et al (2010) Current trends in nontuberculous mycobacteria infections in Canadian children: a pediatric investigators collaborative network on infections in Canada (PICNIC) study. Paediatr Child Health 15(5):276–282PubMedPubMedCentralGoogle Scholar
  13. 13.
    Philip J, Bhatia S, Sugar A, Berry N, Ruddy M (2011) Mycobacterium lentiflavum—a cause of infections in the head and neck: case report and literature review. J Oral Maxillofac Surg 69(4):1114–1116CrossRefPubMedGoogle Scholar
  14. 14.
    Reed C, von Reyn CF, Chamblee S et al (2006) Environmental risk factors for infection with Mycobacterium avium complex. Am J Epidemiol 164(1):32–40CrossRefPubMedGoogle Scholar
  15. 15.
    von Reyn CF, Maslow JN, Barber TW, Falkinham JO III, Arbeit RD (1994) Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS. Lancet 343(8906):1137–1141CrossRefGoogle Scholar
  16. 16.
    Ruiz del Olmo I, Bustillo M, Monforte M, Burgués P, Guerrero C (2016) Linfadenitis por micobacterias no tuberculosas: experiencia de 15 años. An Pediatr (Barc):1–7Google Scholar
  17. 17.
    Tebruegge M, Pantazidou A, MacGregor D et al (2016) Nontuberculous mycobacterial disease in children—epidemiology, diagnosis & management at a tertiary center. PLoS One 11(1):e0147513CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tortoli E, Bartoloni A, Erba ML et al (2002) Human infections due to Mycobacterium lentiflavum. J Clin Microbiol 40(2):728–729CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Varghese B, Memish Z, Abuljadayel N, Al-Hakeem R, AlRabiah F, Al-Hajoj SA (2013) Emergence of clinically relevant non-tuberculous mycobacterial infections in Saudi Arabia. PLoS Negl Trop Dis 7(5):e2234CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Zimmermann P, Tebruegge M, Curtis N, Ritz N (2015) The management of non-tuberculous cervicofacial lymphadenitis in children: a systematic review and meta-analysis. J Infect 71(1):9–18CrossRefPubMedGoogle Scholar
  21. 21.
    Zimmermann P, Tebruegge M, Curtis N, Ritz N (2016) A personalised approach is needed for the management of non-tuberculous mycobacterial cervicofacial lymphadenitis. J Infect 73(4):391–392CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Patricia W. Garcia-Marcos
    • 1
    • 2
  • Mercedes Plaza-Fornieles
    • 1
  • Ana Menasalvas-Ruiz
    • 3
  • Ramon Ruiz-Pruneda
    • 4
  • Pedro Paredes-Reyes
    • 5
  • Santiago Alfayate Miguelez
    • 3
  1. 1.Deparment of General Pediatrics, Arrixaca University Children’s HospitalUniversity of MurciaMurciaSpain
  2. 2.Secretaría de Pediatría, 3a planta Hospital Materno-InfantilMurciaSpain
  3. 3.Pediatrics Infectious Diseases Unit, Arrixaca University Children’s HospitalUniversity of MurciaMurciaSpain
  4. 4.Department of Pediatric Surgery, Arrixaca University Children’s HospitalUniversity of MurciaMurciaSpain
  5. 5.Department of Microbiology, Arrixaca University Children’s HospitalUniversity of Murcia and IMIB-Arrixaca Research InstituteMurciaSpain

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