Head and neck mycobacterial infections in pediatric patients

Abstract

Objective: Lymph nodal disease is one of the most common manifestations of head and neck tuberculosis and is particularly frequent in paediatric patients with an increasing incidence in the last decade. It may represent the manifestation of a systemic tuberculous disease or a clinical entity specific of the neck. Aim of this paper is to retrospectively analyse mycobacterial cervical adenopathies observed in two Paediatric European Centers between 1986 and 2004 and the outcomes of medical or surgical treatment. Methods: 353 children were examined for mycobacterial cervical lymphadenopaties since January 1986 to December 2004. Demografic data about the sample are showed. The retrospective evaluation of the sample underlined distribution according to etiologic patterns, head and neck adenopathies localization. Previous or simultaneous medical or surgical treatment were analyzed. Statistical analysis with Chi Square test was performed. Results: 281 (79.60%) cases showed a higher localization and 72 (20.40%) a lower localization. In relation to the etiological agent, 8 (2.27%) Mycobacterium tuberculosis (MTB) and 222 (62.89%) mycobacteria other than tuberculosis (MOTT) lymphadenopaties were observed in the upper localization as opposed to 21 (5.95%) MTB and 39 (11.05%) MOTT in the lower plane. Two (0.56%) were detected as upper lymph nodal tumefaction in the median line. In 86 (24.36%) cases at the MRI the so-called "iceberg effect" was noted. 163 (62.45%) patients underwent primary excisional biopsy whereas 74 (28.35%) underwent exeresis after other unsuccessfull therapies, 9 underwent only drainage, and 15 drainage with subsequent antibiotic therapy. Number of relapses after surgery was 16 (6.13%). Conclusions:A not homogeneous therapeutic approach to the mycobacterial cervical adenitis arises from literature and WHO guidelines does not give indications for the treatment of the cervical pattern.A therapeutic strategy based on the etiology is mandatory. In case of MBT adenopathy the therapy of choice includes the association, in variable way, of different chemotherapic drugs; surgery is reserved to advanced cases. Conversely, in cases of MOTT adenopathy, surgery is the treatment of choice.

Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections

“…The diagnosis and identification of the infectious agent in case of subacute or chronic cervical lymphadenitis could be difficult and microbiological investigations should be performed on lymph node biopsy. However, a positive culture for NTM is generally obtained only from 40-50% of lymph nodes suspected for NTM infection [42]. In case of negative culture, the clinical picture (young children, sub-acute presentation, fluctuant lymph node, purple overlying skin), the radiological aspect (colliquation, micro-calcifications) and the histological report (necrotizing granuloma) can guide the presumptive diagnosis.…”

Cervical abscess in an immunocompetent patient with Mycobacterium malmoense pulmonary disease

“…However, this presentation is still very uncommon when compared to the same disease due to M. avium complex [13]. It is argued by McCrossin and Mailman [18] that the occurrence of NTM adenitis in young children without predisposing conditions is perhaps a combination of immature immunityeven if there is no evidence that they lack essential immunological protection against mycobacteria as compared to adults [18] -and an increased exposure of their oral mucosa to environmental organisms due to less strict hygienic habits and pica [17].…”

“…Clinical observations also suggest that vaccination with Bacille Calmette-Guérin (BCG) protects children against NTM lymphadenitis, according to the rates of the disease before and after the discontinuation of newborns' BCG vaccination in Sweden [12,19]. Focal cervical NTM disease when treated with complete surgical excision has a very high rate of success [13,20]. On the other hand, fine needle aspiration biopsy or incision and drainage of the involved lymph nodes without a complete excision may be followed by formation of sinus with chronic drainage, as happened in this case [9].…”

“…Most patients are male adults, with a mean age of 60 years, with underlying lung disease, especially chronic obstructive pulmonary disease (COPD), and present clinical symptoms and signs similar to those of pulmonary tuberculosis. The second group is formed by immunocompetent children, mostly younger than 5 years of age, with localized cervical lymphadenitis [1,6,8,[11][12][13]. Albeit rarely, other types of localized disease have been described, including skin, soft tissue infections and osteoarticular infections [14].…”

Microbiological and molecular characterization of environmental mycobacterium strains isolated from the Buruli ulcer endemic and non-endemic zones in Cte dIvoire

“…This is an extremely polymorphic bacterial genus that includes fast-growing species (less than 7 days), and slow growing species (7-60 days) and non-culturable outside animals species, Mycobacterium leprae, leprosy causing agent (Euzéby, 2010). Mycobacteria are divided into two major groups, they are complex tuberculosis and non-tuberculosis mycobacteria (NTM) also called environmental mycobacteria (mycobacteria of leprosy and atypical mycobacteria) (Inderlied et al, 1993;Caruso et al, 2009;del Rio Camacho et al, 2010). Although, molecular biology has helped to discover the existence of diversity in environmental mycobacteria (Domenech et al, 1994;Menendez et al, 2002;Williamson et al, 2008;Kakou-Ngazoa et al, 2015), culturing of species however, remains the most efficient means of knowing their physiology and their antibiotic sensitivity (Kubica et al, 1964;Trujillo et al, 2004).…”