Intrathoracic Disease From Nontuberculous Mycobacteria in Children: Two Cases and a Review of the Literature

Endobronchial Lesions Caused by Nontuberculous Mycobacteria in Apparently Healthy Pediatric Patients

“…M. avium is the predominant NTM species causing pulmonary disease in general 32,34 and intrathoracic disease in pediatric patients in particular. 20,27 In 1 of our patients, PCR products typical for M. chelonae, in one other patient not specifiable mycobacterial PCR products were identified in the molecular pathological investigation only. The full standard ATS criteria for pulmonary NTM disease were thus not fulfilled (i.e., confirmatory identification in a further sample on a second occasion).…”

“…Other reports describe the endobronchial masses caused by NTM to be fleshy, mucoid, cheesy friable or rubbery gray-white. 20,25,27,35,36 Most commonly, the lesions were characterized as granulation tissue, although 1 author 25 noted a caseous node. In all our cases, endobronchial masses significantly obstructed a large bronchus; after debulking, an intact bronchial wall was found.…”

Differential Diagnosis of Cervical Mycobacterial Lymphadenitis in Children

“…9,12,17 Pulmonary or disseminated disease caused by NTM in children are frequently associated with immunodeficiency disorders although cases of pulmonary disease in immunocompetent children has already been reported. 9,27,28 Surgical excision of the affected lymph nodes is the therapy for choice for NTM lymphadenitis since antibiotic regimens are of limited efficacy due to natural resistance of most NTM; moreover, the use of antibiotics in young children is frequently associated with drug intolerance. 29 In our study, NTM were a minor cause of mycobacterial disease as a whole (83 cases, 28% of total), but it was the main etiologic agent of lymphadenitis, being responsible for 56% of lymphadenitis cases in Milan and 82% in Brescia.…”

I/St Mice Hypersusceptible toMycobacterium tuberculosisAre Resistant toM. avium

“…They are present in approximately 70% of patients with advanced untreated AIDS and are considered the major killer in this cohort (24). With a background of less severely impaired immunity (e.g., in older persons and in children), M. avium may cause chronic lung disease (4,13,27). In model systems based on infection of C57BL/6 (B6) inbred mice and their genetic derivatives bearing knockout mutations in genes important for immunity, it was demonstrated that the T-cell immune response to M. avium plays both protective and pathological roles in the course of infection.…”