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NON-TUBERCULOUS MYCOBACTERIAL CERVICOFACIAL LYMPHADENITIS IN CHILDREN – 10 YEAR EXPERIENCE IN A TERTIARY PAEDIATRIC CENTRE
Abstract
Background
Non-tuberculous mycobacteria (NTM) lymphadenitis in children is increasingly recognised, and poses diagnostic and therapeutic challenges.
Aims
To describe the epidemiology and clinical features of NTM lymphadenitis, determine sampling diagnostic yield, and review management and outcomes.
Methods
We performed a 10 year retrospective review (2011-2021) of children aged 0-16 years with NTM lymphadenitis. Diagnosis was based on typical clinical features in the presence of positive histological finding of granulomatous inflammation, culture, or direct polymerase chain reaction testing. Data collection included demographics, risk factors, clinical features, investigations, treatment, complications and outcomes.
Results
Forty-five children had 48 episodes of NTM lymphadenitis; 62.2% female, mean age 80 months (range 12-166 months). 43.7% presented with unilateral single node, most commonly parotid (39.6%), and submandibular (29.2%). 20.8% had reported fever. Three patients with disseminated NTM infection had pre-existing (n=2) or newly diagnosed (n=1) immunodeficiency. Sixty-seven sampling procedures were performed; NTM was identified in 23/64 (35.9%) specimens sent, from culture (n=16) or sequencing (n=7). NTM was identified in 22/48 episodes (45.8%). Mycobacterium abscessus was most common (11/23, 47.8%), followed by Mycobacterium haemophilum (6/23, 26.1%). Surgery was performed in 45/48 episodes (98.3%). 38 children (79.2%) received antibiotics; mean duration 4.96 months (range 0.75-19 months). Outcomes for 43 episodes showed 69.8% fully resolved, 27.9% relapsed at a new site, 2.3% recurred. 10/45 (22.2%) had post-surgical complications and 11/38 (28.9%) developed adverse drug reactions.
Conclusions
Mycobacterium abscessus lymphadenitis was most commonly identified. Culture yield was low but molecular sequencing improved diagnosis. About 1/3 had relapse or recurrence, and 1/4 had treatment complications..