Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review.
OBJECTIVE
We review the management of 31 cases of atypical mycobacterial lymphadenitis presenting to a tertiary referral pediatric otolaryngology department between February 2002 and February 2007.


METHODS
Retrospective case review.


METHODS
Cases were identified by using the hospital's correspondence and pathology databases. Demographic and clinical information was collected. Descriptive and nonparametric inferential statistics (SPSS; SPSS Inc, Chicago, IL) were calculated.


RESULTS
Four patients were treated conservatively with triple-therapy antibiotics. Twenty-seven underwent surgical excision plus 3 months of clarithromycin postoperatively. Thirteen percent developed nodal recurrence; this appeared to be unrelated to the operation performed (chi(2)(8) = 5.8, P = 0.69) or the management modality used (P = 0.35). Patients with previous surgery were more likely to have recurrent infection (chi(2)(2) = 9.3, P = 0.01).


CONCLUSIONS
In our experience, nodal excision plus postoperative clarithromycin remains the best treatment option for most children, although those with limited disease may benefit from combination antibiotic therapy. Previous incision and drainage leads to high recurrence rates after later excision and therefore, heightened awareness of these infections is essential to ensure appropriate early management.
Fraser
Lyndsay
L
Department of Otolaryngology-Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK. LyndsayFraser@doctors.org.uk
Moore
Phillip
P
Kubba
Haytham
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D006257:Head / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009333:Neck / Q000382:microbiology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D017291:Clarithromycin