Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone.
BACKGROUND
Nontuberculous mycobacteria can cause a chronic localized cervicofacial lymphadenitis in immunocompetent children. The recommended treatment is total excision of the affected lymph node. The aim of this study was to describe our experience with an observational approach.


METHODS
Children with chronic nontuberculous mycobacterial (NTM) cervical lymphadenitis, whose parents opted for conservative treatment, were followed at our center from 1990 to 2004. The diagnosis of NTM was based on mycobacterial culture of lymph node specimens obtained by fine needle aspiration. The clinical laboratory and follow-up data were documented.


RESULTS
Ninety-two children with lymph node positive cultures of nontuberculous mycobacterium were included in the study. Mycobacterium avium complex and Mycobacterium hemophilum were isolated in 90% of the cultures. In most cases, the affected lymph nodes underwent violaceous changes with discharge of purulent material for 3-8 weeks. Total resolution was achieved within 6 months in 71% of patients and within 9-12 months in the remainder. At the 2-year follow-up, a skin-colored, flat scar in the region of the drainage was noted. There were no complications.


CONCLUSIONS
We suggest that the observational approach can be effective for managing NTM lymphadenitis in immunocompetent children.
Zeharia
Avraham
A
Day Hospitalization Unit, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
Eidlitz-Markus
Tal
T
Haimi-Cohen
Yishai
Y
Samra
Zmira
Z
Kaufman
Lea
L
Amir
Jacob
J
D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology; D008199:Lymphadenitis / Q000382:microbiology / Q000628:therapy*; D008297:Male; D009164:Mycobacterium Infections / Q000382:microbiology / Q000628:therapy*; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology / Q000628:therapy*; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D018393:Mycobacterium haemophilum / Q000302:isolation & purification; D009333:Neck; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification