title: Differential diagnosis of cervical mycobacterial lymphadenitis in children.
abstract: OBJECTIVE
  The differential diagnosis between tuberculosis (TB) and lymphadenitis caused by nontuberculous mycobacteria (NTM) in children is often based on epidemiologic and clinical data. The aim of this study was to identify epidemiologic and clinical variables associated with TB lymphadenitis in children attending 2 TB out-patient clinics in northern Italy during a 10-year period.
  
  
  METHODS
  All children less than 16 years of age attending the study sites suspected of mycobacterial disease from 1999 through 2008 were included in the analysis. Logistic regression was used to evaluate the variables independently associated with TB lymphadenitis.
  
  
  RESULTS
  From 299 children diagnosed with mycobacterial disease 121 children (40%) had a clinical diagnosis of cervical mycobacterial lymphadenitis: 38 TB (31%) and 83 NTM lymphadenitis (69%) cases. Increasing age (OR, 1.29; 95% CI, 1.02-1.69; P = 0.04), being foreign born (OR, 11.60; 95% CI, 1.37-114.20; P = 0.02), and having an abnormal chest radiograph (OR, 18.32; 95% CI, 2.37-201.68; P = 0.008) were independently associated with TB lymphadenitis. In the selected model, a 5-year-old foreign born child with cervical lymphadenitis and abnormal findings on chest radiograph has an estimated 0.90 probability of having TB disease. On the other hand, an Italy born child of the same age with cervical lymphadenitis and normal chest radiograph has a 0.04 probability of having TB.
  
  
  CONCLUSIONS
  Epidemiologic and clinical data are useful tools in the differential diagnosis between TB and NTM lymphadenitis when etiologic diagnosis is not available.
authors.affiliation: Institute of Infectious and Tropical Diseases, University of Brescia, Spedali Civili di Brescia, Italy. a.carvalho@libero.it
authors.forename: Anna C C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Luigi
authors.initials: L
authors.lastname: Codecasa
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pinsi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrarese
authors.forename: Chiara
authors.initials: C
authors.lastname: Fornabaio
authors.forename: Viviana
authors.initials: V
authors.lastname: Bergamaschi
authors.forename: Carla
authors.initials: C
authors.lastname: Lacchini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ekema
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefini
authors.forename: Mario
authors.initials: M
authors.lastname: Comelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy; D008199:Lymphadenitis / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D008297:Male; D009161:Mycobacterium / Q000145:classification* / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D009333:Neck / Q000473:pathology*; D013902:Radiography, Thoracic; D012307:Risk Factors