title: Current trends in nontuberculous mycobacteria infections in Canadian children: A pediatric investigators collaborative network on infections in Canada (PICNIC) study.
abstract: BACKGROUND
  Nontuberculous mycobacteria (NTM) infections appear to be increasing in number and severity in developed countries worldwide. Surgical excision has been considered the standard treatment for NTM lymphadenitis, but the use of medical therapy seems to be increasing.
  
  
  OBJECTIVE
  To determine the disease characteristics as well as the current therapeutic management of NTM infections in Canadian children.
  
  
  METHODS
  Cases of definite or probable NTM infections were identified prospectively in children up to 18 years of age seen in 10 Canadian paediatric tertiary care centres from September 2005 to August 2006. Clinical, microbiological and pathological data were collected.
  
  
  RESULTS
  A total of 60 cases were identified. Data were complete for 45 patients, including 34 cases of lymphadenitis, four cases of skin and soft tissue infection, and seven cases of pulmonary NTM infection. Seventy-nine per cent of children (27 of 34) with lymphadenitis had an unsuccessful course of antibiotics before diagnosis. Sixty-eight per cent of purified protein derivative tests (15 of 22) were positive. NTM was detected in 76% of samples (29 of 38), of which 62% were Mycobacterium avium complex. All patients with lymphadenitis underwent surgical therapy and most patients (74%) also received antimicrobials.
  
  
  CONCLUSIONS
  Current trends indicate that the majority of the study centres are using medical therapy with variable regimen and duration as an adjunct to surgical excision in the treatment of NTM lymphadenitis. Larger numbers and longer follow-up times are needed to better evaluate the efficacy of medical therapy and outcome of disease. A randomized controlled study comparing surgical therapy alone and chemotherapy for NTM lymphadenitis is required.
authors.affiliation: Infectious Diseases Division, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec.
authors.forename: Anne
authors.initials: A
authors.lastname: Pham-Huy
authors.forename: Joan L
authors.initials: JL
authors.lastname: Robinson
authors.forename: Bruce
authors.initials: B
authors.lastname: Tapiéro
authors.forename: Chantal
authors.initials: C
authors.lastname: Bernard
authors.forename: Sam
authors.initials: S
authors.lastname: Daniel
authors.forename: Simon
authors.initials: S
authors.lastname: Dobson
authors.forename: Pierre
authors.initials: P
authors.lastname: Déry
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Saux
authors.forename: Joanne
authors.initials: J
authors.lastname: Embree
authors.forename: Louis
authors.initials: L
authors.lastname: Valiquette
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach