title: Cervicofacial nontuberculous mycobacterial lymphadenitis in children.
abstract: Nontuberculous mycobacteria are ubiquitous organisms readily isolated from natural waters, drinking water systems and soil. They form a continuous challenge to the human immune system which becomes apparent in patients with impaired immunity. However, most infections occur in seemingly healthy children. The clinical presentation consists of a unilateral, non-tender, persistent, cervical lymphadenopathy without systemic illness. Fistula formation may occur.
  
  
  
  Patients were included if one or more of the following were positive; 1) mycobacterial culture, 2) acid-fast microscopy, 3) polymerase chain reaction and/or 4) granulomatous inflammation.
  
  
  
  On the basis of operative management, two distinct groups were established. Group 1 had an excision of all pathological tissue performed and Group 2 was treated with incision and drainage. There was a difference between the two groups in regard to the risk of developing a postoperative fistula. In Group 1, 50% developed a fistula compared with 91% in Group 2 (p = 0.06).
  
  
  
  Surgical treatment is generally advocated as the treatment of choice. Antibiotic treatment is associated with adverse effects and avoidance of surgery does not justify the inferior results related to antibiotics. A watch-and-wait strategy or antibiotic therapy may be considered when surgical excision carries a high risk of facial nerve injury. Although the lymph nodes may persist for months, spontaneous regression may occur and the children remain systemically well.
  
  
  
  not relevant.
  
  
  
  not relevant.
authors.affiliation: Otorhinolaryngology, Aarhus University Hospital, Denmark. rikkehaahr@hotmail.com
authors.forename: Rikke Haahr
authors.initials: RH
authors.lastname: Iversen
authors.forename: Peter
authors.initials: P
authors.lastname: Illum
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology* / Q000517:prevention & control; D003718:Denmark / Q000453:epidemiology; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D020220:Facial Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008199:Lymphadenitis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D009333:Neck; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D011183:Postoperative Complications; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents