title: Granulomatous cervicofacial lymphadenitis in children: a nine-year study in Singapore.
abstract: BACKGROUND
  Granulomatous cervicofacial lymphadenitis (GCL) is not uncommon in children. Nontuberculous mycobacteria (NTM) seem to be the predominant cause. We sought to study the clinical and microbiological profile of patients with GCL, and identify features that may impact outcome.
  
  
  METHODS
  Children aged < 16 years who presented to KK Women's and Children's Hospital, Singapore, between January 1998 and December 2006, and who had GCL were identified from laboratory records. Clinical and laboratory data was collected and analysed for risk factors for patients with positive lymph node cultures, and for patients with and without recurrence after treatment.
  
  
  RESULTS
  In all, 60 children were identified, with a median age of 56 (interquartile range [IQR] 34-101) months. Median duration of symptoms before presentation was 5 (IQR 4-8) weeks. The majority presented with single (73.3%) or unilateral (96.7%) lymphadenopathy, located in the submandibular, preauricular/parotid or infra-/post-auricular region (76.7%). Out of 51 patients, 26 (51.0%) had a tuberculin skin test reading of ≥ 10 mm. Out of 52 patients, 10 (19.2%) had positive mycobacterial cultures, which included seven isolates of NTM. Out of 34 cases, tuberculous polymerase chain reaction was positive in 11 (32.4%). With regard to recurrence after initial treatment, age < 5 years at presentation was found to be a predictor for recurrence (p = 0.008), while initial complete excision of affected nodes predicted no recurrence (p = 0.003).
  
  
  CONCLUSIONS
  In our study, younger age was noted to be associated with a higher chance of recurrence, while complete excision of the involved node at initial presentation predicted non-recurrence.
authors.affiliation: Infectious Disease Service, Department of Paediatric Medicine, Level 3, Children's Tower, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. Thoon.Koh.Cheng@kkh.com.sg.
authors.forename: Koh Cheng
authors.initials: KC
authors.lastname: Thoon
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Subramania
authors.forename: Chia Yin
authors.initials: CY
authors.lastname: Chong
authors.forename: Kenneth Tou En
authors.initials: KT
authors.lastname: Chang
authors.forename: Nancy Wen Sim
authors.initials: NW
authors.lastname: Tee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000382:microbiology; D008297:Male; D009161:Mycobacterium; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012846:Singapore; D016896:Treatment Outcome; D014374:Tuberculin Test