The management of non-tuberculous cervicofacial lymphadenitis in children: A systematic review and meta-analysis.
OBJECTIVE
Cervicofacial lymphadenitis is the most common manifestation of infection with non-tuberculous mycobacteria (NTM) in immunocompetent children. Although complete excision is considered standard management, the optimal treatment remains controversial. This study reviews the evidence for different management options for NTM lymphadenitis.


METHODS
A systematic literature review and meta-analysis were performed including 1951 children from sixty publications. Generalised linear mixed model regressions were used to compare treatment modalities.


RESULTS
The adjusted mean cure rate was 98% (95% CI 97.0-99.5%) for complete excision, 73.1% (95% CI 49.6-88.3%) for anti-mycobacterial antibiotics, and 70.4% (95% CI 49.6-88.3%) for 'no intervention'. Compared to 'no intervention', only complete excision was significantly associated with cure (OR 33.1; 95% CI 10.8-102.9; p < 0.001). Complete excision was associated with a 10% risk of facial nerve palsy (2% permanent). 'No intervention' was associated with delayed resolution.


CONCLUSIONS
Complete excision is associated with the highest cure rate in NTM cervicofacial lymphadenitis, but also had the highest risk of facial nerve palsy. In the absence of large, well-designed RCTs, the choice between surgical excision, anti-mycobacterial antibiotics and 'no intervention' should be based on the location and extent of the disease, and acceptability of prolonged time to resolution.
Infectious Diseases Unit, University Children's Hospital, University of Berne, 3010 Berne, Switzerland. Electronic address: petra.zimmermann@insel.ch.
Petra
P
Zimmermann
Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, and Institute for Life Sciences, University of Southampton, Southampton, UK; Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia. Electronic address: m.tebruegge@soton.ac.uk.
Marc
M
Tebruegge
Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia. Electronic address: nigel.curtis@rch.org.au.
Nigel
N
Curtis
Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia; Infectious Diseases Unit, University Children's Hospital, University of Basel, 4031 Basel, Switzerland. Electronic address: nicole.ritz@unibas.ch.
Nicole
N
Ritz
D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D006257:Head / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision; D008199:Lymphadenitis / Q000175:diagnosis* / Q000628:therapy*; D009333:Neck / Q000473:pathology*; D016896:Treatment Outcome
Atypical; Children; Lymphadenitis; Management; Mycobacteria; Non-tuberculous; Treatment