Document Detail


Cervicofacial nontuberculous mycobacterial lymphadenitis in children.
MedLine Citation:
PMID:  22239836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: 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.
MATERIAL AND METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.
Authors:
Rikke Haahr Iversen; Peter Illum
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Danish medical journal     Volume:  59     ISSN:  2245-1919     ISO Abbreviation:  Dan Med J     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-13     Completed Date:  2012-05-08     Revised Date:  2012-09-06    
Medline Journal Info:
Nlm Unique ID:  101576205     Medline TA:  Dan Med J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  A4349     Citation Subset:  IM    
Affiliation:
Otorhinolaryngology, Aarhus University Hospital, Denmark. rikkehaahr@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / administration & dosage*,  adverse effects
Child
Child, Preschool
Cutaneous Fistula / etiology*,  prevention & control
Denmark / epidemiology
Drainage* / adverse effects,  methods
Facial Nerve Injuries / etiology*,  prevention & control
Female
Humans
Incidence
Infant
Lymph Node Excision* / adverse effects,  methods
Lymph Nodes* / microbiology,  pathology,  surgery
Lymphadenitis* / epidemiology,  microbiology,  pathology,  therapy
Male
Mycobacterium Infections, Nontuberculous* / epidemiology,  pathology,  therapy
Neck
Nontuberculous Mycobacteria / isolation & purification
Postoperative Complications*
Remission, Spontaneous
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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