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Management of Nontuberculous Mycobacteria-Induced Cervical Lymphadenitis With Observation Alone

Zeharia, Avraham MD, MHA*; Eidlitz-Markus, Tal MD*; Haimi-Cohen, Yishai MD*; Samra, Zmira PhD; Kaufman, Lea BSc; Amir, Jacob MD

The Pediatric Infectious Disease Journal: October 2008 - Volume 27 - Issue 10 - p 920-922
doi: 10.1097/INF.0b013e3181734fa3
Original Studies

Background: Nontuberculous mycobacteria can cause a chronic localized cervicofacial lymphadenitis in immunocompetent children. The recommended treatment is total excision of the affected lymph node. The aim of this study was to describe our experience with an observational approach.

Methods: Children with chronic nontuberculous mycobacterial (NTM) cervical lymphadenitis, whose parents opted for conservative treatment, were followed at our center from 1990 to 2004. The diagnosis of NTM was based on mycobacterial culture of lymph node specimens obtained by fine needle aspiration. The clinical laboratory and follow-up data were documented.

Results: Ninety-two children with lymph node positive cultures of nontuberculous mycobacterium were included in the study. Mycobacterium avium complex and Mycobacterium hemophilum were isolated in 90% of the cultures. In most cases, the affected lymph nodes underwent violaceous changes with discharge of purulent material for 3–8 weeks. Total resolution was achieved within 6 months in 71% of patients and within 9–12 months in the remainder. At the 2-year follow-up, a skin-colored, flat scar in the region of the drainage was noted. There were no complications.

Conclusions: We suggest that the observational approach can be effective for managing NTM lymphadenitis in immunocompetent children.

From the *Day Hospitalization Unit, Schneider Children’s Medical Center of Israel; †Department of Microbiology, Rabin Medical Center, Beilinson Hospital, Petah Tiqwa; and ‡Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Accepted for publication March 11, 2008.

Address for correspondence: Jacob Amir, MD, Department of Pediatrics C, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petah Tiqva, 49202, Israel. E-mail: amirj@clalit.org.il.

© 2008 Lippincott Williams & Wilkins, Inc.