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Differential Diagnosis of Cervical Mycobacterial Lymphadenitis in Children

Carvalho, Anna C. C. MD, PhD*; Codecasa, Luigi MD†; Pinsi, Gabriele MD‡; Ferrarese, Maurizio MD†; Fornabaio, Chiara MD*; Bergamaschi, Viviana MD*; Lacchini, Carla MD†; Ekema, Giorgio MD§; Stefini, Stefania MD¶; Comelli, Mario MD, PhD∥; Matteelli, Alberto MD*

Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - pp 629-633
doi: 10.1097/INF.0b013e3181d1fdcd
Original Studies

Background and Aims: The differential diagnosis between tuberculosis (TB) and lymphadenitis caused by nontuberculous mycobacteria (NTM) in children is often based on epidemiologic and clinical data. The aim of this study was to identify epidemiologic and clinical variables associated with TB lymphadenitis in children attending 2 TB out-patient clinics in northern Italy during a 10-year period.

Patients and Methods: All children less than 16 years of age attending the study sites suspected of mycobacterial disease from 1999 through 2008 were included in the analysis. Logistic regression was used to evaluate the variables independently associated with TB lymphadenitis.

Results: From 299 children diagnosed with mycobacterial disease 121 children (40%) had a clinical diagnosis of cervical mycobacterial lymphadenitis: 38 TB (31%) and 83 NTM lymphadenitis (69%) cases. Increasing age (OR, 1.29; 95% CI, 1.02–1.69; P = 0.04), being foreign born (OR, 11.60; 95% CI, 1.37–114.20; P = 0.02), and having an abnormal chest radiograph (OR, 18.32; 95% CI, 2.37–201.68; P = 0.008) were independently associated with TB lymphadenitis. In the selected model, a 5-year-old foreign born child with cervical lymphadenitis and abnormal findings on chest radiograph has an estimated 0.90 probability of having TB disease. On the other hand, an Italy born child of the same age with cervical lymphadenitis and normal chest radiograph has a 0.04 probability of having TB.

Conclusion: Epidemiologic and clinical data are useful tools in the differential diagnosis between TB and NTM lymphadenitis when etiologic diagnosis is not available.

From the *Institute of Infectious and Tropical Diseases (IITD), University of Brescia, Spedali Civili di Brescia, Italy; †TB Reference Centre and Laboratory, Villa Marelli Institute/Niguarda Hospital, Milan, Italy; ‡U.O. Microbiology and Virology, Spedali Civili di Brescia, Brescia, Italy; §Clinic of Pediatric Surgery; ¶Department of Pediatric Otology and Laryngology, Spedali Civili di Brescia, Brescia, Italy; and ∥Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, University of Pavia, Pavia, Italy.

Accepted for publication December 29, 2009.

We confirm that all the authors do not have any possible conflicts of interest (including financial and other relationships).

Address for correspondence: Anna C. C. Carvalho, MD, PhD, Institute of Infectious and Tropical Diseases, University of Brescia. Piazza Spedali Civili, 1. 25125, Brescia, Italy. E-mail: a.carvalho@libero.it.

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© 2010 Lippincott Williams & Wilkins, Inc.