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Comparison of Mycobacterium lentiflavum and Mycobacterium avium-intracellulare Complex Lymphadenitis

Jiménez-Montero, Beatriz MD*; Baquero-Artigao, Fernando MD; Saavedra-Lozano, Jesús MD, PhD; Tagarro-García, Alfredo MD, PhD*; Blázquez-Gamero, Daniel MD§; Cilleruelo-Ortega, María J. MD, PhD; Ramos-Amador, José T. MD, PhD; Galé-Ansó, Inés MD§; Marín, Natalia MD; Gómez-García, Raquel MD; Santiago-García, Begoña MD; Garrido, Jesus MD§; López, Goosen MD**

The Pediatric Infectious Disease Journal: January 2014 - Volume 33 - Issue 1 - p 28–34
doi: 10.1097/INF.0000000000000007
Original Studies

Background: Mycobacterium lentiflavum is considered a rare pathogen causing nontuberculous mycobacterial (NTM) lymphadenitis.

Methods: A multicenter, retrospective study was performed in immunocompetent children <14 years of age with microbiologically confirmed NTM lymphadenitis treated at 6 hospitals in Madrid, Spain, during 2000–2010. We compared children with M. lentiflavum and Mycobacterium avium-intracellulare complex infection.

Results: Forty-five microbiologically confirmed NTM lymphadenitis patients were identified: 19 (45.2%) caused by M. avium-intracellulare complex, 17 (40.5%) by M. lentiflavum, 1 by both and 5 by other mycobacteria. Out of 17 M. lentiflavum cases, 14 were diagnosed in the past 5 years. Regarding M. lentiflavum cases, median age was 23 months. Submandibular nodes were the most frequently involved (76.5%), with multiple locations seen in 41% of the children and spontaneous drainage in 41% of them. Drug susceptibility tests were performed in 14 isolates and showed a complete susceptibility to clarithromycin and cycloserine, whereas 93% were resistant to rifampin, 33% to quinolones and full resistance to other tested antimycobacterial drugs was detected. All but 1 child required surgery and 11 were treated additionally with various drug combinations. Total resolution was achieved in 50% of children within 6 months.

Compared with M. avium-intracellulare complex cases, children were younger and laterocervical nodes were significantly less frequently involved. No statistically significant differences were found related to clinical characteristics, treatment and outcome.

Conclusions: M. lentiflavum is an emerging pathogen producing NTM lymphadenitis in Madrid.

From the *Department of Pediatrics, Hospital Infanta Sofía, San Sebastián de los Reyes; Division of Pediatric Infectious Diseases, Hospital Universitario La Paz; Division of Pediatric Infectious Diseases, Gregorio Marañón Hospital; §Division of Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre; Department of Pediatrics, Hospital Puerta de Hierro- Majadahonda; Department of Pediatrics, Hospital de Getafe; and **Department of Microbiology, Hospital Universitario La Paz, Madrid.

Accepted for publication August 19, 2013.

The authors have no other funding or conflicts of interest or funding to disclose.

Address for correspondence: Beatriz Jiménez Montero, C/ Violeta 15, 28760 Tres Cantos, Madrid, Spain. E-mail: b.jimenez.montero@gmail.com.

© 2014 by Lippincott Williams & Wilkins, Inc.