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Nontuberculous Mycobacteria in Children: A Focus on Bloodstream Infections

Al Yazidi, Laila S. MD; Marais, Ben J. PhD, FRCP; Hazelton, Briony FRACP, FRCPA; Outhred, Alexander FRCPA; Kesson, Alison PhD, FRACP, FRCPA

The Pediatric Infectious Disease Journal: April 2017 - Volume 36 - Issue 4 - p 374–378
doi: 10.1097/INF.0000000000001448
Original Studies
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Background: Nontuberculous mycobacteria (NTM) are ubiquitous organisms with variable disease-causing potential. Bloodstream infections caused by NTM in children are poorly described.

Methods: We describe a retrospective case series of children with culture-confirmed mycobacterial disease managed at the Children’s Hospital at Westmead between July 2005 and June 2015.

Results: Sixty-five patients had 149 positive NTM cultures; 55 (83.0%) episodes in 54 patients were considered clinically significant. Of the 54 children who met criteria for NTM disease, 25 (46.3%) had lymphadenitis, 13 (24.1%) lung disease, 8 (14.8%) had soft tissue infection or osteomyelitis and 8 (14.8%) had bacteremia. All children with bacteremia had a central venous catheter; those with pulmonary infection had underlying lung disease and all children with soft tissue infection or osteomyelitis had a history of recent penetrating injury. Disease caused by Mycobacterium avium–intracellulare complex was most common, accounting for 19 (76.0%) and 7 (53.8%) lymph node and lung infections, respectively. The most frequently isolated rapid growing mycobacteria were Mycobacterium fortuitum (8; 15%) and Mycobacterium abscessus (6; 11%), with M. fortuitum accounting for the majority (6; 75%) of bloodstream infections. Six (75%) patients with bacteremia had their intravenous catheter removed and all had a favorable outcome. A single disease relapse was reported in 1 of 2 patients with a retained catheter.

Conclusion: Lymphadenitis was the most common NTM disease manifestation and not associated with comorbidity. NTM bacteremia was always associated with a central line and catheter removal with cure. We were unable to assess the added value of various antibiotic regimens.

From the *Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, Australia; and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.

Accepted for publication October 19, 2016.

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

Address for correspondence: Laila Al Yazidi, MD, Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. E-mail: laila.alyazidi@health.nsw.gov.au; drlaila83@hotmail.com.

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