Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Overview of nontuberculous mycobacterial lymphadenitis in children

INTRODUCTION

Nontuberculous mycobacteria (NTM) are a miscellaneous collection of acid-fast bacteria that are widespread in the environment [1]. They have been isolated from numerous environmental sources including water, soil, food products, and domestic and wild animals [2]. Nosocomial transmission has occurred with medical equipment [3-5].

More than 130 species of have been identified, not all of which have been documented to cause disease in humans [6-9]. NTM pathogens are classified as rapidly growing or slowly growing (table 1). Rapidly growing species grow within seven days and include Mycobacterium fortuitum, M. abscessus, and M. chelonae. Slowly growing species require several weeks to grow and include M. avium complex (MAC), M. marinum, and M. kansasii. (See "Microbiology of nontuberculous mycobacteria", section on 'Classification'.)

NTM can cause a broad range of infections that vary depending on the particular NTM species and the host. In children, NTM cause four main clinical syndromes: lymphadenitis, skin and soft tissue infection (SSTI), pulmonary disease (predominantly in children with underlying pulmonary conditions), and disseminated disease (predominantly in children with immune compromise).

This topic will provide an overview of NTM lymphadenitis in children. NTM SSTI, pulmonary infections, disseminated infections, and bacteremia in children are discussed separately. (See "Overview of nontuberculous mycobacterial skin and soft tissue infections in children" and "Overview of nontuberculous mycobacterial pulmonary infections in children" and "Overview of disseminated nontuberculous mycobacterial (NTM) infections and NTM bacteremia in children".)

MICROBIOLOGY

In case series of nontuberculous mycobacterial lymphadenitis among children in the United States, the majority of cases are caused by M. avium complex (MAC), which includes M. avium and M. intracellulare [2,10,11]. In series from other countries, MAC and M. haemophilum are frequently isolated [12-15].

                            

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Oct 4, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Fraser L, Moore P, Kubba H. Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review. Otolaryngol Head Neck Surg 2008; 138:311.
  2. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
  3. Bolan G, Reingold AL, Carson LA, et al. Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis 1985; 152:1013.
  4. Celdrán A, Esteban J, Mañas J, Granizo JJ. Wound infections due to Mycobacterium fortuitum after polypropylene mesh inguinal hernia repair. J Hosp Infect 2007; 66:374.
  5. Ferguson DD, Gershman K, Jensen B, et al. Mycobacterium goodii infections associated with surgical implants at Colorado hospital. Emerg Infect Dis 2004; 10:1868.
  6. McNabb A, Eisler D, Adie K, et al. Assessment of partial sequencing of the 65-kilodalton heat shock protein gene (hsp65) for routine identification of Mycobacterium species isolated from clinical sources. J Clin Microbiol 2004; 42:3000.
  7. Tortoli E. Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev 2003; 16:319.
  8. American Academy of Pediatrics. Diseases caused by nontuberculous mycobacteria: (atypical mycobacteria, mycobacteria other than Mycobacterium tuberculosis. In: Red Book: 2012 Report of the Committee on Infectious Diseases, 29th, Pickering LK. (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2012. p.759.
  9. Mycobacterium. In: List of Prokaryotic names with Standing in Nomenclature. http://www.bacterio.cict.fr/m/mycobacterium.html (Accessed on July 21, 2012).
  10. Wolinsky E. Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up. Clin Infect Dis 1995; 20:954.
  11. Cruz AT, Ong LT, Starke JR. Mycobacterial infections in Texas children: a 5-year case series. Pediatr Infect Dis J 2010; 29:772.
  12. Lindeboom JA, Kuijper EJ, Prins JM, et al. Tuberculin skin testing is useful in the screening for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis 2006; 43:1547.
  13. Zeharia A, Eidlitz-Markus T, Haimi-Cohen Y, et al. Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone. Pediatr Infect Dis J 2008; 27:920.
  14. Cohen YH, Amir J, Ashkenazi S, et al. Mycobacterium haemophilum and lymphadenitis in immunocompetent children, Israel. Emerg Infect Dis 2008; 14:1437.
  15. Levy I, Grisaru-Soen G, Lerner-Geva L, et al. Multicenter cross-sectional study of nontuberculous mycobacterial infections among cystic fibrosis patients, Israel. Emerg Infect Dis 2008; 14:378.
  16. Chesney PJ. Nontuberculous mycobacteria. Pediatr Rev 2002; 23:300.
  17. Grange JM, Yates MD, Pozniak A. Bacteriologically confirmed non-tuberculous mycobacterial lymphadenitis in south east England: a recent increase in the number of cases. Arch Dis Child 1995; 72:516.
  18. Pham-Huy A, Robinson JL, Tapiéro B, et al. Current trends in nontuberculous mycobacteria infections in Canadian children: A pediatric investigators collaborative network on infections in Canada (PICNIC) study. Paediatr Child Health 2010; 15:276.
  19. Vu TT, Daniel SJ, Quach C. Nontuberculous mycobacteria in children: a changing pattern. J Otolaryngol 2005; 34 Suppl 1:S40.
  20. Blyth CC, Best EJ, Jones CA, et al. Nontuberculous mycobacterial infection in children: a prospective national study. Pediatr Infect Dis J 2009; 28:801.
  21. Reuss AM, Wiese-Posselt M, Weissmann B, et al. Incidence rate of nontuberculous mycobacterial disease in immunocompetent children: a prospective nationwide surveillance study in Germany. Pediatr Infect Dis J 2009; 28:642.
  22. Haverkamp MH, Arend SM, Lindeboom JA, et al. Nontuberculous mycobacterial infection in children: a 2-year prospective surveillance study in the Netherlands. Clin Infect Dis 2004; 39:450.
  23. Mangione EJ, Huitt G, Lenaway D, et al. Nontuberculous mycobacterial disease following hot tub exposure. Emerg Infect Dis 2001; 7:1039.
  24. Stout JE, Gadkowski LB, Rath S, et al. Pedicure-associated rapidly growing mycobacterial infection: an endemic disease. Clin Infect Dis 2011; 53:787.
  25. Lee WJ, Kim TW, Shur KB, et al. Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath. J Dermatol 2000; 27:264.
  26. von Baum H, Bommer M, Forke A, et al. Is domestic tap water a risk for infections in neutropenic patients? Infection 2010; 38:181.
  27. Fleming GA, Frangoul H, Dermody TS, Halasa N. A cord blood transplant recipient with Mycobacterium mucogenicum central venous catheter infection after infusion of tap water. Pediatr Infect Dis J 2006; 25:567.
  28. Hall-Stoodley L, Stoodley P. Biofilm formation and dispersal and the transmission of human pathogens. Trends Microbiol 2005; 13:7.
  29. Haverkamp MH, Lindeboom JA, de Visser AW, et al. Nontuberculous mycobacterial cervicofacial lymphadenitis in children from the multicenter, randomized, controlled trial in The Netherlands: relevance of polymorphisms in candidate host immunity genes. Int J Pediatr Otorhinolaryngol 2010; 74:752.
  30. Romanus V, Hallander HO, Wåhlén P, et al. Atypical mycobacteria in extrapulmonary disease among children. Incidence in Sweden from 1969 to 1990, related to changing BCG-vaccination coverage. Tuber Lung Dis 1995; 76:300.
  31. Katila ML, Brander E, Backman A. Neonatal BCG vaccination and mycobacterial cervical adenitis in childhood. Tubercle 1987; 68:291.
  32. Holland AJ, Holland J, Martin HC, et al. Noncervicofacial atypical mycobacterial lymphadenitis in childhood. J Pediatr Surg 2001; 36:1337.
  33. Lindeboom JA, Smets AM, Kuijper EJ, et al. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol 2006; 36:1063.
  34. Penn R, Steehler MK, Sokohl A, Harley EH. Nontuberculous mycobacterial cervicofacial lymphadenitis--a review and proposed classification system. Int J Pediatr Otorhinolaryngol 2011; 75:1599.
  35. Suskind DL, Handler SD, Tom LW, et al. Nontuberculous mycobacterial cervical adenitis. Clin Pediatr (Phila) 1997; 36:403.
  36. Staufner C, Sommerburg O, Holland-Cunz S. Algorithm for early diagnosis in nontuberculous mycobacterial lymphadenitis. Acta Paediatr 2012; 101:e382.
  37. Hazra R, Robson CD, Perez-Atayde AR, Husson RN. Lymphadenitis due to nontuberculous mycobacteria in children: presentation and response to therapy. Clin Infect Dis 1999; 28:123.
  38. Robson CD, Hazra R, Barnes PD, et al. Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings. AJNR Am J Neuroradiol 1999; 20:1829.
  39. Carvalho AC, Codecasa L, Pinsi G, et al. Differential diagnosis of cervical mycobacterial lymphadenitis in children. Pediatr Infect Dis J 2010; 29:629.
  40. Kraus M, Benharroch D, Kaplan D, et al. Mycobacterial cervical lymphadenitis: the histological features of non-tuberculous mycobacterial infection. Histopathology 1999; 35:534.
  41. Tunkel DE, Romaneschi KB. Surgical treatment of cervicofacial nontuberculous mycobacterial adenitis in children. Laryngoscope 1995; 105:1024.
  42. Haimi-Cohen Y, Zeharia A, Mimouni M, et al. Skin indurations in response to tuberculin testing in patients with nontuberculous mycobacterial lymphadenitis. Clin Infect Dis 2001; 33:1786.
  43. Detjen AK, Keil T, Roll S, et al. Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. Clin Infect Dis 2007; 45:322.
  44. Iversen RH, Illum P. Cervicofacial nontuberculous mycobacterial lymphadenitis in children. Dan Med J 2012; 59:A4349.
  45. Spyridis P, Maltezou HC, Hantzakos A, et al. Mycobacterial cervical lymphadenitis in children: clinical and laboratory factors of importance for differential diagnosis. Scand J Infect Dis 2001; 33:362.
  46. Scott CA, Atkinson SH, Sodha A, et al. Management of lymphadenitis due to non-tuberculous mycobacterial infection in children. Pediatr Surg Int 2012; 28:461.
  47. Taha AM, Davidson PT, Bailey WC. Surgical treatment of atypical mycobacterial lymphadenitis in children. Pediatr Infect Dis 1985; 4:664.
  48. Bruijnesteijn Van Coppenraet ES, Lindeboom JA, Prins JM, et al. Real-time PCR assay using fine-needle aspirates and tissue biopsy specimens for rapid diagnosis of mycobacterial lymphadenitis in children. J Clin Microbiol 2004; 42:2644.
  49. Lindeboom JA, Bruijnesteijn van Coppenraet LE, van Soolingen D, et al. Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2011; 24:701.
  50. Richardson ET, Samson D, Banaei N. Rapid Identification of Mycobacterium tuberculosis and nontuberculous mycobacteria by multiplex, real-time PCR. J Clin Microbiol 2009; 47:1497.
  51. http://www.gen-probe.com/products-services/culture-identification (Accessed on July 10, 2012).
  52. Mandell DL, Wald ER, Michaels MG, Dohar JE. Management of nontuberculous mycobacterial cervical lymphadenitis. Arch Otolaryngol Head Neck Surg 2003; 129:341.
  53. Haustein T, Ridout DA, Hartley JC, et al. The likelihood of an indeterminate test result from a whole-blood interferon-gamma release assay for the diagnosis of Mycobacterium tuberculosis infection in children correlates with age and immune status. Pediatr Infect Dis J 2009; 28:669.
  54. Panesar J, Higgins K, Daya H, et al. Nontuberculous mycobacterial cervical adenitis: a ten-year retrospective review. Laryngoscope 2003; 113:149.
  55. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, et al. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis 2007; 44:1057.
  56. Starke JR. Commentary: The natural history of nontuberculous mycobacterial cervical adenitis. Pediatr Infect Dis J 2008; 27:923.
  57. Lindeboom JA. Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children. J Oral Maxillofac Surg 2012; 70:345.
  58. Lindeboom JA, Lindeboom R, Bruijnesteijn van Coppenraet ES, et al. Esthetic outcome of surgical excision versus antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Infect Dis J 2009; 28:1028.
  59. Lindeboom JA. Conservative wait-and-see therapy versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis 2011; 52:180.
  60. Berger C, Pfyffer GE, Nadal D. Treatment of nontuberculous mycobacterial lymphadenitis with clarithromycin plus rifabutin. J Pediatr 1996; 128:383.
  61. Coulter JB, Lloyd DA, Jones M, et al. Nontuberculous mycobacterial adenitis: effectiveness of chemotherapy following incomplete excision. Acta Paediatr 2006; 95:182.
  62. Luong A, McClay JE, Jafri HS, Brown O. Antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis. Laryngoscope 2005; 115:1746.
  63. Timmerman MK, Morley AD, Buwalda J. Treatment of non-tuberculous mycobacterial cervicofacial lymphadenitis in children: critical appraisal of the literature. Clin Otolaryngol 2008; 33:546.
  64. Steele RW, Thomas MP, Bégué RE. Compliance issues related to the selection of antibiotic suspensions for children. Pediatr Infect Dis J 2001; 20:1.
  65. Matsui D, Lim R, Tschen T, Rieder MJ. Assessment of the palatability of beta-lactamase-resistant antibiotics in children. Arch Pediatr Adolesc Med 1997; 151:599.
  66. van Ingen J, Totten SE, Heifets LB, et al. Drug susceptibility testing and pharmacokinetics question current treatment regimens in Mycobacterium simiae complex disease. Int J Antimicrob Agents 2012; 39:173.
  67. Swenson JM, Wallace RJ Jr, Silcox VA, Thornsberry C. Antimicrobial susceptibility of five subgroups of Mycobacterium fortuitum and Mycobacterium chelonae. Antimicrob Agents Chemother 1985; 28:807.
  68. Brown BA, Wallace RJ Jr, Onyi GO, et al. Activities of four macrolides, including clarithromycin, against Mycobacterium fortuitum, Mycobacterium chelonae, and M. chelonae-like organisms. Antimicrob Agents Chemother 1992; 36:180.
  69. Wallace RJ Jr, Brown BA, Onyi GO. Susceptibilities of Mycobacterium fortuitum biovar. fortuitum and the two subgroups of Mycobacterium chelonae to imipenem, cefmetazole, cefoxitin, and amoxicillin-clavulanic acid. Antimicrob Agents Chemother 1991; 35:773.
  70. Wallace RJ Jr, Brown BA, Onyi GO. Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections, and resistance to oral antimicrobials other than clarithromycin. J Infect Dis 1992; 166:405.
  71. Wallace RJ Jr, Brown-Elliott BA, Ward SC, et al. Activities of linezolid against rapidly growing mycobacteria. Antimicrob Agents Chemother 2001; 45:764.
  72. Wallace RJ Jr, Bedsole G, Sumter G, et al. Activities of ciprofloxacin and ofloxacin against rapidly growing mycobacteria with demonstration of acquired resistance following single-drug therapy. Antimicrob Agents Chemother 1990; 34:65.
  73. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother 2009; 53:1367.
  74. Kiehn TE, White M. Mycobacterium haemophilum: an emerging pathogen. Eur J Clin Microbiol Infect Dis 1994; 13:925.
  75. Atkinson BA, Bocanegra R, Graybill JR. Treatment of Mycobacterium haemophilum infection in a murine model with clarithromycin, rifabutin, and ciprofloxacin. Antimicrob Agents Chemother 1995; 39:2316.
  76. McBride ME, Rudolph AH, Tschen JA, et al. Diagnostic and therapeutic considerations for cutaneous Mycobacterium haemophilum infections. Arch Dermatol 1991; 127:276.
  77. Kristjansson M, Bieluch VM, Byeff PD. Mycobacterium haemophilum infection in immunocompromised patients: case report and review of the literature. Rev Infect Dis 1991; 13:906.
  78. Plemmons RM, McAllister CK, Garces MC, Ward RL. Osteomyelitis due to Mycobacterium haemophilum in a cardiac transplant patient: case report and analysis of interactions among clarithromycin, rifampin, and cyclosporine. Clin Infect Dis 1997; 24:995.