atypical mycobacterium cervical adenitis

Digital cases

 HPC:154 : Atypical mycobacterium cervical adenitis

Definition: Nontuberculosis mycobacterial cervical lymphadenitis is a relatively common disease in immunocompetent children but a rare disease in immunocompetent adults.

Evaluation of immune competence, including gamma interferon (IFN-gamma) and interleukin-12 (IL-12) signaling, finds no evidence of deficiency in these cases.

Nontuberculous mycobacteria can cause a chronic localized cervicofacial lymphadenitis in immunocompetent children. The recommended treatment is total excision of the affected lymph node.

Mycobacterium avium complex and Mycobacterium hemophilum are isolated in 90% of the cultures (18787500).

In most cases, the affected lymph nodes underwent violaceous changes with discharge of purulent material for 3-8 weeks.

Nontuberculous mycobacterium (NTM) is one of the well-known causes of cervicofacial lymphadenopathy in children under 5 years of age.

Children often present with a painless cervical mass that fails to respond to conventional antibiotics.

They are often referred under the suspicion of a neoplasm or bacterial adenitis rather than NTM cervical lymphadenitis.

The lack of systemic symptoms, modest or negative purified protein derivative test and absence of exposure to active tuberculosis are characteristics of NTM lymphadenitis.

The diagnosis usually requires the isolation of pathogen or pathologic proof. Complete excision is the choice of treatment by the majority of authors in the literature.

This not only enables rapid diagnosis but ensures the lowest recurrence rate.

Medical management is sometimes successful when complete resection is impossible or refused.

Atypical (nontuberculous) mycobacterium is an uncommon cause of cervical lymphadenitis in immunocompetent children.

Rarely, this disease progresses to locoregional destruction of the deep structures of the neck including salivary glands.

Types

 Mycobacterium avium intracellulare (Mycobacterium avium complex)
 Mycobacterium haemophilum

Management

Total resolution after surgery alone can be 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 is noted. (18787500)

Recent reports suggest medical monotherapy as an effective treatment of this disease.

See also

 Mycobacterium avium intracellulare lymphadenitis
 disseminated Mycobacterium avium intracellulare infection

Open access references

 Cervicofacial lymphadenitis in children caused by Mycobacterium haemophilum. Lindeboom JA, Prins JM, Bruijnesteijn van Coppenraet ES, Lindeboom R, Kuijper EJ. Clin Infect Dis. 2005 Dec 1;41(11):1569-75. PMID: 16267728 [Free]

 Management of nontuberculous mycobacterial cervical lymphadenitis. Mandell DL, Wald ER, Michaels MG, Dohar JE. Arch Otolaryngol Head Neck Surg. 2003 Mar;129(3):341-4. PMID: 12622546 (Free)

 A new agent of mycobacterial lymphadenitis in children: Mycobacterium heidelbergense sp. nov. Haas WH, Butler WR, Kirschner P, Plikaytis BB, Coyle MB, Amthor B, Steigerwalt AG, Brenner DJ, Salfinger M, Crawford JT, Böttger EC, Bremer HJ. J Clin Microbiol. 1997 Dec;35(12):3203-9.PMID: 9399520 (Free)

 Cervical lymphadenitis caused by a fastidious mycobacterium closely related to Mycobacterium genavense in an apparently immunocompetent woman: diagnosis by culture-free microbiological methods. Bosquée L, Böttger EC, De Beenhouwer H, Fonteyne PA, Hirschel B, Larsson L, Meyers WM, Palomino JC, Realini L, Rigouts L, et al. J Clin Microbiol. 1995 Oct;33(10):2670-4.PMID: 8567903 [Free]

References

 Mycobacterium avium complex cervical lymphadenitis in an immunocompetent adult. Christensen JB, Koeppe J. Clin Vaccine Immunol. 2010 Sep;17(9):1488-90. PMID: 20668140

 Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone. Zeharia A, Eidlitz-Markus T, Haimi-Cohen Y, Samra Z, Kaufman L, Amir J. Pediatr Infect Dis J. 2008 Oct;27(10):920-2. PMID: 18787500

 Mycobacterium abscessus cervical lymphadenitis: an immunocompetent child. Chang JT, Huang YF, Lin YT, Liu YC, Chiu LH, Tu HZ, Hsieh KS. Kaohsiung J Med Sci. 2006 Aug;22(8):415-9.PMID: 16911925

 Atypical mycobacterial cervical lymphadenitis with extensive local spread: a surgical disease. Hogan M, Price D, Burrage K, Pushpanathan C. Pediatr Surg Int. 2005 Sep;21(9):758-60. PMID: 16133519

 Cervical lymphadenitis caused by nontuberculous mycobacteria in immunocompetent children: clinical and therapeutic experience. Losurdo G, Castagnola E, Cristina E, Tasso L, Toma P, Buffa P, Giacchino R. Head Neck. 1998 May;20(3):245-9. PMID: 9570631

 Cervical lymphadenitis in a child caused by a previously unknown mycobacterium. Haas WH, Kirschner P, Ziesing S, Bremer HJ, Böttger EC. J Infect Dis. 1993 Jan;167(1):237-40. PMID: 7678107