Treatment outcomes for nontuberculous mycobacterial cervicofacial lymphadenitis in children based on the type of surgical intervention

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Abstract
To report treatment outcomes of nontuberculous mycobacteria (NTM) cervicofacial lymphadenitis. A retrospective study from 1995 to 2006. Fifty-one patients (mean age, 30.3 months). All but one patient presented with lymphadenopathy. The mean time from symptoms to diagnosis was 42.3 days. Tuberculin skin testing (TST) was performed on 21 of 51 patients and was positive on 14 of 21 patients. Imaging was ordered in 23; 19 had CT scans. Pathology confirmed caseating granuloma in 45 (88%); cultures grew Mycobacterium avium-intracellulare complex in 46 of 51. Interventions included fine-needle aspiration (5, 10%), incision and drainage +/- curettage (24, 46%), and complete excisional biopsy (20, 38%). Of those who underwent complete excisional biopsy initially, 95 percent were cured compared with 32 of 51 (63%) with nonexcisional surgery. Macrolides and rifampin were more likely to be recommended in referred cases and when nonexcisional surgical treatment was not feasible or had failed. The average total duration of antibiotic therapy was 89.1 days. NTM infections require high levels of suspicion for timely diagnosis, and complete excisional biopsy results in least likelihood of persistent/recurrent disease.