Affiliations: Pediatric Infectious Diseases Unit, Hospital La Paz,
Madrid, Spain | Department of Microbiology, Hospital La Paz, Madrid,
Spain | Department of Statistics, Hospital La Paz, Madrid,
Spain
Note: [] Correspondence: Ana Méndez-Echevarría, MD, Servicio de
Pediatría, Infecciosos. Hospital Infantil La Paz, Paseo de la 4 Castellana
261, 28046 Madrid, Spain. Tel.: +34 620780002; E-mail: amendezes@yahoo.es
Abstract: The aim of this study is to study the management and evolution of
nontuberculous mycobacterial lymphadenitis and to analyze different therapeutic
options. A retrospective study was performed on patients under 14 years
diagnosed from 1987 to 2004 in a tertiary care children's hospital. Inclusion
criteria were: (1) Positive polymerase chain reaction or culture. (2)
Histopathological features compatible with mycobacterial infection and/or
positive direct smear for acid-fast bacilli and sensitive skin test 6 mm above
Mantoux. (3) Histopathological features compatible with mycobacterial infection
and/or positive direct smear for acid-fast bacilli, Mantoux reaction less than
15 mm and absence of risk factors for tuberculous infection. In order to
analyze the effectiveness of the different therapeutic options, we divided our
patients into 4 groups, based on the initial treatment received: Group 1
antibiotics alone (n=21), Group 2 drainage
(n=13), Group 3 excision (n=8) and
Group 4 no treatment (n=6). Fifty-four patients were
included. Therapy failed in 38% of patients receiving antibiotics
(n=8), in 77% of patients with drainage alone
n=10) and in none of the patients who underwent surgery.
Healing time was shortest in patients undergoing surgery. Sinus formation
occurred either spontaneously (66.6%) or despite the medical treatment
(57%) or drainage (53%). No patients developed fistulas after surgical
excision. Transient paresis of the mandibular branch of the facial nerve
occurred in three patients (13%) after complete excision. Some
nontuberculous adenitis respond to medical treatment alone, but complete
surgical excision remains the most effective treatment, obtaining an early
definitive healing. Transient mandibular nerve paresis was the main
complication observed in the excision group.
