Adenitis due to nontuberculous mycobacteria: Which is the best treatment?

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.

Keywords

Lymphadenitis - Mycobacterium avium - excision - macrolides