Atypical Mycobacterial infections in children: the case for early diagnosis

Atypical Mycobacteria (ATB) are a miscellaneous collection of Mycobacteriaceae which also includes M. tuberculosis, M. bovis and M. leprae. In the paediatric population, ATB infections present with non-tender unilateral lymphadenopathy in a systemically well child. Initially the disease may be mistaken for a staphylococcal or streptococcal abscess. Inappropriate surgical incision and drainage is often performed and specimens may be sent for routine histopathology and bacteriology analysis only without considering Mycobacterial infection. The simple incision and drainage procedures can complicate the management and may result in a poor cosmetic outcome. ATB can go undiagnosed until the initial medical management has failed, these surgical interventions performed and the child remains symptomatic. We wish to highlight the importance of considering ATB infection in the differential diagnosis of a child with painless lymphadenitis.

An illustrative case report is described. A review of the paediatric data from the Mycobacterial laboratories in Northern Ireland over the last 14 years was performed to ascertain disease trends and prevalence of species.

Overall an upward trend in the number of cases of cervical lymphadenitis caused by ATB infections in children was demonstrated. Organisms isolated in our population were M avium intracellulare, M malmoense and M interjectum.

We would like to present this data and a literature review, illustrated by case report, on the optimal management of these infections. We suggest that early definitive surgery is the management of choice, performed ideally by a surgeon with experience of this condition. A heightened awareness of these infections is essential to ensure appropriate early management.