Nontuberculous mycobacterial cervicofacial adenitis in children: epidemiologic study

To determine whether there is an increase in the incidence of nontuberculous mycobacteria (NTM) adenitis at our tertiary care pediatric hospital and to determine whether there is an association between geographic location and prevalence of cases. Also, to investigate the role of nongeographic risk factors such as bacille Calmette-Guérin (BCG) vaccination in the incidence of NTM adenitis.

We conducted a retrospective chart review of 153 pediatric patients with NTM adenitis diagnosed between 1994 and 2004 and a prospective telephone survey of geographic and nongeographic risk factors for 82 patients.

The annual incidence, calculated with the number of hospitalizations for that year as the denominator, was 25.1 in 100,000 during the 1994-1998 period and 107.4 in 100,000 for 1999-2004. A statistically significant increase in the incidence of NTM adenitis was observed after 1999, with an incidence ratio of 4.28 (95% confidence interval 2.84-6.65; p < .0000). We found a nonsignificant increase in incidence for cases in the suburbs compared with the city. The survey did not reveal any significant risk factors for NTM adenitis in our population. However, none of the affected children had had the BCG vaccination.

There has been a significant increase in the incidence of NTM adenitis at our tertiary care centre, particularly since 1999. No clear risk factors could be identified to account for this increase, even though geographic location and discontinuation of BCG vaccination could be implicated. More studies are needed to confirm those hypotheses.