Non-tuberculous mycobacterial lymphadenitis in children

Eighty-six children (44 males, 42 females) were identified as having non-tuberculous mycobacterial lymphadenitis. The diagnostic criteria were either culture of the organism from the affected lymph node (n = 68), or, when culture was negative, a positive skin test with non-tuberculous mycobacterial antigens and negative skin test responses to tuberculin purified protein derivative (PPD) in association with typical histological features (n = 18). All children had histopathological findings of granulomatous inflammation with caseation and/or acid-fast bacilli. Eighty-two percent of the children were under 5 years of age at presentation and 30% were less than 2 years old. Most (79%) were city dwellers. Lymph node enlargement had been present for less than 6 months in almost all children (97.5%) and was almost exclusively in the face and neck region (97%). Disease was confined to the involved lymph nodes in 56% but had extended beyond the confines of the infected node to form a collar stud abscess in 38% and 6% presented with a skin sinus. Extranodal extension did not show any statistically significant association with the duration of lymphadenopathy. The duration of lymphadenopathy had been greater in those children in whom an organism was not isolated on culture resected tissue (chi 2 = 10.07, P less than 0.01). All children were treated surgically, and recurrence occurred in five patients. This study describes the clinical and demographic characteristics of non-tuberculous mycobacterial lymphadenopathy in children in a population in which tuberculous adenitis is rare. Recognition of these features may allow earlier diagnosis and appropriate surgical therapy.