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Diagnostics, Management and Outcomes of Pediatric Nontuberculous Mycobacterial Infections: A 12-Year Retrospective
Lise Bols Toustrup1, Emma Holm1, Troels Lillebaek2,3
1From the Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Pediatric nontuberculous mycobacterial (NTM) infections are common, often causing cosmetic issues despite favorable outcomes. Management varies widely, highlighting a need for standardized, evidence-based treatment guidelines for children.
Area of Science:
- Pediatric Infectious Diseases
- Mycobacterial Infections
- Clinical Microbiology
Background:
- Pediatric nontuberculous mycobacterial (NTM) infections pose diagnostic and therapeutic challenges.
- Clinical presentations can mimic malignancy, and treatment is lengthy with potential for cosmetic sequelae.
- Despite a generally favorable prognosis, effective management strategies remain complex.
Purpose of the Study:
- To describe the clinical characteristics, management, and treatment outcomes of pediatric NTM infections.
- To analyze incidence rates and common presentations in a specific region.
- To evaluate trends in management strategies and identify areas for improved patient care.
Main Methods:
- Retrospective analysis of pediatric NTM cases in the Central Denmark Region (2011-2023).
- Identification of patients using mycobacteriologic data and ICD-10 codes.
- Extraction of clinical data from hospital records for descriptive analysis.
Main Results:
- Eighty children were identified, with incidence rates between 0.7-3.3 per 100,000.
- Lymphadenitis was the most common presentation (92.5%), with Mycobacterium avium being the predominant species (78.8%).
- Cosmetic sequelae like scarring (76%) were frequent, despite declining active interventions and favorable overall outcomes.
Conclusions:
- Pediatric NTM infections present a significant clinical burden due to prolonged illness and common cosmetic sequelae.
- Management practices for pediatric NTM infections are highly variable, with a trend towards reduced active interventions.
- A lack of treatment consensus underscores the need for interdisciplinary collaboration and evidence-based guidelines to standardize care for pediatric NTM infections.
Background:
Pediatric nontuberculous mycobacterial (NTM) infections present diagnostic and therapeutic challenges. Clinical features may mimic malignancy, and although prognosis is favorable, treatment is often prolonged and may result in cosmetic sequelae.
Methods:
We described the clinical characteristics, management and treatment outcomes of children diagnosed with NTM infections in the Central Denmark Region between 2011 and 2023. Children were identified using mycobacteriologic data and ICD-10 diagnostic codes. Detailed clinical information was extracted from hospital records, and descriptive analyses were performed.
Results:
Eighty children were included, corresponding to annual incidence rates of 0.7-3.3 per 100,000. The median age at presentation was 2 years, and 55% were female. Lymphadenitis was the most common presentation (92.5%), and fever was reported in 28% of cases. Mycobacterium avium was the predominant species (78.8%). Management strategies varied considerably: 47% of the children received no treatment, and both surgical and antibiotic interventions declined over time. Despite favorable clinical outcomes, cosmetic sequelae were common, including scarring (76%), residual discoloration (30%), fistulation or suppuration (12%). The median hospital admission was 2 days, and the median in-hospital follow-up was 236.5 days.
Conclusions:
The incidence of pediatric NTM infections remained stable, but the clinical burden was considerable due to prolonged disease course and frequent cosmetic sequelae. Management practices varied widely, with decreasing use of active interventions over time. The apparent lack of consensus on treatment further emphasizes the importance of interdisciplinary collaboration and the development of evidence-based guidelines to standardize care and improve outcomes.
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