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Atypical mycobacterial infection in childhood: a "surgical disease'

J Akhtar1, A G Howatson, P A Raine

  • 1Department of Paediatric Surgery and Pathology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.

Journal of the Royal College of Surgeons of Edinburgh
|April 1, 1997
PubMed

Insights

Atypical mycobacterial (AMB) infection causes pediatric lymph node enlargement. Primary excision effectively treated lymphadenitis in children, while other methods led to complications.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Surgical Pathology

Background:

  • Atypical mycobacterial (AMB) infections are a significant cause of cervical lymphadenitis in children.
  • Diagnosis can be challenging due to limitations of traditional methods.

Purpose of the Study:

  • To review the clinical presentation, diagnostic challenges, and treatment outcomes of pediatric lymphadenitis caused by atypical mycobacteria.
  • To evaluate the effectiveness of different surgical interventions.

Main Methods:

  • Retrospective review of 17 pediatric patients treated for AMB lymphadenitis between January 1992 and December 1993.
  • Analysis of clinical data, diagnostic test results (tuberculin skin test, staining, cultures), histopathology, and treatment outcomes.
  • Assessment of surgical techniques including primary excision and incision/drainage.

Main Results:

  • The mean age of presentation was 5.37 years, with most cases involving cervicofacial lymph nodes.
  • Tuberculin skin tests were unhelpful (14/15 negative).
  • Primary excision was curative in all 11 patients who underwent it.
  • Incision and drainage or partial excision resulted in chronic discharging sinuses in all 6 patients.
  • AMB were not consistently detected by staining (11/17) or culture (8/17 negative).
  • Diagnosis relied on clinical features and histopathology in many cases.

Conclusions:

  • Primary surgical excision is the most effective treatment for atypical mycobacterial lymphadenitis in children.
  • Conventional diagnostic methods like tuberculin skin tests, staining, and cultures have limitations.
  • Polymerase chain reaction (PCR) is being investigated for improved diagnosis in non-cultured cases.

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