gms | German Medical Science

Infections with atypical, so called non-tuberculous mycobacteria (NTM) are diagnosed increasingly frequent nowadays.

In children, the most common site of infection are the cervical lymph nodes, but often the pre-auricular, intraparotideal lymph nodes are affected.

We report on 11 children who were treated for NTM at our hospital, 7 with intranodal or intraglandular and 4 with extranodal disease. Surgical treatment was performed in all children primarily. In 57% of children with nodal disease, M.avium/ intracellulare-complex was isolated, and in all 4 children with extranodal disease, M. marinum was found.

In contrast to findings in literature, GT-10-testing has been positive in all children. Chest x-rays were performed in all our patients to exclude pulmonary disease.

In otherwise healthy children with histological findings of granulomatous infection, NTM has to be taken into consideration. Diagnosis is confirmed by cultures of NTM. Histology, Ziehl-Neelsen stains and history alone do not allow differentiation between “typical” and “atypical” mycobacteria.

Wide surgical excision of the lymph node and, if affected, the overlying skin is considered to be the only effective treatment of NTM. This procedure leads to healing in 95% of patients. In case of recurrence or inadequate resection, antimicrobial chemotherapy with clarithromycin or rifabutin for 6 months is advised.