RESUMEN
BACKGROUND: Nontuberculous mycobacteria (NTM) lymphadenitis is an under-recognized entity, and data of the true burden in children are limited. Without a high index of suspicion, diagnosis may be delayed and microbiological detection is challenging. Here, we report a cluster of NTM lymphadenitis experienced in Korean children. METHODS: Subjects under 19 years of age diagnosed with NTM lymphadenitis during November 2016–April 2017 and April 2018 were included. Electronic medical records were reviewed for clinical, laboratory and pathological findings. Information regarding underlying health conditions and environmental exposure factors was obtained through interview and questionnaires. RESULTS: A total of ten subjects were diagnosed during 18 months. All subjects were 8–15 years of age, previously healthy, male and had unilateral, nontender, cervicofacial lymphadenitis for more than 3 weeks with no significant systemic symptoms and no response to empirical antibiotics. Lymph nodes involved were submandibular (n = 8), preauricular (n = 6) and submental (n = 1). Five patients had two infected nodes and violaceous discoloration was seen in seven subjects. Biopsy specimens revealed chronic granulomatous inflammation and acid-fast bacteria culture identified Mycobacterium haemophilum in two cases and NTM polymerase chain reaction was positive in two cases. Survey revealed various common exposure sources. CONCLUSION: NTM lymphadenitis is rare but increasing in detection and it may occur in children and adolescents. Diagnosis requires high index of suspicion and communication between clinicians and the laboratory is essential for identification of NTM.
Asunto(s)
Adolescente , Niño , Humanos , Masculino , Antibacterianos , Bacterias , Biopsia , Diagnóstico , Registros Electrónicos de Salud , Exposición a Riesgos Ambientales , Inflamación , Ganglios Linfáticos , Linfadenitis , Mycobacterium , Mycobacterium haemophilum , Micobacterias no Tuberculosas , Reacción en Cadena de la Polimerasa , Tuberculosis GanglionarRESUMEN
No abstract available.
Asunto(s)
Humanos , Histiocitosis , Mycobacterium haemophilum , MycobacteriumRESUMEN
Objective To improve the understanding of cutaneous Mycobacterium haemophilum infection.Methods Clinical and laboratory data were collected from two patients with cutaneous Mycobacterium haemophilum infection.The clinical and histopathologic manifestations, etiology and treatment of cutaneous Mycobacterium haemophilum infection were analyzed.Results The two patients were both immunocompromised.Lesions, which occurred after trauma in both the patients, began as well-marginated subcutaneous nodules, and then gradually progressed into ulceration with crusting and abscess formation.Histopathological examination revealed epithelial cell granuloma or histiocytic infiltrate in the dermis, as well as focal necrosis and neutrophil abscesses.Acid-fast staining showed abundant bacilli in tissues.These bacilli only grew in iron-containing medium, and were finally identified as Mycobacterium haemophilum by PCR and sequencing.According to the result of antimicrobial sensitivity testing, both the patients were treated with rifampicin, clarithromycin and moxifloxacin.Three months later, the condition was improved in both of them.Conclusions Mycobacterium haemophilum infection occurs most frequently in immunocompromised populations after trauma, manifests as subcutaneous nodules and abscesses with histopathological changes consistent with infectious granuloma.Molecular biological approaches are reliable for the identification of Mycobacterium haemophilum.