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Danis DO, Jamil TL, Levi JR, Scott AR. Regional differences in admissions and surgical management of pediatric nontuberculous mycobacterial cervicofacial lymphadenitis. Int J Pediatr Otorhinolaryngol 2024; 183:112051. [PMID: 39084101 DOI: 10.1016/j.ijporl.2024.112051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES This study aims to determine the overall incidence of medical and surgical admissions related to non-tuberculous mycobacterial cervicofacial lymphadenitis (NTMCL) and determine if rates vary by geographic region in the US. It also aims to assess if the relative frequency of varying treatment modalities for NTMCL differ among geographic regions. STUDY DESIGN Population-based inpatient registry analysis. SETTING Academic medical center. METHODS The Kids' Inpatient Database (2016 and 2019) was used to determine NTMCL-related admissions and common head and neck procedures performed during these admissions were identified. Analysis was performed on regional differences in demographic factors and procedures performed during NTMCL-related admissions. RESULTS There were 159 weighted admissions (1.31 per 100,000) for NTMCL in 2016 and 2019 in the US, with the Midwest having the highest proportion of NTML-related admissions (1.59:100,000). NTMCL-related admissions were 2.21 times as likely to be elective rather than non-elective in the Midwest when compared to all other geographic regions (p = 0.038). The Midwest was 2.83 times as likely to treat with surgery (p = 0.011), while the Northeast was negatively associated with performing procedures (OR 0.38; p = 0.026). In the Midwest, significantly more excisional surgeries were preformed when compared to other regions, with an OR of 2.98 (p = 0.003). CONCLUSION The Midwest had the highest incidence of pediatric NTMCL-related admissions and was more likely to perform excisional surgery as primary NTMCL treatment. Regions that rarely see pediatric NTMCL have a more inconsistent approach to management.
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Affiliation(s)
- David O'Neil Danis
- Dr. Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 860 Washington St Building 1st Floor, Boston, MA, 02111, USA
| | - Taylor Lynn Jamil
- Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA; Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA; Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue 3001, Aurora, CO, 80045, USA
| | - Jessica R Levi
- Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA, 02118, USA
| | - Andrew R Scott
- Dr. Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 860 Washington St Building 1st Floor, Boston, MA, 02111, USA; Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, 02114, USA.
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Jensen FN, Nielsen AB, Dungu KHS, Poulsen A, Schmidt G, Hjuler T, Zhang H, Vissing NH, Nygaard U. Distinct clinical parameters were associated with shorter spontaneous resolution in children with non-tuberculous mycobacterial lymphadenitis. Acta Paediatr 2024. [PMID: 38226417 DOI: 10.1111/apa.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/17/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
AIM Non-tuberculous mycobacteria (NTM) lymphadenitis typically resolves spontaneously, yet factors influencing the duration remain explored. We aimed to identify clinical parameters associated with shorter spontaneous resolution. METHODS This cohort study included children with NTM lymphadenitis from 1 January 2015 to 1 March 2021 at Copenhagen University Hospital. Time-to-event analysis assessed clinical parameters associated with the duration of NTM lymphadenitis. RESULTS Sixty children (57% boys) with a median age of 24 months (range 11-84) were included; 13 (22%) received primary surgery, 13 (22%) underwent surgery after a wait-and-see period and 34 (57%) received no intervention. In children without intervention, the median duration was 10 months (range 2-25). Faster resolution was associated with parental-reported lymph node enlargement within 2 weeks (HR 2.3, 95% CI 1.0-5.0; p = 0.044), abscess on ultrasound examination (HR 3.3, 95% CI 1.5-7.3; p = 0.003) and skin discoloration and/or perforation within 3 months of onset (HR 4.3, 95% CI 1.3-14.4; p = 0.017 and HR 3.7, 95% CI 1.5-9.1; p = 0.005). CONCLUSION Knowledge of predictors for shorter spontaneous resolution of NTM lymphadenitis, such as rapid initial lymph node enlargement, abscess on ultrasound examination, and skin discoloration and/or perforation within 3 months of disease onset, may guide clinical management decisions concerning surgery versus a conservative approach.
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Affiliation(s)
- Frederikke Nonboe Jensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Bybeck Nielsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kia Hee Schultz Dungu
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Hjuler
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology and Audiology, University of Copenhagen, Copenhagen, Denmark
| | - He Zhang
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nadja Hawwa Vissing
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Gromov AL, Gubin MA, Shchenin AV, Ivanov VI. [Results of modified submandibular surgical approach usage for the mouth floor phlegmons treatment with respect to dynamic of local non-specific resistance]. STOMATOLOGIIA 2022; 101:87-92. [PMID: 35362709 DOI: 10.17116/stomat202210102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
THE AIM OF THE STUDY Was increasing of treatment effectiveness of patients with mouth floor odontogenic phlegmon (MFOP) by modified of surgical approach usage. MATERIALS AND METHODS The prospective controlled, randomized, simple blinded clinical trial, II b level of evidence, comprised 86 patients with MFOP which formed main and control groups. The main group consisted of 40 patients treated with designed «Method for surgical treatment of odontogenic oral phlegmon of mouth floor with partial dissection of sublingual-submandibular sac». The control group involved 46 patients treated with traditional surgical procedure. The differences significance between the values has been evaluated with nonparametric Fisher's exact P-test and parametric Student's t-test for independent samples. RESULTS The modified surgical approach statistically significantly (p<0.05) decreased the number of inflammatory complications (from 26±7% to 9±4%), terms of secondary sutures application (from 7.9±1.4 to 5.7±1.6 days) and time of hospital stay (from 9.4±1.8 to 8.3±1.7 days). On the 5th day of treatment white blood cells count in the main group was significantly (p<0.05) lower (7.2±1.1·109/l) than in controls (9.4±1.3·109/l) showing improved intoxication syndrome resolution in the main group. Index of reaction of bacteria adsorption to the oral epithelium in the main group on the 5th day of treatment was significantly (p<0.05) higher (77.1±6.9%) than in controls (62.4±7.1%). More successful correction of local non-specific resistance was registered in the main group. CONCLUSION The proposed modified submandibular surgical approach is more effective for the treatment of patients with MFOP.
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Affiliation(s)
- A L Gromov
- Kursk State Medical University, Kursk, Russia
| | - M A Gubin
- Voronezh State Medical University of a name of N.N. Burdenko, Voronezh, Russia
| | | | - V I Ivanov
- Kursk State Medical University, Kursk, Russia
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Willemse SH, Schreuder WH, Apperloo RC, Lindeboom JA. Long-Term Outcome of Surgical Treatments for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children. J Oral Maxillofac Surg 2021; 80:537-544. [PMID: 34758350 DOI: 10.1016/j.joms.2021.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Information on long-term treatment outcome for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children is scarce. The purpose of this study is to evaluate long-term outcome for surgical treatment, which is the mainstay treatment modality. METHODS This case series describes recurrence rates of surgically treated NTM cervicofacial lymphadenitis patients with a follow-up of at least 10 years. The current study data were partially collected from a randomized, prospective, multicenter, multidisciplinary trial (CHIMED study), which was conducted between 2000 and 2006 to determine the optimal treatment for NTM cervicofacial lymphadenitis in children. After the CHIMED trial inclusion ended, our institute continued to serve as a referral center. This enabled us to enlarge the surgical CHIMED cohort by adding patients who were treated during 2007 to 2010 in our center and collect the rest of the current study data. RESULTS About 427 children with chronic cervicofacial lymphadenopathy were analyzed. Among these, 290 had microbiologically confirmed cervicofacial mycobacterial infections (n = 3 Mycobacterium tuberculosis, n = 1 Mycobacterium bovis, n = 286 NTM). Of these 286 children with NTM cervicofacial lymphadenitis, 189 were treated surgically (median age: 41 months, range: 9-144, 46.0% males). The affected lymph nodes were excised in 151 children (79.9%), and curettage was performed in 38 children (20.1%). One patient (0.07%) experienced a reactivation/recurrence 2 years after surgical excision and required another surgical excision. Three children (7.9%) experienced infection reactivation/recurrences after curettage, confirmed by redness or a draining fistula, within the first year after healing. Two of these 3 patients were treated with additional surgical excisions. CONCLUSION The long-term outcome of surgical excision for NTM cervicofacial lymphadenitis is favorable with a low recurrence rate. Curettage or a conservative wait-and-see approach can be considered an alternative in advanced and surgically challenging cases. However, healing will take longer, and late recurrences are possible.
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Affiliation(s)
- Samuel H Willemse
- PhD Student, Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem H Schreuder
- Associate Professor, Department of Head and Neck Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ruben C Apperloo
- Private Practice, Department of Oral and Maxillofacial Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jerome A Lindeboom
- Associate Professor, Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, and Private Practice, Amstelland Hospital, Amstelveen, the Netherlands.
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Abstract
Salivary gland diseases are rare. In the European Union (EU) a disease is considered to be rare if not more than 5 of 10,000 people are affected by it. According to estimates in Germany are about 4 million people with a rare disease. In the EU are about 30 million people with rare diseases [1]. In the present work most of the described diseases of salivary glands and of the facial nerve fall in this category. They form a very heterogeneous group whose treatment takes place mainly in specialized centers. Still, it is essential for the otolaryngologist to identify and to diagnose these diseases in order to initiate the right therapeutic steps. The work is a compilation of innate andacquired rare salivary gland disorders and of rare facial nerve disorders. The etiologies of inflammatory diseases, autoimmune disorders and tumors are taken into account. For the individual topics, the current literature, if available, was evaluated and turned into summarized facts. In this context the development of new processes, diagnostics, imaging and therapy are considered. Genetic backgrounds of salivary gland tumors and the trends in the treatment of tumorous lesions of the facial nerve are picked up. Furthermore, also rare diseases of the salivary glands in childhood are described. Some of them can occur in adults as well, but differ in frequency and symptoms. Due to the rarity of these diseases, it is recommended to tread these in centers with special expertise for it. Finally, the difficulties of initiation of studies and the problems of establishing disease registries concerning salivary gland disorders are discussed. This is very relevant because these pathologies are comparatively seldom.
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Affiliation(s)
- Claudia Scherl
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie,
Universitätsklinikum Mannheim
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Lindeboom JA. Long-term outcome of nonsurgical treatment of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:195-201. [PMID: 33358987 DOI: 10.1016/j.oooo.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic cervicofacial lymphadenitis in children is often caused by nontuberculous mycobacteria (NTM). Children with NTM infection who were not surgically treated were evaluated for long-term outcome with a follow-up of at least 10 years. RESULTS Among the 117 nonsurgically treated children, the median age was 46 months (range, 9-155 months), 56 were male (47.9%), and 61 were female (52.1%). Of the overall group, 75 received antibiotic therapy consisting of clarithromycin and rifabutin (64.1%), and for 54, observation (a wait-and-see approach) was chosen (46.2%). In 100 patients, treatment was considered successful (85%), with a median resolution of 24 (range, 11-134) weeks in the antibiotic group compared to 44.5 (range, 18-130) weeks in the wait-and-see group (P < .05). After 6 months, 58 patients in the antibiotic group were successfully treated (77%), whereas 42 patients of the wait-and-see group demonstrated complete resolution after a median observation time of 44.5 weeks (100%). In 10 patients who experienced complete resolution of the lymphadenitis, infection recurrence developed years later (10%). CONCLUSION Nonsurgical treatment of NTM infection can be considered an alternative in advanced and surgically challenging cases. However, healing will take months to years, and late recurrences are possible.
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Affiliation(s)
- Jerome A Lindeboom
- Associate Professor, Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center and Amstelland Hospital, University of Amsterdam, Amsterdam, the Netherlands.
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Papatsoutsos E, Aumann V, Vorwerk P, Redlich A, Tammer I, Arens C, Vorwerk U. [Cervical lymphadenitis caused by non-tuberculous mycobacteria in children with different residence]. Laryngorhinootologie 2020; 99:628-636. [PMID: 32268397 DOI: 10.1055/a-1146-3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Atypical mycobacteria form a heterogeneous group. Although more than 140 species have been identified, only 25 of them are considered responsible for infection in humans. The most frequent manifestation of the disease in immunocompetent children is the cervical lymphadenitis. Aims of this study were to identify a correlation of the location of residence with patients' demographics and disease characteristics, to evaluate the ultrasonographic findings and the different operative treatments modalities and to develop an algorithm for the diagnosis and treatment. MATERIALS AND METHODS Cases were identified by using the hospital's correspondence, microbiology and pathology databases. Demographic and clinical data were collected. A statistical analysis of the results was performed. RESULTS 32 patients were included. Our data revealed no significant correlation between area of residence and disease characteristics. Hypoechoic lymph nodes with intraglandular necrosis and low vascularity were observed in the majority of patients. Surgical treatment included abscess incision with biopsy, lymphadenectomy, selective neck dissection and partial parotidectomy. A recurrent disease was significantly more frequent after abscess incision. CONCLUSIONS Further studies with prospective design are required, in order to confidently identify the correlation between area of residence and disease characteristics. Similar ultrasonographic findings suggest a constant constellation of changes that facilitate diagnostic evaluation. Complete surgical excision offers an effective management option as it combines definitive treatment and histological confirmation with low risk of complications.
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Affiliation(s)
- Efstathios Papatsoutsos
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Germany
| | - Volker Aumann
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Magdeburg Kinderklinik, Magdeburg, Germany
| | - Peter Vorwerk
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Magdeburg Kinderklinik, Magdeburg, Germany
| | - Antje Redlich
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Magdeburg Kinderklinik, Magdeburg, Germany
| | - Ina Tammer
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Magdeburg, Germany
| | - Christoph Arens
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Germany
| | - Ulrich Vorwerk
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Germany
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Long-term outcome of surgical excision for treatment of cervicofacial granulomatous lymphadenitis in children. Eur Arch Otorhinolaryngol 2020; 277:1785-1792. [PMID: 32144570 PMCID: PMC7222061 DOI: 10.1007/s00405-020-05880-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022]
Abstract
Purpose Granulomatous inflammation is a common cause of subacute cervicofacial lymphadenitis in children. Nontuberculous mycobacterial (NTM) infections and cat-scratch disease (CSD) are the most frequent causes. Optimal treatment, which may include surgery, antibiotic treatment or wait-and-see approach, is debatable. The goal of this study was to compare the short- and long-term outcome of various surgical procedures. Methods Case series with a chart review of all children treated by surgical excision of granulomatous lymph nodes in the cervicofacial area from 2000 to 2016 at two tertiary care centers. Results Forty patients were included in this study. The median age at first symptoms was 3.7 years (13 months–14 years). Mean follow-up was 5.8 years (6 months–15.3 years). 25 patients fit with diagnosis of NTM infection, 6 with CSD while diagnosis remained uncertain in 9 patients. The primary surgical procedure consisted of total excision (n = 27), incision/drainage (n = 9) or incomplete excision (n = 4). None of the patients treated by primary complete excision needed further intervention contrary to the group of patients with incomplete surgical procedures where additional surgical management was required in 54%. At follow-up, all patients were healthy without evidence of recurrence. Conclusion We advocate early surgical intervention with complete excision to reach quick resolution and reduce the need for additional surgery. The long-term outcome was favorable.
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Compton RA, Scott AR. Use of the facelift incision for excision of non-tuberculous mycobacterial lymphadenitis in children. Int J Pediatr Otorhinolaryngol 2019; 125:182-186. [PMID: 31344608 DOI: 10.1016/j.ijporl.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision. METHODS Retrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018. RESULTS The series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage. CONCLUSION The facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.
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Affiliation(s)
- Rebecca A Compton
- Tufts Medical Center, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, USA
| | - Andrew R Scott
- Tufts Medical Center, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery and Pediatric Facial Plastic Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA.
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Gallois Y, Cogo H, Debuisson C, Guet-Revillet H, Brehin C, Baladi B, Calmels MN. Nontuberculous lymphadenitis in children: What management strategy? Int J Pediatr Otorhinolaryngol 2019; 122:196-202. [PMID: 31039497 DOI: 10.1016/j.ijporl.2019.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a "wait-and-see" approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. METHODS Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as "proven diagnosis" (NTM detected), "highly probable" (suggestive clinical and anatomopathological aspect) or "possible" infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. RESULTS Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85-3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20-13.43]). We found 17 "proven diagnosis" (58.62%), 5 "highly probable" (17.24%) and 7 "possible" infections (24.14%). "Proven" infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17-7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. CONCLUSION Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of "wait-and-see" attitude in the literature make excision surgery a second line treatment.
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Affiliation(s)
- Yohan Gallois
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France.
| | - Haude Cogo
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Cécile Debuisson
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Guet-Revillet
- Bacteriology and Hygiene Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
| | - Camille Brehin
- General Pediatrics Department, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Blandine Baladi
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
| | - Marie-Noëlle Calmels
- Otoneurology and Pediatric ENT Department, Hôpital Pierre Paul RIQUET, Centre Hospitalier Universitaire de Toulouse, France
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Torretta S, Gaffuri M, Ibba T, Capaccio P, Marchisio P, Maruca A, Bosis S, Pignataro L. Surgical treatment of non-tuberculous mycobacterial lymphadenitis in children: Our experience and a narrative review. Int J Immunopathol Pharmacol 2019; 32:2058738418806413. [PMID: 30354841 PMCID: PMC6202736 DOI: 10.1177/2058738418806413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-tuberculous mycobacterial lymphadenitis (NTML) accounts for about 95% of the cases of head-and-neck mycobacterial lymphadenitis, and its prevalence has been increasing in the Western world. The diagnostic work-up can be challenging, and differential diagnoses such as tuberculous and suppurative lymphadenitis need to be considered. It may, therefore, not be diagnosed until the disease is in a late stage, by which time it becomes locally destructive and is characterized by a chronically discharging sinus. The treatment options include a medical approach, a wait-and-see policy, and surgery, with the last being considered the treatment of choice despite the high risk of iatrogenic nerve lesions. The aim of this article is to provide an overview of pediatric, head-and-neck NTML based on the literature and our own experience, with particular emphasis on the impact and limitations of surgery.
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Affiliation(s)
- Sara Torretta
- 1 Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tullio Ibba
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 Department of Biomedical, Surgical and Odontoiatric Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Paola Marchisio
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,4 Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Antonella Maruca
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- 1 Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Hatzenbuehler LA, Tobin-D'Angelo M, Drenzek C, Peralta G, Cranmer LC, Anderson EJ, Milla SS, Abramowicz S, Yi J, Hilinski J, Rajan R, Whitley MK, Gower V, Berkowitz F, Shapiro CA, Williams JK, Harmon P, Shane AL. Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infection. J Pediatric Infect Dis Soc 2017; 6:e116-e122. [PMID: 28903524 DOI: 10.1093/jpids/pix065] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mycobacterium abscessus is an uncommon cause of invasive odontogenic infection. METHODS M abscessus-associated odontogenic infections occurred in a group of children after they each underwent a pulpotomy. A probable case-child was defined as a child with facial or neck swelling and biopsy-confirmed granulomatous inflammation after a pulpotomy between October 1, 2013, and September 30, 2015. M abscessus was isolated by culture in confirmed case-children. Clinical presentation, management, and outcomes were determined by medical record abstraction. RESULTS Among 24 children, 14 (58%) were confirmed case-children. Their median age was 7.3 years (interquartile range, 5.8-8.2 years), and the median time from pulpotomy to symptom onset was 74 days (range, 14-262 days). Clinical diagnoses included cervical lymphadenitis (24 [100%] of 24), mandibular or maxillary osteomyelitis (11 [48%] of 23), and pulmonary nodules (7 [37%] of 19). Each child had ≥1 hospitalization and a median of 2 surgeries (range, 1-6). Of the 24 children, 12 (50%) had surgery alone and 11 (46%) received intravenous (IV) antibiotics. Nineteen of the 24 (79%) children experienced complications, including vascular access malfunction (7 [64%] of 11), high-frequency hearing loss (5 [56%] of 9), permanent tooth loss (11 [48%] of 23), facial nerve palsy (7 [29%] of 24), urticarial rash (3 [25%] of 12), elevated liver enzyme levels (1 [20%] of 5), acute kidney injury (2 [18%] of 11), incision dehiscence/fibrosis (3 [13%] of 24), and neutropenia (1 [9%] of 11). CONCLUSIONS M abscessus infection was associated with significant medical morbidity and treatment complications. Unique manifestations included extranodal mandibular or maxillary osteomyelitis and pulmonary nodules. Challenges in the identification of case-children resulted from an extended incubation period and various clinical manifestations. Clinicians should consider the association between M abscessus infection and pulpotomy in children who present with subacute cervical lymphadenitis. The use of treated/sterile water during pulpotomy might prevent further outbreaks.
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Affiliation(s)
- Lindsay A Hatzenbuehler
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Baylor College of Medicine, Houston, Texas
| | | | | | | | - Lisa C Cranmer
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Evan J Anderson
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Division of Infectious Diseases.,Department of Medicine
| | - Sarah S Milla
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Radiology
| | - Shelly Abramowicz
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Oral and Maxillofacial Surgery
| | - Jumi Yi
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph Hilinski
- Department of Pediatrics.,St. Luke's Children's Hospital, Boise, Idaho
| | - Roy Rajan
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Otolaryngology-Head & Neck Surgery
| | - Matthew K Whitley
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Verlia Gower
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Frank Berkowitz
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Craig A Shapiro
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph K Williams
- Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Plastic and Reconstructive Surgery
| | - Paula Harmon
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Andi L Shane
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
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