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A 2-year-old boy presents with an 8-week history of enlarged right-sided cervical lymph nodes. He is afebrile and otherwise systemically well. A fine-needle biopsy revealed Mycobacterium avium complex (MAC), and management by complete excision was considered not suitable by the local surgical team. His lymphadenopathy remained significant for many weeks following his curettage, and you think antibiotics may have a role in treating his infection; however, you wonder about the choice, dosage and duration of therapy.
Structured clinical question
In a child with non-tuberculous mycobacterial (NTM) lymphadenitis in whom surgery is not considered appropriate, what antibiotics are the most effective, tolerable and safe?
Two authors performed a literature search using the Cochrane Library, PubMed and Embase databases (from 1974 to present) with the keywords “nontuberculous Mycobacteria” AND “lymphadenitis”. The search was limited to children (birth–18 years of age) and included all data regarding medical, surgical or wait-and-see treatments to avoid missing relevant papers. After duplicates were removed, 299 papers remained which were independently screened by both authors. Ultimately, eight papers met the inclusion criteria. Studies were excluded if they were not available in English and/or full text, did not contain adequate detail regarding the dosage and duration of antimicrobial management, or pertained to NTM infections beyond lymphadenopathy.
Chronic lymphadenitis caused by NTM in immunocompetent children is relatively rare, yet can cause prolonged and disfiguring disease that is difficult to treat.1 2 Infection predominantly localises in the cervicofacial area and occurs mainly in young children (<5 years of age), with reported incidence rates ranging from …
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Contributors TN drafted the manuscript, edited through multiple revisions and is responsible for ongoing correspondence.BM supported the main authors in reviewing and editing the final manuscript. PCMW conceptualised the topic for this paper and is the main supervisor for the entire process including manuscript reviewing and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.