Surgical treatment of children with nontuberculous mycobacteria cervical lymphadenitis

Persistent cervical lymphadenopathy is the typical clinical manifestation of nontuberculous mycobacterial (NTM) infection in otherwise healthy children 1-5 years of age. A positive NTM culture or PCR is necessary to proof the diagnosis. In the case of localized disease, cervical lymphadenectomy simultaneously serves both diagnosis and therapy. A typical complication of surgical treatment, i.e. incision, puncture or excision, is the formation of a fistula, which then requires further surgical intervention. In the case of an unconfirmed diagnosis, the extent of the initial surgical intervention remains unclear. On the basis of this diagnosis, 17 operations were performed in 10 children under the age of 7 years (8 female, 2 male; age 17 months to 5 years, median 36 months) in the Charit, ENT clinics between 2009 and 2012. Clinical course and diagnostics, as well as the results of therapies and treatments were retrospectively analysed. Duration of anamnesis prior to initial surgery was 2-30 weeks (mean 10.4 weeks). A second intervention was performed in 7 out of 10 patients. No patient developed recurrent disease after selective cervical lymphadenectomy. The clinical course of 1 patient was complicated by a cefuroxime-responsive Staph. aureus superinfection. A second patient experienced transient accessory nerve paresis after lymphadenectomy, which resolved 2 months after the second surgery. In case of persistent cervical lymphadenopathy a complete diagnostic workup is necessary. If lymphadenopathy continues to persist 1 month after a 10-day course of broad-spectrum antibiotics, a selective cervical lymphadenectomy should be performed. In order to avoid the development of fistulae and avoid secondary surgical procedures, incision, drainage and puncture should be deferred.