Infections with atypical mycobacteria (AM) are increasing, especially with the decline in BCG immunisation. The most frequent presentation is a lymphadenopathy in an immunocompetent child. This poses a difficult diagnostic challenge if the clinician is not aware of this entity. In this retrospective study the authors reviewed the records of 30 children. The main clinical presentations were a fluctuant cervical mass (42%), a firm adenopathy (35%) and a fistula (10%). Cultures were obtained either by aspiration or by curettage. The main infectious organisms were M avium and M intracellulare. The initial treatment was by antibiotic therapy in 22 cases (clarithromycin alone or in combination with rifampicine or rifampicine and ethambutol) for a mean duration of 2.45 months. A complete response was achieved in 90% of cases. In eight cases (27%) surgery was necessary (six cured only by surgery and two by a combination of surgery and medical treatment). This article illustrates the need for clinicians to be aware of pathologies which were thought to be extinct but which are re-emerging and how to properly manage them in view of better diagnostic and therapeutic options. It may also be of concern to public health authorities to reconsider BCG vaccination in view of the possible mycobacterial epidemic.
AM and the neck
Reviewed by Badr Eldin Mostafa
Mycobacteries atypiques de localization cervico-faciale.
CONTRIBUTOR
Badr Eldin Mostafa
Ain-Shams Faculty of Medicine, Almaza , Heliopolis, Egypt.
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