Petra Zimmermann1, Marc Tebruegge2, Nigel Curtis3, Nicole Ritz4. 1. Infectious Diseases Unit, University Children's Hospital, University of Berne, 3010 Berne, Switzerland. Electronic address: petra.zimmermann@insel.ch. 2. Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, and Institute for Life Sciences, University of Southampton, Southampton, UK; Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia. Electronic address: m.tebruegge@soton.ac.uk. 3. Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia. Electronic address: nigel.curtis@rch.org.au. 4. Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, 3052, Australia; Infectious Diseases Unit, University Children's Hospital, University of Basel, 4031 Basel, Switzerland. Electronic address: nicole.ritz@unibas.ch.
Abstract
OBJECTIVES: Cervicofacial lymphadenitis is the most common manifestation of infection with non-tuberculous mycobacteria (NTM) in immunocompetent children. Although complete excision is considered standard management, the optimal treatment remains controversial. This study reviews the evidence for different management options for NTM lymphadenitis. METHODS: A systematic literature review and meta-analysis were performed including 1951 children from sixty publications. Generalised linear mixed model regressions were used to compare treatment modalities. RESULTS: The adjusted mean cure rate was 98% (95% CI 97.0-99.5%) for complete excision, 73.1% (95% CI 49.6-88.3%) for anti-mycobacterial antibiotics, and 70.4% (95% CI 49.6-88.3%) for 'no intervention'. Compared to 'no intervention', only complete excision was significantly associated with cure (OR 33.1; 95% CI 10.8-102.9; p < 0.001). Complete excision was associated with a 10% risk of facial nerve palsy (2% permanent). 'No intervention' was associated with delayed resolution. CONCLUSIONS: Complete excision is associated with the highest cure rate in NTM cervicofacial lymphadenitis, but also had the highest risk of facial nerve palsy. In the absence of large, well-designed RCTs, the choice between surgical excision, anti-mycobacterial antibiotics and 'no intervention' should be based on the location and extent of the disease, and acceptability of prolonged time to resolution.
OBJECTIVES:Cervicofacial lymphadenitis is the most common manifestation of infection with non-tuberculous mycobacteria (NTM) in immunocompetent children. Although complete excision is considered standard management, the optimal treatment remains controversial. This study reviews the evidence for different management options for NTM lymphadenitis. METHODS: A systematic literature review and meta-analysis were performed including 1951 children from sixty publications. Generalised linear mixed model regressions were used to compare treatment modalities. RESULTS: The adjusted mean cure rate was 98% (95% CI 97.0-99.5%) for complete excision, 73.1% (95% CI 49.6-88.3%) for anti-mycobacterial antibiotics, and 70.4% (95% CI 49.6-88.3%) for 'no intervention'. Compared to 'no intervention', only complete excision was significantly associated with cure (OR 33.1; 95% CI 10.8-102.9; p < 0.001). Complete excision was associated with a 10% risk of facial nerve palsy (2% permanent). 'No intervention' was associated with delayed resolution. CONCLUSIONS: Complete excision is associated with the highest cure rate in NTM cervicofacial lymphadenitis, but also had the highest risk of facial nerve palsy. In the absence of large, well-designed RCTs, the choice between surgical excision, anti-mycobacterial antibiotics and 'no intervention' should be based on the location and extent of the disease, and acceptability of prolonged time to resolution.
Authors: Patricia W Garcia-Marcos; Mercedes Plaza-Fornieles; Ana Menasalvas-Ruiz; Ramon Ruiz-Pruneda; Pedro Paredes-Reyes; Santiago Alfayate Miguelez Journal: Eur J Pediatr Date: 2017-03-06 Impact factor: 3.183
Authors: T Nebreda Mayoral; A G Andrés Andrés; S Fuentes Carretero; R Calleja Fernández; M S Jiménez Pajares Journal: New Microbes New Infect Date: 2017-12-20