Mycobacterial cervical lymphadenitis in children: Clinical and laboratory factors of importance for differential diagnosis

The role of epidemiological and clinical features for the early differentia l diagnosis between Mycobacterium tuberculosis (MTB) complex and non-tuberc ulous mycobacterial (NTM) cervical lymphadenitis in children was examined i n this study. From 1982 to 1997, 24 MTB complex cases and 26 NTM cases were diagnosed, of which 75% and 25%, respectively, presented during the first half of the study period. Epidemiological and lymph-node features and anato mical areas were not helpful in the differential diagnosis between the 2 gr oups. Fulfilment of 2 out of 3 criteria (positive tuberculin skin test reac tion, abnormal chest radiograph, contact with a person with infectious tube rculosis) was associated with 92% sensitivity for the diagnosis of MTB lymp hadenitis. 37.5% of the MTB cases and 88.5% of the NTM cases were culture-c onfirmed; all inconclusive cultures concerned patients with spontaneous dra inage and fistula. Surgical intervention was required in 67% of the MTB cas es. AU NTM cases were managed by surgery alone. Fistulae or cheloids occurr ed in all patients in whom incision and drainage were applied instead of to tal excision. Excellent aesthetic results were achieved in patients who pre sented within 1 month following the onset of lymphadenitis. The spectrum of mycobacterial cervical lymphadenitis in children in Greece has changed dur ing the 1990s. Early and prompt treatment contributes to the diagnosis and response.