International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of non-tuberculous mycobacterial cervicofacial lymphadenitis

Catherine F Roy; Karthik Balakrishnan; An Boudewyns; Alan Cheng; Robert H Chun; Sam J Daniel; Pierre Fayoux; Catherine Hart; Ann Hemansson; Richard Hewitt; Wei-Chung Hsu; Michael Kuo; Christopher Liu; John Maddalozzo; Anna H Messner; Seth Pransky; Reza Rahbar; Scott Rickert; Soham Roy; John Russell; Michael J Rutter; Kathleen C Y Sie; Douglas Sidell; Richard Smith; Marlene Soma; Jorge Spratley; Karen Watters; David R White; Nikolaus Wolter; George Zalzal; Jeffrey C Yeung

doi:10.1016/j.ijporl.2023.111469

International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of non-tuberculous mycobacterial cervicofacial lymphadenitis

Int J Pediatr Otorhinolaryngol. 2023 Mar:166:111469. doi: 10.1016/j.ijporl.2023.111469. Epub 2023 Feb 2.

Authors

Catherine F Roy¹, Karthik Balakrishnan², An Boudewyns³, Alan Cheng⁴, Robert H Chun⁵, Sam J Daniel¹, Pierre Fayoux⁶, Catherine Hart⁷, Ann Hemansson⁸, Richard Hewitt⁹, Wei-Chung Hsu¹⁰, Michael Kuo¹¹, Christopher Liu¹², John Maddalozzo¹³, Anna H Messner¹⁴, Seth Pransky¹⁵, Reza Rahbar¹⁶, Scott Rickert¹⁷, Soham Roy¹⁸, John Russell¹⁹, Michael J Rutter⁷, Kathleen C Y Sie²⁰, Douglas Sidell², Richard Smith²¹, Marlene Soma²², Jorge Spratley²³, Karen Watters¹⁵, David R White²⁴, Nikolaus Wolter²⁵, George Zalzal²⁶, Jeffrey C Yeung²⁷

Affiliations

¹ Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada.
² Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium.
⁴ Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia.
⁵ Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
⁶ Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
⁷ Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
⁹ Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
¹⁰ Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan.
¹¹ Department of Pediatric Otolaryngology, Birmingham Children's Hospital, Birmingham, United Kingdom.
¹² Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Dallas, TX, USA.
¹³ Department of Otolaryngology/Head and Neck Surgery, Lurie Children's Hospital, Chicago, IL, USA.
¹⁴ Department of Otolaryngology/Head & Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
¹⁵ Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA.
¹⁶ Department of Pediatric Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Aurora, CO, USA.
¹⁹ Department of Pediatric Otorhinolaryngology, Children's Health Ireland (Crumlin), Dublin, Ireland.
²⁰ Department of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, USA.
²¹ Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
²² Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia.
²³ Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal.
²⁴ Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA.
²⁵ Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
²⁶ Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington, DC, USA.
²⁷ Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada. Electronic address: Jeffrey.yeung@mcgill.ca.

PMID: 36764081
DOI: 10.1016/j.ijporl.2023.111469

Abstract

Introduction: Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial.

Objectives: This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges.

Methods: A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature.

Setting: Multinational, multi-institutional, tertiary pediatric hospitals.

Results: Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation.

Conclusion: The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation.

Keywords: Atypical mycobacteria; Cervical lymphadenitis; Consensus recommendations; Non-tuberculous mycobacteria.

Publication types

Review

MeSH terms

Anti-Bacterial Agents / therapeutic use
Child
Humans
Lymph Node Excision
Lymphadenitis* / microbiology
Mycobacterium Infections, Nontuberculous* / diagnosis
Nontuberculous Mycobacteria
Otolaryngology*

Substances

Anti-Bacterial Agents