Current trends in nontuberculous mycobacteria infections in Canadian children: A Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study

BACKGROUND: Nontuberculous mycohacteria (NTM) infections appear to be increasing in number and severity in developed countries worldwide Surgical excision has been considered die standard treatment for NTM lymphadenitis, but the use of medical therapy seems to be increasing OBJECTIVE: To determine the disease characteristics as well as the current therapeutic management of NTM Infections in Canadian children METHODS: Cases of definite or probable NTM infections were identified prospectively in children up to IS years of age seen in 10 Canadian paediatric tertiary care centres from September 2005 to August 2006 Clinical, microbiological and pathological data were collected RESULTS: A total of 60 cases were identified Data were complete for 45 patients, including 34 cases of lymphadenitis, four cases of skin and soft tissue infection, and seven cases of pulmonary NTM infection Seventy-nine per cent of children (27 of 34) with lymphadenitis had an unsuccessful course of antibiotics before diagnosis Sixty-eight per cent of purified protein derivative tests (15 of 22) were positive NTM was detected in 76% of samples (29 of 38), of which 62% were Mycobacterium avium complex All patients with lymphadenitis underwent surgical therapy and most patients (74%) also received antimicrobials CONCLUSIONS: Current trends indicate that the majority of die study centres :ire using medical therapy with variable regimen and duration as kin adjunct to surgical excision in the treatment of NTM lymphadenitis Larger numbers and longer follow-up tunes are needed to better evaluate the efficacy of medical therapy and outcome of disease A randomized controlled study comparing surgical therapy alone and chemotherapy for NTM lymphadenitis is required