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Nontuberculous mycobacterial disease in children – epidemiology, diagnosis & management at a tertiary center

Nontuberculous mycobacterial disease in children – epidemiology, diagnosis & management at a tertiary center
Nontuberculous mycobacterial disease in children – epidemiology, diagnosis & management at a tertiary center
Background: There are limited data on the epidemiology, diagnosis and optimal management of nontuberculous mycobacterial (NTM) disease in children.

Methods: Retrospective cohort study of NTM cases over a 10-year-period at a tertiary referral hospital in Australia.

Results: A total of 140 children with NTM disease, including 107 with lymphadenitis and 25 with skin and soft tissue infections (SSTIs), were identified. The estimated incidence of NTM disease was 0.6–1.6 cases / 100,000 children / year; no increasing trend was observed over the study period. Temporal analyses revealed a seasonal incidence cycle around 12 months, with peaks in late winter/spring and troughs in autumn. Mycobacterium-avium-complex accounted for most cases (77.8%), followed by Mycobacterium ulcerans (14.4%) and Mycobacterium marinum (3.3%). Polymerase chain reaction testing had higher sensitivity than culture and microscopy for acid-fast bacilli (92.0%, 67.2% and 35.7%, respectively). The majority of lymphadenitis cases underwent surgical excision (97.2%); multiple recurrences in this group were less common in cases treated with clarithromycin and rifampicin compared with clarithromycin alone or no anti-mycobacterial drugs (0% versus 7.1%; OR:0.73). SSTI recurrences were also less common in cases treated with two anti-mycobacterial drugs compared with one or none (10.5% versus 33.3%; OR:0.23).

Conclusions: There was seasonal variation in the incidence of NTM disease, analogous to recently published observations in tuberculosis, which have been linked to seasonal variation in vitamin D. Our finding that anti-mycobacterial combination therapy was associated with a reduced risk of recurrences in patients with NTM lymphadenitis or SSTI requires further confirmation in prospective trials.
1932-6203
1-14
Tebruegge, Marc
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Pantazidou, Anastasia
7264d9c8-59ea-49c5-a933-6b2e5fbef7d4
MacGregor, Duncan
2954e525-4f65-4e48-adf5-5771514e7a6f
Gonis, Gena
90467b02-e323-449d-bbd2-822c1fa7b848
Leslie, David
e4fa8a59-bf57-41c8-ba80-3cffe7e5076e
Sedda, Luigi
ee74dbd8-4f61-4f7f-a4ff-a08ecbc57723
Ritz, Nicole
ce6604a1-f373-4d76-838a-1ae75f35b20b
Connell, Tom
7c1afb37-45bd-44a3-a274-20839e68f2c3
Curtis, Nigel
60e08f70-7ce9-42b3-8074-d5df55131b12
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Pantazidou, Anastasia
7264d9c8-59ea-49c5-a933-6b2e5fbef7d4
MacGregor, Duncan
2954e525-4f65-4e48-adf5-5771514e7a6f
Gonis, Gena
90467b02-e323-449d-bbd2-822c1fa7b848
Leslie, David
e4fa8a59-bf57-41c8-ba80-3cffe7e5076e
Sedda, Luigi
ee74dbd8-4f61-4f7f-a4ff-a08ecbc57723
Ritz, Nicole
ce6604a1-f373-4d76-838a-1ae75f35b20b
Connell, Tom
7c1afb37-45bd-44a3-a274-20839e68f2c3
Curtis, Nigel
60e08f70-7ce9-42b3-8074-d5df55131b12

Tebruegge, Marc, Pantazidou, Anastasia, MacGregor, Duncan, Gonis, Gena, Leslie, David, Sedda, Luigi, Ritz, Nicole, Connell, Tom and Curtis, Nigel (2016) Nontuberculous mycobacterial disease in children – epidemiology, diagnosis & management at a tertiary center. PLoS ONE, 11 (1), 1-14. (doi:10.1371/journal.pone.0147513). (PMID:26812154)

Record type: Article

Abstract

Background: There are limited data on the epidemiology, diagnosis and optimal management of nontuberculous mycobacterial (NTM) disease in children.

Methods: Retrospective cohort study of NTM cases over a 10-year-period at a tertiary referral hospital in Australia.

Results: A total of 140 children with NTM disease, including 107 with lymphadenitis and 25 with skin and soft tissue infections (SSTIs), were identified. The estimated incidence of NTM disease was 0.6–1.6 cases / 100,000 children / year; no increasing trend was observed over the study period. Temporal analyses revealed a seasonal incidence cycle around 12 months, with peaks in late winter/spring and troughs in autumn. Mycobacterium-avium-complex accounted for most cases (77.8%), followed by Mycobacterium ulcerans (14.4%) and Mycobacterium marinum (3.3%). Polymerase chain reaction testing had higher sensitivity than culture and microscopy for acid-fast bacilli (92.0%, 67.2% and 35.7%, respectively). The majority of lymphadenitis cases underwent surgical excision (97.2%); multiple recurrences in this group were less common in cases treated with clarithromycin and rifampicin compared with clarithromycin alone or no anti-mycobacterial drugs (0% versus 7.1%; OR:0.73). SSTI recurrences were also less common in cases treated with two anti-mycobacterial drugs compared with one or none (10.5% versus 33.3%; OR:0.23).

Conclusions: There was seasonal variation in the incidence of NTM disease, analogous to recently published observations in tuberculosis, which have been linked to seasonal variation in vitamin D. Our finding that anti-mycobacterial combination therapy was associated with a reduced risk of recurrences in patients with NTM lymphadenitis or SSTI requires further confirmation in prospective trials.

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Accepted/In Press date: 25 December 2015
e-pub ahead of print date: 26 January 2016
Published date: 26 January 2016
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 386724
URI: https://eprints.soton.ac.uk/id/eprint/386724
ISSN: 1932-6203
PURE UUID: f54daf31-cccb-414d-a624-fd708661deb7

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Date deposited: 03 Feb 2016 15:24
Last modified: 09 Dec 2019 19:46

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