Nontuberculous Mycobacterial Disease in Pediatric Populations

  • Andrea T. CruzEmail author
  • Jeffrey R. Starke
Part of the Respiratory Medicine book series (RM)


Increasing numbers of children with nontuberculous mycobacterial (NTM) infections have been reported from many pediatric hospitals. The most common manifestation, cervical lymphadenitis, is most common in preschool-aged, immunocompetent children, and surgical excision may be curative. Isolated skin and soft tissue infections (SSTIs) can be seen in immunocompetent children after direct inoculation from penetrating trauma or can be the first presentation of disseminated disease in immunocompromised hosts. Disseminated and pulmonary NTM infection is almost always seen in children with either immunocompromising conditions (primary or acquired) or in children with conditions predisposing them to parenchymal lung damage (e.g., cystic fibrosis). While the treatment principles are the same as for adults, many children may have paucibacillary disease and may thus either require fewer medications or a shorter duration of therapy.


Lymphadenitis Surgical excision Sinus tract Pediatric Child 


  1. 1.
    Blyth CC, Best EJ, Jones CA, et al. Nontuberculous mycobacterial infection in children: a prospective national study. Pediatr Infect Dis J. 2009;28(9):801–5.CrossRefGoogle Scholar
  2. 2.
    Haverkamp MH, Arend SM, Lindeboom JA, et al. Nontuberculous mycobacterial infection in children: a 2-year prospective surveillance study in the Netherlands. Clin Infect Dis. 2004;39:450–6.CrossRefGoogle Scholar
  3. 3.
    Carvalho AC, Codecasa L, Pinsi G, et al. Differential diagnosis of cervical mycobacterial lymphadenitis in children. Pediatr Infect Dis J. 2010;29(7):629–33.CrossRefGoogle Scholar
  4. 4.
    Gallivan M, Shah N, Flood J. Epidemiology of Mycobacterium bovis disease, California, USA, 2003–2011. Emerg Infect Dis. 2015;21(3):435–43.CrossRefGoogle Scholar
  5. 5.
    Kuchukhidze G, Kasradze A, Dolakidze T, et al. Increase in lymphadenitis cases after shift in BCG vaccine strain. Emerg Infect Dis. 2015;21(9):1677–9.CrossRefGoogle Scholar
  6. 6.
    The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices. Available online at: Accessed 11 Oct 2016.
  7. 7.
    Haimi-Cohen Y, Zeharia A, Mimouni M, et al. Skin indurations in response to tuberculin testing in patients with nontuberculous mycobacterial lymphadenitis. Clin Infect Dis. 2001;33(10):1786–8.CrossRefGoogle Scholar
  8. 8.
    Lindeboom JA, Smets AM, Kuijper EJ, et al. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol. 2006;36(10):1063–7.CrossRefGoogle Scholar
  9. 9.
    Robson CD. Imaging of granulomatous lesions of the neck in children. Radiol Clin N Am. 2000;38(5):969–77.CrossRefGoogle Scholar
  10. 10.
    Ellison E, Lapuerta P, Martin SE. Fine needle aspiration diagnosis of mycobacterial lymphadenitis: sensitivity and predictive value in the United States. Acta Cytol. 1999;32(2):153–7.CrossRefGoogle Scholar
  11. 11.
    Lindeboom JA. Conservative wait-and-see therapy versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis. 2011;52(2):180–4.CrossRefGoogle Scholar
  12. 12.
    Haimi-Cohen Y, Markus-Eidlitz T, Amir J, Zeharia A. Long-term follow-up of observation-only management of nontuberculous mycobacterial lymphadenitis. Clin Pediatr (Phila). 2016;55(12):1160–4.CrossRefGoogle Scholar
  13. 13.
    Zeharia A, Eidlitz-Markus T, Haimi-Cohen Y, et al. Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone. Pediatr Infect Dis J. 2008;27(10):920–2.CrossRefGoogle Scholar
  14. 14.
    Lindeboom JA. Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children. J Oral Maxillofac Surg. 2012;70(2):345–8.CrossRefGoogle Scholar
  15. 15.
    Lindeboom JA, Lindeboom R, Bruijnesteijn van Coppenraet ES, et al. Esthetic outcome of surgical excision versus antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Infect Dis J. 2009;28(11):1028–30.CrossRefGoogle Scholar
  16. 16.
    Parker NP, Scott AR, Finkelstein M, et al. Predicting surgical outcomes in pediatric cervicofacial mycobacterial lymphadenitis. Ann Otol Rhinol Laryngol. 2012;121(7):478–84.CrossRefGoogle Scholar
  17. 17.
    Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175(4):367–416.CrossRefGoogle Scholar
  18. 18.
    Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147–95.CrossRefGoogle Scholar
  19. 19.
    Cuello-Garcia CA, Perez-Gaxiola G, Jimenez Gutierrez C. Treating BCG-induced disease in children. Cochrane Database Syst Rev. 2013;1:CD008300.Google Scholar
  20. 20.
    Banani SA, Alborzi A. Needle aspiration for suppurative post-BCG adenitis. Arch Dis Child. 1994;71(5):446–7.CrossRefGoogle Scholar
  21. 21.
    Tebruegge M, Pantazidou A, MacGregor D, et al. Nontuberculous mycobacterial disease in children – epidemiology, diagnosis & management at a tertiary center. PLoS One. 2016;11(1):e0147513.CrossRefGoogle Scholar
  22. 22.
    Asiimwe BB, Bagyenzi GB, Sengooba W, et al. Species and genotypic diversity of non-tuberculous mycobacteria isolated from children investigated for pulmonary tuberculosis in rural Uganda. BMC Infect Dis. 2013;13:88.CrossRefGoogle Scholar
  23. 23.
    Pham-Huy A, Robinson JL, Tapiero B, et al. Current trends in nontuberculous mycobacteria infections in Canadian children: a pediatric investigators collaborative network on infections in Canada (PICNIC) study. Paediatr Child Health. 2010;15(5):276–82.CrossRefGoogle Scholar
  24. 24.
    Stone AB, Schelonka RL, Drehner DM, et al. Disseminated Mycobacterium avium complex in non-human immunodeficiency virus-infected pediatric patients. Pediatr Infect Dis J. 1992;11:960–4.CrossRefGoogle Scholar
  25. 25.
    Arlotta A, Cefalo MG, Maurizi P, et al. Critical pulmonary infection due to nontuberculous mycobacterium in pediatric leukemia: report of a difficult diagnosis and review of pediatric series. J Pediatr Hematol Oncol. 2014;36(1):66–70.CrossRefGoogle Scholar
  26. 26.
    Haverkamp MH, van de Vosse E, van dissel JT. Nontuberculous mycobacterial infections in children with inborn errors of the immune system. J Infect. 2014;68(Suppl 1):S134–50.CrossRefGoogle Scholar
  27. 27.
    Safdar A, White DA, Stover D, et al. Profound interferon gamma deficiency in patients with chronic pulmonary nontuberculous mycobacteriosis. Am J Med. 2002;113(9):756–9.CrossRefGoogle Scholar
  28. 28.
    Qu H-Q, Fisher-Hoch SP, McCormick JB. Molecular immunity to mycobacteria; knowledge from the mutation and phenotype spectrum analysis of Mendelian susceptibility to mycobacterial diseases. Int J Infect Dis. 2011;15(5):e305–13.CrossRefGoogle Scholar
  29. 29.
    Newport MJ, Huxley CM, Huston S, et al. A mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infection. N Engl J Med. 1996;335(26):1941–9.CrossRefGoogle Scholar
  30. 30.
    Floto RA, Olivier KN, Saiman L, et al. US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis. Thorax. 2016;71(1):1–22.CrossRefGoogle Scholar
  31. 31.
    Adjermian J, Olivier KN, Prevots DR. Nontuberculous mycobacteria among patients with cystic fibrosis in the United States. Screening practices and environmental risk. Am J Respir Crit Care Med. 2014;190(5):581–6.CrossRefGoogle Scholar
  32. 32.
    Leung JM, Olivier KN. Nontuberculous mycobacteria: the changing epidemiology and treatment challenges in cystic fibrosis. Curr Opin Pulm Med. 2013;19(6):662–9.CrossRefGoogle Scholar
  33. 33.
    Harris KA, Underwood A, Kenna DTD, et al. Whole-genome sequencing and epidemiological analysis do not provide evidence for cross-transmission of Mycobacterium abscessus in a cohort of pediatric cystic fibrosis patients. Clin Infect Dis. 2015;60(7):1007–16.PubMedGoogle Scholar
  34. 34.
    Bryant JM, Grogono DM, Greaves D, et al. Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystic fibrosis: a retrospective cohort study. Lancet. 2013;381(9877):1551–60.CrossRefGoogle Scholar
  35. 35.
    Bryant JM, Grogono DM, Rodriguez-Rincon D, et al. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science. 2016;354(6313):751–7.CrossRefGoogle Scholar
  36. 36.
    Nolt D, Michaels MG, Wald ER. Intrathoracic disease from nontuberculous mycobacteria in children: two cases and a review of the literature. Pediatrics. 2003;112(5):e434.CrossRefGoogle Scholar
  37. 37.
    Freeman AF, Olivier KN, Rubio TT, et al. Intrathoracic nontuberculous mycobacterial infections in otherwise healthy children. Pediatr Pulmonol. 2009;44(11):1051–6.CrossRefGoogle Scholar
  38. 38.
    Gupta SK, Katz BZ. Intrathoracic disease associated with Mycobacterium avium-intracellulare complex in otherwise healthy children: diagnostic and therapeutic considerations. Pediatrics. 1994;94(5):741–2.PubMedGoogle Scholar
  39. 39.
    Lopez-Varela E, Garcia-Basteiro AL, Santiago B, et al. Nontuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis. Lancet Respir Med. 2015;3(3):244–56.CrossRefGoogle Scholar
  40. 40.
    Fergie JE, Milligan TW, Henderson BM, et al. Intrathoracic Mycobacterium avium complex infection in immunocompetent children: case report and review. Clin Infect Dis. 1997;24(2):250–3.CrossRefGoogle Scholar
  41. 41.
    Levelink B, de Vries E, van Dissel JT, et al. Pulmonary Mycobacterium avium intracellulare infection in an immunocompetent child. Pediatr Infect Dis J. 2004;23(9):892.CrossRefGoogle Scholar
  42. 42.
    Kröner C, Griese M, Kappler M, et al. Endobronchial lesions caused by nontuberculous mycobacteria in apparently healthy pediatric patients. Pediatr Infect Dis J. 2015;34(5):532–5.CrossRefGoogle Scholar
  43. 43.
    del Rio Camacho G, Soriano Guillén L, Flandes Aldeyturriaga J, et al. Endobronchial atypical mycobacteria in an immunocompetent child. Pediatr Pulmonol. 2012;45(5):511–3.Google Scholar
  44. 44.
    Glatstein M, Scolnick D, Bensira L, et al. Lung abscess due to non-tuberculous, non-Mycobacterium fortuitum in a neonate. Pediatr Pulmonol. 2012;47(10):1034–7.CrossRefGoogle Scholar
  45. 45.
    Osorio A, Kessler RM, Guruuprasad H, et al. Isolated intrathoracic presentation of Mycobacterium avium complex in an immunocompetent child. Pediatr Radiol. 2001;31(12):848–51.CrossRefGoogle Scholar
  46. 46.
    Kelsey DS, Chambers RT, Hudspeth AS. Nontuberculous mycobacterial infection presenting as a mediastinal mass. J Pediatr. 1981;98(3):431–2.CrossRefGoogle Scholar
  47. 47.
    Dore ND, LeSouëf PN, Masters B, et al. Atypical mycobacterial pulmonary disease and bronchial obstruction in HIV-negative children. Pediatr Pulmonol. 1998;26(6):380–8.CrossRefGoogle Scholar
  48. 48.
    Do PC, Nussbaum E, Moua J, et al. Clinical significance of respiratory isolates for Mycobacterium abscessus complex from pediatric patients. Pediatr Pulmonol. 2013;48(5):470–80.CrossRefGoogle Scholar
  49. 49.
    Martiniano SL, Nick JA. Nontuberculous mycobacterial infections in cystic fibrosis. Clin Chest Med. 2015;36(1):101–15.CrossRefGoogle Scholar
  50. 50.
    Robinson PD, Harris KA, Aurora P, et al. Paediatric lung transplant outcomes vary with Mycobacterium abscessus complex species. Eur Respir J. 2013;41(5):1230–2.CrossRefGoogle Scholar
  51. 51.
    Koh WJ, Stout JE, Yew W-W. Advances in the management of pulmonary disease due to Mycobacterium abscessus complex. Int J Tuberc Lung Dis. 2014;18(10):1141–8.CrossRefGoogle Scholar
  52. 52.
    Johnson MG, Stout JE. Twenty-eight cases of Mycobacterium marinum infection: retrospective case series and literature review. Infection. 2015;43(6):655–62.CrossRefGoogle Scholar
  53. 53.
    Lillis JV, Ansdell VE, Ruben K, et al. Sequelae of World War II: an outbreak of chronic cutaneous nontuberculous mycobacterial infection among Satowanese islanders. Clin Infect Dis. 2009;48(11):1541–6.CrossRefGoogle Scholar
  54. 54.
    Franklin DJ, Starke JR, Brady MT, Brown BA, Wallace RJ Jr. Chronic otitis media after tympanostomy tube placement caused by Mycobacterium abscessus: a new clinical entity? Am J Otol. 1994;15(3):313–20.PubMedGoogle Scholar
  55. 55.
    World Health Organization. Global leprosy update, 2013: reducing disease burden. Wkly Epidemiol Rec. 2014;89(36):389–400.Google Scholar
  56. 56.
    Kothavade RJ, Dhurat RS, Mishra SN, Kothavade UR. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis. 2013;32(2):161–88.CrossRefGoogle Scholar
  57. 57.
    Toll A, Gallardo F, Ferran M, et al. Aggressive multifocal Buruli ulcer with associated osteomyelitis in an HIV-positive patient. Clin Exp Dermatol. 2005;30(6):649–51.CrossRefGoogle Scholar
  58. 58.
    Sia TY, Taimur S, Blau DM, et al. Clinical and pathological evaluation of Mycobacterium marinum group skin infections associated with fish markets in New York City. Clin Infect Dis. 2016;62(5):590–5.CrossRefGoogle Scholar
  59. 59.
    El Sahly HM, Septimus E, Soini H, et al. Mycobacterium simiae pseudo-outbreak resulting from a contaminated water supply in Houston, Texas. Clin Infect Dis. 2002;35(7):802–7.CrossRefGoogle Scholar
  60. 60.
    World Health Organization. Leprosy elimination: WHO recommended MDT regimens. Available online at: Accessed 10/13/16.
  61. 61.
    World Health Organization. Treatment of Mycobacterium ulcerans disease (Buruli Ulcer). 2012. Available online at: Accessed 10/13/16.
  62. 62.
    Phillips P, Bonner S, Gataric N, et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis. 2005;41(10):1483–97.CrossRefGoogle Scholar
  63. 63.
    Shachor-Meyouhas Y, Sprecher H, Eluk O, et al. An outbreak of Mycobacterium mucogenicum bacteremia in pediatric hematology-oncology patients. Pediatr Infect Dis J. 2011;30(1):30–2.CrossRefGoogle Scholar
  64. 64.
    Department of Health and Human Services. Panel on opportunistic infections in HIV-exposed and HIV-infected children: guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. 2013. Available online at: Accessed 13 Oct 2016.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PediatricsBaylor College of MedicineHoustonUSA

Personalised recommendations