A 28-Year Multicenter Cohort Study of Nontuberculous Mycobacterial Lymphadenitis in Children, Spain

Abstract

We describe the epidemiology, diagnosis, and management of nontuberculous mycobacterial lymphadenitis cases detailed in a 28-year (1996-2023) multicenter cohort from Spain. The case numbers remained stable during the initial prospective phase (2013-2020), but a sharp decline was observed during 2021-2022. Disease onset occurred during spring or June in 45.9% of cases. Mycobacterium avium complex (43.1%) and M. lentiflavum (39.9%) were the most common species detected. M. lentiflavum affected mostly younger children from central Spain. The most common treatment strategy was complete surgical resection with (n = 80) or without (n = 88) antimicrobial drug treatment, followed by antimicrobial drugs alone (n = 76). Facial palsy developed in 10.4% of surgical cases. Adverse events because of antimicrobial drugs were uncommon. New fistula formation during follow-up occurred more in children managed with observation alone than in those treated with antimicrobial drugs alone (relative risk 2.7 [95% CI 1.3-5.3]; p = 0.014).

Keywords: Mycobacterium avium complex; Mycobacterium lentiflavum; Spain; bacteria; interferon-gamma release assay; lymphadenitis; nontuberculous mycobacteria; seasonality; tuberculin skin test; tuberculosis and other mycobacteria.

Figure 1

Annual case numbers of NTM lymphadenitis and the causative species in a 28-year multicenter cohort study of NTM lymphadenitis in children in Spain, 1996–2023. NTM, nontuberculous mycobacteria.

Figure 2

Seasonality of symptom onset, stratified by NTM species, in a 28-year multicenter cohort study of NTM lymphadenitis in children, Spain. NTM, nontuberculous mycobacteria.

Figure 3

Geographic distribution of nontuberculous mycobacterial lymphadenitis cases in Spain. The pie charts show the species in each region: yellow, Mycobacterium avium complex; red, Mycobacterium lentiflavum; green, all other species. The size of each pie chart is proportional to the number of cases reported in the respective region.