Non-Tuberculous Mycobacterial Lymphadenitis

Lymph nodes are collections of cells that are part of the immune system. They trap and process germs that get into our bodies.

Sometimes the lymph nodes get infected. When this happens, it is called lymphadenitis or adenitis.

Non-tuberculous mycobacteria (NTM) also known as atypical mycobacteria, are a type of bacteria that can cause lymphadenitis. These bacteria are slow growing and rarely cause serious disease in children with normal immune systems.

They are sometimes called environmental mycobacteria because they are found throughout our environment, including in soil and water. Non-tuberculous mycobacteria don’t spread from person to person.

• A lump under the skin that slowly gets bigger over several weeks. It usually is a single lymph node, but it can involve more than one.
• The skin over the nodes can redden and take on a purplish color.
• The infected lymph nodes are usually in the neck or on the face in front of the ear. They can also happen in the armpit or groin area and almost always only on one side of the body.
• The infected lymph nodes are firm when they first appear, but they can soften and start draining pus.
• The infection doesn’t get better with routine antibiotic treatment.
• Some children may have low grade fevers.
• The infected lymph nodes are usually not sore to the touch.

Because of the way that this infection develops, we can be pretty sure it is non-tuberculous mycobacteria lymphadenitis by asking questions and examining your child.

But we may do some tests to make sure there isn’t another cause of the infection. These may include a culture from the infection, and rarely, a skin test for tuberculosis and blood tests. Sometimes we also need to do a biopsy of the lymph node to look for the infection.

Without any treatment, your child's immune system will usually clear the infection on its own over time. This can take a very long time (6 to 12 months) and the lymph nodes may become red and start to drain. If the lymph nodes are red, draining or uncomfortable, then we have some options for treatment.

• The most common treatment is observation with local wound care to allow the immune system time to clear the infection.
• An effective treatment is to remove the infected lymph nodes. This usually cures the infection. But sometimes it is not possible to remove all, or even part, of the node safely without a risk of damage to the nerves in the face and neck. This would leave a small scar on the neck.
• If the whole node can’t be taken out safely, sometimes it can be surgically drained if it is uncomfortable but isn’t safe to remove. There is often still a risk of fluid drainage even after this procedure.
• In some situations, antibiotics can also be helpful. Mycobacteria grow very slowly and so are also killed very slowly with antibiotics. Because of this, the antibiotics need to be given for at least 3 to 6 months in order to clear the infection. If part of the node was removed, the antibiotics may not need to be given as long.
• Important: Studies have shown that the impact of antibiotics may be limited. The use of long treatment courses 3 to 6 months can have problems. Because of this, antibiotics are not used for most patients, but can be considered in some cases.

Sometimes after the infection runs its course, there can be a small scar left behind on the neck. That could be safely removed later if needed.