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Klin Padiatr 2003; 215(1): 9-15
DOI: 10.1055/s-2003-36889
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Lymphadenitis colli durch nichttuberkulöse Mykobakterien (NTM) im Kindesalter - Eine Fallserie und Literaturübersicht

Lymphadenitis Colli due to Non-Tuberculous Mycobacteria (NTM): a Case-Series and Review of the LiteratureM.  Knuf1 , P.  Habermehl1 , F.  Zepp1 , P.  Schmidtke1 , W.  Mannhardt-Laakmann1 , H.-I.  Huppertz2 , S.  Rüsch-Gerdes3 , F.  Erdnüß4 , F.  Kowalzik4 , H.-J.  Schmitt4
  • 1Pädiatrische Immunologie und Infektiologie, Kinderklinik der Johannes-Gutenberg-Universität Mainz
  • 2Zentrum für Kinderheilkunde und Jugendmedizin, Zentralkrankenhaus St.-Jürgen-Straße, Bremen
    (Univ.-Kinderklinik Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg)
  • 3Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel
  • 4Zentrum für Präventive Pädiatrie, Johannes-Gutenberg-Universität Mainz
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Publication History

Publication Date:
24 January 2003 (online)

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Zusammenfassung

Anliegen: Die Lymphadenitis colli durch NTM gehört zur Differenzialdiagnose bei zervikaler Lymphadenitis im Kindesalter. Angaben zur Häufigkeit, zum Erregerspektrum, zur Diagnostik, Klinik und Therapie fehlen weitgehend für Deutschland. Methoden: In den 90er-Jahren wurde bei 277 deutschen Kinderkliniken eine Fragebogenerhebung durchgeführt. Außerdem wurden Fälle aus dem „Nationalen Referenzlabor für Mykobakterien” in Borstel in die Untersuchung integriert. Es wird eine Literaturübersicht zu „NTM und Lymphadenitis colli im Kindesalter” gegeben. Ergebnisse: Es konnten 51 Fälle von Lymphadenitis durch NTM identifiziert werden. Die Erkrankung manifestiert sich typischerweise im Kleinkindesalter. Häufigste Erreger waren Bakterien des Mycobacterium-avium-intracellulare-scrofulaceum (MAIS)-Komplexes. Neben dem Lokalbefund der einseitigen Lymphadenitis fehlen weitere klinische (Allgemein-)Symptome, ebenso wie spezifische Laborparameter. Der Verlauf ist subakut oder chronisch. Der Tuberkulin-Hauttest kann (falsch-)positiv ausfallen. Die Diagnose wird durch Biopsie mit Histologie und mikrobiologischen Methoden gesichert. Schlussfolgerungen: Die Exstirpation ist die Therapie der Wahl, während die Bedeutung einer alleinigen oder zusätzlichen Therapie mit Clarithromycin, Rifabutin und anderen Medikamenten nicht abschließend geklärt ist. Für AIDS-Patienten scheint die Antibiotika-Therapie oder auch -Prophylaxe allerdings vorteilhaft zu sein. Eine medikamentöse Therapie sollte auch dann erfolgen, wenn die chirurgische Entfernung nicht vollständig möglich ist. Unklar bleibt, ob NTM-Infektionen im Kindesalter tatsächlich zunehmen.

Abstract

Objective: Lymphadenitis colli due to NTM should always be considered in children with cervical Lymphadenitis. For Germany there is a lack of data concerning the incidence, the epidemiology, the diversity and frequency of the different bacteria, the diagnosis, the clinical manifestation and the medical treatment. Methods: By means of a questionnaire, which was retrospective for 1985 to 1994 and was sent to 277 children's hospitals in Germany, we collected data on Lymphadenitis colli in Germany. In our study we also incorporated cases from the “National Laboratory for Mycobacteria” in Borstel as well as six cases from our hospital in Mainz. Therefore our data includes both clinical (28) and laboratory (30) cases. Additionally we screened the literature on “Lymphadenitis colli in children due to NTM”. Results: A total of 51 cases of Lymphadenitis due to NTM could be identified. The illness occurs typically in young children up to six years of age. The most frequent cause were species of the Mycobacterium avium-intracellulare-scrofulaceum complex. Except for the local diagnosis of a cervical Lymphadenitis other clinical symptoms are missing, just as specific laboratory parameters with a subacute or chronical course. The tuberculin skin test can be false positive. The diagnosis is confirmed by biopsy and histology as well as through microbiological tests. Conclusions: The best treatment is complete surgical excision, whereas the importance of additional or exclusive treatment with Clarithromycin, Rifabutin and other antibiotics could not be clarified completely. But in patients with AIDS Rifabutin and other drugs could perhaps be useful, even for prophylaxis. Also if complete excision is impossible, treatment with certain drugs (Clarithromycin or Azithromycin in combination with Rifampicin) will be recommended. It still remains in question if NTM infections in children are really increasing.

Schlüsselwörter

Lymphadenitis colli - NTM - Diagnose - Therapie

Key words

Lymphadenitis colli - NTM - diagnosis - therapy

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Dr. med. M. Knuf

Johannes-Gutenberg-Universität, Kinderklinik, Pädiatrische Immunologie und Infektiologie

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55101 Mainz

Phone: + 49-6131-17-3331

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