Mycobacterial lymphadenitis in childhood
K. E. Schuit and D. A. Powell
A total of 42 cases of childhood mycobacterial adenitis have been studied
to define the optimal steps that lead to the correct diagnosis of this
disease. Antigens from the atypical mycobacteria are not currently
available, so the usefulness of tuberculin skin testing as a diagnostic
tool was examined. Skin testing differentiates mycobacterial adenitis from
infection caused by pyogenic bacteria. In addition, repetitive skin testing
with tuberculin over a three- to six-month period is also useful in
differentiating adenitis caused by atypical mycobacteria from that due to
Mycobacterium tuberculosis. Children with atypical mycobacterial adenitis
have a decreasing tuberculin response to repeated testing, while children
with tuberculous adenitis have a stable response. Other factors that assist
in the differentiation of adenitides include a history of recent exposure
to tuberculosis and evidence of extralymphatic tuberculosis. Needle
aspiration or partial excision in mycobacterial adenitis may lead to
drainage and sinus tract information. A PPD skin test should be done prior
to surgical manipulation of enlarged nodes. Children with reactive skin
tests should undergo complete excision.
