The management of non-tuberculous cervicofacial lymphadenitis in children: AÂ systematic review and meta-analysis

- In children, non-tuberculous mycobacterial infections mainly cause lymphadenitis.
- We did a meta-analysis to determine the optimal management of NTM lymphadenitis.
- Complete excision has the highest cure rates but can cause facial nerve palsy.
- Treatment with antibiotics or no intervention is associated with slow resolution.
- Individualised management based on the location and extent of disease is recommended.

SummaryObjectivesCervicofacial lymphadenitis is the most common manifestation of infection with non-tuberculous mycobacteria (NTM) in immunocompetent children. Although complete excision is considered standard management, the optimal treatment remains controversial. This study reviews the evidence for different management options for NTM lymphadenitis.MethodsA systematic literature review and meta-analysis were performed including 1951 children from sixty publications. Generalised linear mixed model regressions were used to compare treatment modalities.ResultsThe adjusted mean cure rate was 98% (95% CI 97.0-99.5%) for complete excision, 73.1% (95% CI 49.6-88.3%) for anti-mycobacterial antibiotics, and 70.4% (95% CI 49.6-88.3%) for 'no intervention'. Compared to 'no intervention', only complete excision was significantly associated with cure (OR 33.1; 95% CI 10.8-102.9; p < 0.001). Complete excision was associated with a 10% risk of facial nerve palsy (2% permanent). 'No intervention' was associated with delayed resolution.ConclusionsComplete excision is associated with the highest cure rate in NTM cervicofacial lymphadenitis, but also had the highest risk of facial nerve palsy. In the absence of large, well-designed RCTs, the choice between surgical excision, anti-mycobacterial antibiotics and 'no intervention' should be based on the location and extent of the disease, and acceptability of prolonged time to resolution.