Mycobacterium Abscessus Cervical Lymphadenitis: An Immunocompetent Child

孩童的頭頸部淋巴腺腫，特別是五歲以下，非結核分枝桿菌的感染是重要原因之一，在世界各地的發生率均有逐漸增加的趨勢，然而在台灣卻幾乎沒有病歷報告的記載。臨床表現通常是單一、無痛的頸部腫塊，最常發生於頜下及頦下的淋巴結，且對於傳統的抗生素治療無效。若不處理，會有慢性流膿不止的情形。轉介到大醫院時，通常懷疑的診斷是腫瘤或者是細菌性淋巴結發炎，而不是非結核分枝桿菌的感染。非結核分枝桿菌的感染原本通常是好發於免疫不全的病人，但有越來越多的報告顯示，此類感染亦常出現於免疫正常也沒有其他危險因子的病人身上。非結核分枝桿菌所造成的淋巴結發炎會有以下特色：缺乏全身性症狀、結核菌素試驗呈陰性反應以及沒有肺結核的接觸史。然而確切診斷還是要靠組織切片的培養報告證明。感染的淋巴結完全切除是目前廣被接受的治療主流，它不僅可提供快速的診斷依據，也是所有治療方式中復發率最低的。至於內科藥物治療，通常是手術完全切除有困難或者是家屬拒絕時，可以嘗試的選擇。我們希望藉此提醒各位臨床醫師：幼童的頸部腫塊，要記得把非結核分枝桿菌的感染列入鑑別診斷。

關鍵字

免疫功能正常；淋巴腺炎；膿瘍分枝桿菌；非結核分枝桿菌；台灣

並列摘要

Nontuberculous mycobacterium (NTM) is one of the well-known causes of cervicofacial lymphadenopathy in children under 5 years of age. Children often present with a painless cervical mass that fails to respond to conventional antibiotics. They are often referred under the suspicion of a neoplasm or bacterial adenitis rather than NTM cervical lymphadenitis. The lack of systemic symptoms, modest or negative purified protein derivative test and absence of exposure to active tuberculosis are characteristics of NTM lymphadenitis. The diagnosis usually requires the isolation of pathogen or pathologic proof. Complete excision is the choice of treatment by the majority of authors in the literature. This not only enables rapid diagnosis but ensures the lowest recurrence rate. Medical management is sometimes successful when complete resection is impossible or refused. To our knowledge, the incidence of NTM cervical lymphadenitis in children is increasing throughout the world. However, such reports of children in Taiwan is lacking. Clinicians should suspect a possible nontuberculous mycobacterial infection when a cervical lump is found in a child.

並列關鍵字

immunocompetent ； lymphadenitis ； Mycobacterium abscessus ； nontuberculous mycobacteria ； Taiwan

國際替代計量

Mycobacterium Abscessus Cervical Lymphadenitis: An Immunocompetent Child

未授權

主題瀏覽