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中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (10): 1259-1265.doi: 10.19982/j.issn.1000-6621.20240177

• 论著 • 上一篇    下一篇

儿童非结核分枝杆菌腮腺淋巴结炎三例并文献复习

李翠萍, 陈品儒(), 薛丽京, 郑圣坤   

  1. 广州市胸科医院儿科,广州市胸科医院结核科/非结核分枝杆菌病诊疗中心,广州市结核病研究重点实验室,呼吸疾病全国重点实验室,广州 510095
  • 收稿日期:2024-05-08 出版日期:2024-10-10 发布日期:2024-09-29
  • 通信作者: 陈品儒,Email:13802974258@126.com
  • 基金资助:
    广州市科技计划项目(2023A03J0991)

Nontuberculous mycobacterium parotid lymphadenitis in children: report of 3 cases and literature review

Li Cuiping, Chen Pinru(), Xue Lijing, Zheng Shengkun   

  1. Department of Pediatrics, Guangzhou Chest Hospital, Diagnosis and Treatment Center of Non-Tuberculous Mycobacteria Diseases, Guangzhou Key Laboratory of Tuberculosis Research, State Key Laboratory of Respiratory Diseases, Guangzhou 510095, China
  • Received:2024-05-08 Online:2024-10-10 Published:2024-09-29
  • Contact: Chen Pinru, Email: 13802974258@126.com
  • Supported by:
    Project of Guangzhou Science and Technology Plan(2023A03J0991)

摘要:

目的:总结并分析儿童非结核分枝杆菌腮腺淋巴结炎的临床特点、影像学特征、病理学特征、治疗及预后,以提高对儿童非结核分枝杆菌腮腺淋巴结炎的认识。方法:回顾性分析2020年12月至2023年12月在广州市胸科医院住院诊断的3例儿童非结核分枝杆菌腮腺淋巴结炎的临床资料,包括一般资料(年龄、性别、身高、体质量、卡介苗接种史、结核病接触史等)、临床表现、实验室检查、影像学检查、手术及病理结果、治疗方案及预后。以“non-tuberculous mycobacteria,children,lymphadenitis”为检索词,在PubMed数据库中进行检索,检索时间为2004—2023年,共检索到相关文献189篇,以“non-tuberculous mycobacteria,children,lymphadenitis,parotid gland”为检索词,在PubMed数据库中进行检索,仅检索到相关文献5篇;分别以“非结核分枝杆菌,儿童,淋巴结炎”和“非结核分枝杆菌,儿童,腮腺”为检索词,在万方数据库和中国知网数据库中进行检索,未检索到相关中文文献。阅读文献入选50例及本研究病例,共53例进行文献复习。结果:53例患者中,男性32例,女性21例,平均年龄为(2.71±1.52)岁。以反复颈面部肿物为主要表现,常为无痛性淋巴结肿大,病程1个月至1年,多数无发热,无明显咳嗽及其他呼吸道症状,彩色超声、CT及核磁检查提示腮腺脓肿,25例结核菌素皮肤试验阳性,10例脓液及病灶组织抗酸杆菌染色阳性,病理均提示慢性肉芽肿性炎,非结核分枝杆菌复合群核酸阳性,抗酸杆菌染色阴性,脓液及病灶组织GeneXpert MTB/RIF阴性,血γ-干扰素释放试验(IGRA)阴性。经手术联合阿奇霉素、利福平、乙胺丁醇等抗感染治疗后痊愈,未再复发。结论:当婴幼儿反复出现单侧无痛性腮腺或耳前淋巴结肿大,皮肤潮红至紫罗兰色,不伴发热、咳嗽、消瘦、盗汗等全身症状,常规抗生素治疗效果差,血IGRA阴性,无活动性肺结核病史,需警惕非结核分枝杆菌腮腺淋巴结炎,确诊后需及时手术切除联合抗感染治疗。

关键词: 分枝杆菌感染, 儿童, 淋巴结炎, 腮腺

Abstract:

Objective: To summarize and analyze the clinical features, imaging findings, pathological characteristics, treatment, and prognosis of nontuberculous mycobacterium (NTM) parotid lymphadenitis in children, with the aim of enhancing the understanding of this condition. Methods: A retrospective analysis was conducted on the clinical data of three children diagnosed with nontuberculous mycobacterium (NTM) parotid lymphadenitis at Guangzhou Chest Hospital between December 2020 and December 2023. The data included general information (age, gender, height, body mass, BCG vaccination history, tuberculosis contact history, etc.), clinical manifestations, laboratory tests, imaging findings, surgical and pathological results, treatment options, and prognosis. A search using the terms ‘non-tuberculous mycobacteria, children, lymphadenitis’ in the PubMed database from 2004 to 2023 retrieved 189 cases. When the search was refined to ‘non-tuberculous mycobacteria, children, lymphadenitis, parotid gland,’ only 5 relevant references were found in PubMed. Additionally, searches using the terms ‘non-tuberculous mycobacterium, children, lymphadenitis’ and ‘non-tuberculous mycobacterium, children, parotid gland’ in the Wanfang and CNKI databases yielded no relevant Chinese literature. A total of 53 and 50 cases, respectively, were reviewed. Results: Of the 53 patients, 32 were male and 21 were female, with an average age of (2.71±1.52)years. The primary clinical manifestation was recurrent neck and facial swelling, typically presenting as painless lymphadenopathy. The duration of illness ranged from 1 month to 1 year. Most patients did not exhibit fever or significant respiratory symptoms such as coughing. Imaging studies, including color Doppler ultrasound, CT, and MRI, revealed parotid gland abscesses. Twenty-five cases tested positive for the tuberculin skin test, and acid-fast staining was positive in pus and lesion tissues in 10 cases. Pathological examination showed chronic granulomatous inflammation. Nucleic acid testing for the nontuberculous mycobacterium complex was positive, while acid-fast staining was negative. Both pus and lesion tissues tested negative for GeneXpert MTB/RIF, and the blood gamma interferon release assay was also negative. After surgical intervention combined with azithromycin, rifampicin, ethambutol, and other anti-infective treatments, the patients recovered without recurrence. Conclusion: When infants present with recurrent unilateral painless enlargement of the parotid gland or preauricular lymph nodes, along with skin discoloration from flushing to violet, and without systemic symptoms such as fever, cough, weight loss, or night sweats, and when conventional antibiotic treatment is ineffective, blood IGRA is negative, and there is no history of active pulmonary tuberculosis, clinicians should be alert to the possibility of NTM parotid gland lymphadenitis. Timely surgical resection combined with appropriate anti-infective therapy is recommended.

Key words: Mycobacterium infections, Child, Lymphadenitis, Parotid gland

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