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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Nontuberculous mycobacterial disease in children
T2 - epidemiology, diagnosis and management at a tertiary center
AU - Tebruegge, Marc
AU - Pantazidoe, Anastasia
AU - MacGregor, Duncan
AU - Gonis, Gena
AU - Leslie, David
AU - Sedda, Luigi
AU - Ritz, Nicole
AU - Connell, Tom
AU - Curtis, Nigel
N1 - © 2016 Tebruegge et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/1/26
Y1 - 2016/1/26
N2 - BackgroundThere are limited data on the epidemiology, diagnosis and optimal management of nontuberculousmycobacterial (NTM) disease in children.MethodsRetrospective cohort study of NTM cases over a 10-year-period at a tertiary referral hospitalin Australia.ResultsA total of 140 children with NTM disease, including 107 with lymphadenitis and 25 with skinand soft tissue infections (SSTIs), were identified. The estimated incidence of NTM diseasewas 0.6–1.6 cases / 100,000 children / year; no increasing trend was observed over thestudy period. Temporal analyses revealed a seasonal incidence cycle around 12 months,with peaks in late winter/spring and troughs in autumn. Mycobacterium-avium-complexaccounted for most cases (77.8%), followed by Mycobacterium ulcerans (14.4%) andMycobacterium marinum (3.3%). Polymerase chain reaction testing had higher sensitivitythan culture and microscopy for acid-fast bacilli (92.0%, 67.2% and 35.7%, respectively).The majority of lymphadenitis cases underwent surgical excision (97.2%); multiple recurrencesin this group were less common in cases treated with clarithromycin and rifampicincompared with clarithromycin alone or no anti-mycobacterial drugs (0% versus 7.1%; OR:0.73). SSTI recurrences were also less common in cases treated with two anti-mycobacterialdrugs compared with one or none (10.5% versus 33.3%; OR:0.23).ConclusionsThere was seasonal variation in the incidence of NTM disease, analogous to recently publishedobservations in tuberculosis, which have been linked to seasonal variation in vitaminD. Our finding that anti-mycobacterial combination therapy was associated with a reducedrisk of recurrences in patients with NTM lymphadenitis or SSTI requires further confirmationin prospective trials.
AB - BackgroundThere are limited data on the epidemiology, diagnosis and optimal management of nontuberculousmycobacterial (NTM) disease in children.MethodsRetrospective cohort study of NTM cases over a 10-year-period at a tertiary referral hospitalin Australia.ResultsA total of 140 children with NTM disease, including 107 with lymphadenitis and 25 with skinand soft tissue infections (SSTIs), were identified. The estimated incidence of NTM diseasewas 0.6–1.6 cases / 100,000 children / year; no increasing trend was observed over thestudy period. Temporal analyses revealed a seasonal incidence cycle around 12 months,with peaks in late winter/spring and troughs in autumn. Mycobacterium-avium-complexaccounted for most cases (77.8%), followed by Mycobacterium ulcerans (14.4%) andMycobacterium marinum (3.3%). Polymerase chain reaction testing had higher sensitivitythan culture and microscopy for acid-fast bacilli (92.0%, 67.2% and 35.7%, respectively).The majority of lymphadenitis cases underwent surgical excision (97.2%); multiple recurrencesin this group were less common in cases treated with clarithromycin and rifampicincompared with clarithromycin alone or no anti-mycobacterial drugs (0% versus 7.1%; OR:0.73). SSTI recurrences were also less common in cases treated with two anti-mycobacterialdrugs compared with one or none (10.5% versus 33.3%; OR:0.23).ConclusionsThere was seasonal variation in the incidence of NTM disease, analogous to recently publishedobservations in tuberculosis, which have been linked to seasonal variation in vitaminD. Our finding that anti-mycobacterial combination therapy was associated with a reducedrisk of recurrences in patients with NTM lymphadenitis or SSTI requires further confirmationin prospective trials.
U2 - 10.1371/journal.pone.0147513
DO - 10.1371/journal.pone.0147513
M3 - Journal article
VL - 11
SP - 1
EP - 14
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 1
M1 - e0147513
ER -