Diagnosing Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children: An Updated Systematic Review Publisher



M Mohammadi MOHAMMAD ; N Norouzkhani NARGES ; M Rouhparvarzamin MOTAHAREH ; S Afshari SHAGHAYEGH ; A Rahmanifar ATENA ; Aa Kohnehshahri Ata AKHTARI ; A Ghadam ALI ; A Mehrani AIDA ; S Mohit SEPIDE ; H Dadras HADIYEH
Source: Microbes and Infectious Diseases Published:2025

Abstract

Background: Nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis is an emerging infectious disease that affects children. Regarding the correct diagnosis of NTM cervicofacial lymphadenitis, there is widespread controversy. This updated systematic review aimed to reevaluate the efficacy and safety of diagnostic methods for NTM cervicofacial lymphadenitis. Method: We systematically searched the databases PubMed, Web of Science, Embase, and Google Scholar (from March 3, 2017, through January 11, 2023) to detect relevant studies, using Mesh keywords. The inclusive criteria were i) NTM cervicofacial lymphadenitis studies, ii) Reports on patients under 18 years old, iii) Reports on diagnostic methods. Immuno-incompetent patients, studies that reported adults, and non-clinical studies (laboratory studies, technical notes, letters to editors, reviews) or case reports/series were excluded. Results: 512 patients between the ages of 0 and 18 are included in eight research studies. Diagnostic accuracy of acid-fast bacilli (AFB) staining, histology, culture, polymerase chain reaction (PCR), tuberculin skin test (TST), immunodiagnostic assays, enzyme-linked immunosorbent spot assays, and radiomic features were studied. Culture sensitivity was 67.2%, while PCR sensitivity was 92%, AFB staining specificity was between 80 and 100%, and sensitivity was between 46 and 85%. Using radiomic markers to differentiate benign from malignant lymphadenopathy has a specificity of 93% and sensitivity of 91%. Conclusion: This review indicates that isolation of the specimen by PCR or culture is still required for the precise identification of mycobacterial infections. While TST cannot distinguish between tuberculosis (TB) and NTM, interferon-gamma release assays (IGRAs) and radiomic analyses show promising sensitivity and specificity and reduce the need for invasive procedures. While TST is not able to distinguish between TB and NTM, IGRA appears to perform more efficiently. IGRA with PPD stimulation appears to be an effective approach for the diagnosis of NTM cervicofacial lymphadenitis. © 2025 Elsevier B.V., All rights reserved.