Diagnosing nontuberculous mycobacterial cervicofacial lymphadenitis in children: An updated systematic review

Mohammadi, Mohammad; Norouzkhani, Narges; Rouhparvarzamin, Motahare; Afshari, Shaghayegh; Rahmanifar, Atena; Akhtari Kohnehshahri, Ata; Ghadam, Ali; Mehrani, Aida; Mohit, Sepide; Dadras, Hadiyeh; Mohammadi, Nasrin; Sheikhzadeh, Farzad; Ghajary, Alireza; Mousazadeh, Kourosh; Khakpour, Yaser; Malek, Mahta; Behshood, Parisa; Poudineh, Mohadeseh; Deravi, Niloofar

doi:10.21608/mid.2025.324731.2256

Diagnosing nontuberculous mycobacterial cervicofacial lymphadenitis in children: An updated systematic review

Document Type : Systematic review or meta-analysis

Authors

¹ School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

² Department of Medical Informatics, faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Student research committee, school of nursing and midwifery, Shahid sadoughi University of medical sciences, Yazd, Iran.

⁴ Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

⁵ Student Research committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

⁶ Student Research Committee, Faculty of medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran

⁷ Medical student, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Iran

⁸ Faculty of medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

⁹ Student Research Committee, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.

¹⁰ Department of Medical Informatics, faculty of medicine, Babol University of Medical Sciences, Babol, Iran.

¹¹ Faculty of medicine, Iran University of Medical Sciences, Tehran, Iran.

¹² School of medicine, Iran University of Medical Sciences, Tehran, Iran

¹³ School of pharmacy, Mashhad University of medical science, Mashhad, Iran

¹⁴ Medical doctor, school of medicine, Islamic Azad university, Tehran medical branch, Tehran, Iran

¹⁵ Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran

¹⁶ Faculty of Dentistry, Tehran Medical Science, Islamic Azad University, Tehran, Iran

¹⁷ Department of Microbiology, Young Researchers and Elite Club, Islamic Azad University, Shahrekord, Iran

¹⁸ School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

¹⁹ School of medicine, Shahid beheshti universityof medical sciences

10.21608/mid.2025.324731.2256

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. Methods: 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. Inclusion 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 can not 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.

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