[Cervicofacial nontuberculous mycobacteria in children: Clinical, microbiological and therapeutic features. A retrospective study and literature review]. / Adénites cervico-faciales à mycobactéries atypiques de l'enfant : caractéristiques cliniques, microbiologiques et thérapeutiques. Étude rétrospective et revue de la littérature.

BACKGROUND: Nontuberculous mycobacteria (NTM) is a common cause of lymphadenitis. A rise in incidence has been reported. Our main aim was to describe the clinical features, microbiological aspects and treatment of the disease. METHODS: We conducted a retrospective, monocentric study between January 2008 and December 2017 (University Hospital of Nantes). INCLUSION CRITERIA: age<18 years, 1 positive lymph node specimen with identification of the species in culture, head-and-neck localization. RESULTS: Forty-nine patients were enrolled from 2008 to 2017. Median age was 28 months (range: 6-141 months). Median time to confirmation of diagnosis was 2.1 months (range: 0.7-6 months). The sites encountered were mandibular (45%), cervical (33%), and parotid (16%). The main clinical signs were a tender nodule (70%), purplish nodule (59%) or painless nodule (83%), without fever (88%). The species identified were: Mycobacterium avium (n=26), M. lentiflavum (n=13), M. intracellulare (n=7), M. malmoense (n=2) and M. scrofulaceum (n=1). Antibiotic treatment was frequent (77% of cases). DISCUSSION: This study is the second largest French cohort of NTM lymphadenitis in children with microbiological confirmation. The most frequent presentation was a tender, purplish, and painless mandibular nodule. The predominant species was M. avium. M. lentiflavum, which emerged during our study, does not figure in any European studies before 2014 but appears in the most recent studies. The effects of discontinuation of mandatory BCG immunization in France in NMT is not statistically demonstrable here due to lack of relevant data prior to 2007. CONCLUSION: A possible diagnosis of NTM lymphadenitis should not be overlooked in children presenting painless, purplish, cervicofacial tumefaction.

[Hot tub lung: A retrospective analysis of 14 cases]. / Poumon de jacuzzi : analyse rétrospective de 14 cas.

INTRODUCTION: Hot tub lung (HTL) is a hypersensitivity pneumonitis (HP) related to inhalation of non-tuberculous mycobacteria (NTM) when exposed to ejected jet droplets from a jacuzzi. The aetiological debate is not completely settled in the literature. METHOD: An observational study of 14 cases of HTL, diagnosed at the University Hospital of Besançon, France, between 2004 and 2018 according to the diagnostic criteria used in the clinic. RESULTS: This cohort corresponds to type I HP (inflammatory), with one case of type II HP. Decrease of lung transfer for carbon monoxide was present in 86% of examinations (n=12/14). In total, 84% of bronchoalveolar lavages showed a lymphocytic cellular pattern≥30% (n=11/13). The environmental survey enabled the identification of NTM in 93% of cases (n=13/14), mainly Mycobacterium avium. Serum precipitins directed against NTM were found in 10% of the cases (n=2/20). Three cases received corticosteroid therapy and none received antibiotics. Antigenic eviction has improved the symptomatology in all cases. CONCLUSIONS: Our cohort supports the hypothesis that HTL is predominantly a type I HP. Avoidance of the agent involved (NTM) is necessary. The diagnosis is difficult because serum precipitins against NTM are not easily demonstrable. An environmental survey could facilitate the identification of the NTM. Prevention of HTL depends on education of the clinician and the patient.

[Mycobacterial pulmonary infection due to Mycobacterium simiae]. / Mycobactériose pulmonaire à Mycobacterium simiae.

INTRODUCTION: Mycobacterium simiae pulmonary infections remain exceptional in France. CASE REPORT: We report a case of M. simiae lung infection and a 10-year follow-up in a non-immunocompromised host. CONCLUSION: This case emphasizes the difficulties of choosing the appropriate drugs and their side effects in the absence of any existing gold standard.

[Pulmonary Mycobacterium abscessus sensu lato infection in patients without cystic fibrosis]. / Infection pulmonaire à Mycobacterium abscessus sensu lato chez des patients exempts de mucoviscidose.

INTRODUCTION: Infection with Mycobacterium abscessus sensu lato is uncommon in patients without cystic fibrosis. We are interested in these patients and have collected cases in Finistère between 2007 and 2011. CASE REPORTS: Four patients met the infection criteria recommended by the American Thoracic Society in 2007. Among them, all had Aspergillus spp. in sputum, 3 had gastroesophageal reflux and two had the criteria for allergic bronchopulmonary aspergillosis. We identified Mycobacterium massiliense in the single patient in our series whose therapeutic outcome was successful. CONCLUSION: By comparing these data with those in the literature, we believe that the search for allergic bronchopulmonary aspergillosis and gastroesophageal reflux is necessary in these patients and that species identification is essential for prognosis.

Detecção rápida e diferenciação de espécies de micobactérias através de um sistema de pcr multiplex

O gênero Mycobacterium é constituído por espécies do complexo Mycobacterium tuberculosis e outras denominadas micobactérias não tuberculosas (MNT). Nas infecções causadas por micobactérias, o diagnóstico precoce é essencial para a implementação do tratamento e cura do paciente. Métodos moleculares têm proporcionado à melhoria considerável da velocidade e precisão de identificação das micobactérias. Este estudo teve como objetivo avaliar um sistema PCR Multiplex em diferentes amostras clínicas de pacientes com tuberculose e micobacterioses, além de cepas de micobactérias isoladas em meio de cultura para ser proposta como ferramenta auxiliar no diagnóstico diferencial da tuberculose e doenças causadas por MNT. Foram analisados 40 pacientes com diagnóstico de tuberculose realizado pelo médico assistente do serviço de saúde, 63,15% do sexo masculino e 36,85% do feminino. Foram processadas 58 espécimes biológicos de origem pulmonar e extrapulmonar e as amostras clínicas pulmonares bacíliferas extraídas com Kit QIAamp DNA Mini and Blood Mini Handbook foram as que amplificaram pelo menos um alvo específico quando utilizamos a PCR multiplex. Em relação às características fenotípicas e bioquímicas das 40 cepas de micobactérias, 55% foram caracterizadas como M. tuberculosis, 22,5% como micobactérias não tuberculosas. Quando comparamos os resultados dos testes fenotípicos e bioquímicos com a PCR multiplex, observamos 93,3% de concordância nos resultados. Na comparação dos resultados da PCR multiplex com a técnica de PRA- hsp65 e com o diagnóstico final dos pacientes, verificamos que houve concordância em 100% e 74,28% dos resultados, respectivamente. Concluímos que a PCR multiplex poderá ser utilizada como ferramenta auxiliar no diagnóstico diferencial da tuberculose e das infecções causadas pelas MNT. Entretanto é de fundamental importância que o diagnóstico diferencial seja baseado na análise conjunta de vários parâmetros que identifiquem as espécies de MNT.