背景:非结核性分枝杆菌颈面部淋巴结炎(NTMCL)是一种罕见的疾病,通常表现为颈部无触痛性肿块的免疫功能正常的儿童。已经提出了各种测试来协助怀疑NTMCL的工作,具有不同的诊断实用程序。本系统综述研究了儿科NTMCL检查中使用的各种诊断方法的敏感性。
方法:使用Pubmed,EMBASE,和WebofScience数据库。对22年10月5日之前发表的英语研究进行了过滤。符合标准的研究包括以15名确诊或疑似NTMCL的儿科患者为特征的研究。包括在NTMCL后处理中使用的任何报道的诊断方法的研究。
结果:在836篇摘要/文章中,21项研究符合纳入标准。诊断方法包括培养(n=11项研究),PPD-Tb(结核菌素)(n=12),PPD-Scrofulaceum,-Avium,或-Kansasii(n=6),染色技术(n=4),IGRA(n=3),和超声(n=2)。所有研究的偏倚风险总体较低。在根据PCR和/或培养证实患有NTMCL的患者中,最敏感的检测是PPD-A(0.94,95%CI0.91~0.97;n=210例患者)和PPD-S(0.75,95%CI0.68~0.81;n=171).金胺和Ziehl-Neelsen染色技术具有中等高的灵敏度(分别为0.85和0.60),尽管受低患者人数限制(n=20)。PPD-Tb(0.45,95%CI0.39至0.50;n=300)和IGRA(0.02;95%CI0至0.06;n=48)显示敏感性差。根据全球评估,在怀疑患有NTM淋巴结炎的患者中,最敏感的测试包括PPD-S+A+K的组合(0.92,95%CI0.86至0.98;n=85),PCR(0.82,95%CI0.75至0.88;n=136),和PPD-A(0.72,95%CI0.62至0.81;n=84)。培养显示0.54的敏感性(95%CI0.50至0.58;n=494)。PPD-K,PPD-S,IGRA,和染色技术显示较低的灵敏度。
结论:这项系统评价是调查儿科NTMCL检查中使用的各种诊断方法的敏感性的最大研究。临床怀疑NTMCL和PPD-Tb阳性的患者应首先使用IGRA排除结核性淋巴结炎。PPD-Tb阳性和IGRA阴性且临床高度怀疑NTMCL的患者可以接受推定的手术干预。PPD-Tb阴性的患者可以接受NTM抗原皮肤测试,或者如果存在高度的临床怀疑,手术干预,以减少组织负担,并获得额外的组织数据。
BACKGROUND: Nontuberculous mycobacterial cervicofacial lymphadenitis (NTMCL) is an uncommon condition detected in young immunocompetent children who typically present with a nontender neck mass. Various tests have been proposed to assist in the work-up of suspected NTMCL, with varying diagnostic utility. This systematic review investigates the sensitivity of the various diagnostic methods used in the work-up of pediatric NTMCL.
METHODS: A systematic review in accordance with PRISMA guidelines was performed using the Pubmed, EMBASE, and Web of Science databases. Searches were filtered for English language studies published prior to 05/10/22. Studies meeting criteria included studies featuring 15+ pediatric patients with confirmed or suspected NTMCL. Studies with any reported diagnostic methodology used in the workup of NTMCL were included.
RESULTS: Of 836 abstracts/articles reviewed, 21 studies met inclusion criteria. Diagnostic methods included culture(n = 11 studies), PPD-Tb(Tuberculin)(n = 12), PPD-Scrofulaceum, -Avium, or -Kansasii(n = 6), staining techniques(n = 4), IGRA(n = 3), and ultrasound(n = 2). All studies had an overall low risk of bias. Among patients confirmed to have NTMCL based on PCR and/or culture, the most sensitive tests were PPD-A(0.94, 95 % CI 0.91 to 0.97; n = 210 patients) and PPD-S(0.75, 95 % CI 0.68 to 0.81; n = 171). Auramine and Ziehl-Neelsen staining techniques had moderately high sensitivity(0.85 and 0.60 respectively), though were limited by low patient numbers(n = 20). PPD-Tb(0.45, 95 % CI 0.39 to 0.50; n = 300) and IGRA(0.02; 95 % CI 0 to 0.06; n = 48) demonstrated poor sensitivity. Among patients suspected to have NTM lymphadenitis based on global assessment, the most sensitive tests included combined PPD-S + A + K(0.92, 95 % CI 0.86 to 0.98; n = 85), PCR(0.82, 95 % CI 0.75 to 0.88; n = 136), and PPD-A(0.72, 95 % CI 0.62 to 0.81; n = 84). Culture showed a sensitivity of 0.54(95 % CI 0.50 to 0.58; n = 494). PPD-K, PPD-S, IGRA, and staining techniques demonstrated lower sensitivity.
CONCLUSIONS: This systematic review is the largest study investigating the sensitivity of the various diagnostic methods used in the work-up of pediatric NTMCL. Patients with clinical suspicion for NTMCL and a positive PPD-Tb should first have tuberculous lymphadenitis ruled out with IGRA. Patients with a positive PPD-Tb and negative IGRA and high clinical suspicion for NTMCL can undergo presumptive surgical intervention. Patients with a negative PPD-Tb can undergo NTM antigen skin testing if available, or if high clinical suspicion exists, surgical intervention to reduce tissue burden and elicit additional tissue data.