FLEX February 2024

C.F. Roy et al.

International Journal of Pediatric Otorhinolaryngology 166 (2023) 111469

Fig. 1. Diagnosis and initial management of suspected NTM lymphadenitis Legend: CBC, complete blood count; CMV, cytomegalovirus; CRP, C-reactive protein; CT, Computed tomography; CXR, chest X-ray; ESR, Erythrocyte Sedimentation Rate; IGRA, Interferon-gamma release assay; LDH, Lactate Dehydrogenase; MRI, Magnetic resonance imaging; PCR, Polymerase chain reaction; TST, Tuberculin skin test; US, Ultrasound.

expected to be normal in cases of NTM cervical lymphadenitis (unless a superimposed acute bacterial lymphadenitis is present) [5]. Inflamma tory parameters such as the C-reactive protein and erythrocyte sedi mentation rate are usually within normal limits or mildly elevated [5]. Uric acid and lactate dehydrogenase levels are not routinely requested unless there is a clinical suspicion of malignancy. 6.1.3. Microbiology and virology If the affected node has suppurated to the skin, the purulent

discharge should be sent for mycobacterial culture and/or polymerase chain reaction (PCR), to aid in establishing the diagnosis. In cases of a deep node with no cutaneous tract, obtaining a fine needle aspirate (FNA) for microbiology and/or cytological analysis remains an area of debate, and this is discussed further in section 1.5. Isolation of myco bacterial species in cultures may take up to six weeks, with reported sensitivity rates of 50 – 80% [6 – 8]. Tissue culture has the highest diag nostic yield as more material is available and may provide diagnostic confirmation in operative cases (see Section 3). Antimicrobial

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