Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

Environmental atypical mycobacteria, such as M. avium intracellulare (MAI) may rarely cause lymphadenitis, easily treated by surgery, in basically healthy children. Invasive infections occur only in immune compromised children.
We present a case of invasive MAI infection in a school girl with no apparent immune suppression. As newborn, the child was vaccinated by BCG vaccine, and local lymphadenitis developed requiring surgery and drug therapy.
When the child was 7 years old, she lost weight, suffered from limb pains and finally caught fever.
Chest radiograph was first normal, and gradually, infiltrations developed in left lower and right upper lobes. In computerized tomography, there were infiltrations in lungs and mediastinum. When bone pains were prominent, multiple infiltrations were seen in femoral and iliacal bones and in the spine by magnetic resonance imagination. There were multiple infiltrations in the spleen by ultrasound. The diagnosis in the bone and mediastinal biopsies was granulomatous inflammation, and acid fast bacilli were seen in the staining. Finally, the cultures of tissue samples from bone, pleura and mediastinum, as well as blood cultures, grew MAI strain.
The patient was treated with five drugs, and later, based on susceptibility testing, with chlarithromycin, rifabutol and ethambutol, with intravenous nutrition, and with gamma-interferon. After two months treatment, the patient was well, and inflammatory markers were normal. The radiological changes in the bones and lungs, and ultrasound findings in the spleen, were less prominent but still to be seen.
Based on literature, the patient will need drug therapy for years. The key question is the function of the gamma-interferon axis, which will be studied.

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Citations should be made in the following way:
R. Suokas, J. L. Casanova, M. Korppi (Kuopio, Finland; Paris, France). Invasive Mycobacterium avium intracellulare infection. Eur Respir J 2006; 28: Suppl. 50, 1796

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