Chronic lymphadenitis is the most common manifestation of nontuberculous mycobacterium infection, with M. avium as the major pathogen. M.marinum is an infrequent pathogen, especially in the pediatric age group, usually affecting the skin and soft tissues. Lymphadenitis has rarely been reported in children in association with M. marinum infection.
We describe 4 children with Mycobaterium marinum infection manifesting as chronic lymphadenitis. Diagnosis was delayed because a history of aquatic exposure was initially missed. 3 out of 4 patients had visited the same natural spring near the Dead Sea (Ein Bokek)
We searched the database of the microbiology laboratory of Schneider`s children medical center for all culture-based diagnoses of NTM infection from 1996 to 2016. A total of 180 NTM isolates were identified and 8 of them were M. marinum isolates. Lymphadenitis was the major manifestation in 4 of the 8 M. marinum isolates.
The median interval from cutaneous exposure in the spring water of Ein Bokek to the appearance of the enlarged lymph node was 21 days. The long incubation period may have impaired the parents recall of their child’s often minor trauma and its association to water exposure.
In conclusion- pediatricians should be aware of M. marinum not only as a skin and soft tissue pathogen but also as a cause of chronic lymphadenitis. A meticulous search for aquatic exposure during anamnesis, specifically in the area of "Ein Bokek" may change the management and spare patient`s unnecessary surgery, as M. marinum infection is generally managed conservatively.
