Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infection.
BACKGROUND: Mycobacterium abscessus is an uncommon cause of invasive odontogenic infection.
METHODS: M abscessus-associated odontogenic infections occurred in a group of children after they each underwent a pulpotomy. A probable case-child was defined as a child with facial or neck swelling and biopsy-confirmed granulomatous inflammation after a pulpotomy between October 1, 2013, and September 30, 2015. M abscessus was isolated by culture in confirmed case-children. Clinical presentation, management, and outcomes were determined by medical record abstraction.
RESULTS: Among 24 children, 14 (58%) were confirmed case-children. Their median age was 7.3 years (interquartile range, 5.8-8.2 years), and the median time from pulpotomy to symptom onset was 74 days (range, 14-262 days). Clinical diagnoses included cervical lymphadenitis (24 [100%] of 24), mandibular or maxillary osteomyelitis (11 [48%] of 23), and pulmonary nodules (7 [37%] of 19). Each child had ≥1 hospitalization and a median of 2 surgeries (range, 1-6). Of the 24 children, 12 (50%) had surgery alone and 11 (46%) received intravenous (IV) antibiotics. Nineteen of the 24 (79%) children experienced complications, including vascular access malfunction (7 [64%] of 11), high-frequency hearing loss (5 [56%] of 9), permanent tooth loss (11 [48%] of 23), facial nerve palsy (7 [29%] of 24), urticarial rash (3 [25%] of 12), elevated liver enzyme levels (1 [20%] of 5), acute kidney injury (2 [18%] of 11), incision dehiscence/fibrosis (3 [13%] of 24), and neutropenia (1 [9%] of 11).
CONCLUSIONS: M abscessus infection was associated with significant medical morbidity and treatment complications. Unique manifestations included extranodal mandibular or maxillary osteomyelitis and pulmonary nodules. Challenges in the identification of case-children resulted from an extended incubation period and various clinical manifestations. Clinicians should consider the association between M abscessus infection and pulpotomy in children who present with subacute cervical lymphadenitis. The use of treated/sterile water during pulpotomy might prevent further outbreaks.
Published In/Presented At
Hatzenbuehler, L. A., Tobin-D'Angelo, M., Drenzek, C., Peralta, G., Cranmer, L. C., Anderson, E. J., Milla, S. S., Abramowicz, S., Yi, J., Hilinski, J., Rajan, R., Whitley, M. K., Gower, V., Berkowitz, F., Shapiro, C. A., Williams, J. K., Harmon, P., & Shane, A. L. (2017). Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infection. Journal of the Pediatric Infectious Diseases Society, 6(3), e116–e122. https://doi.org/10.1093/jpids/pix065
Medicine and Health Sciences
Department of Medicine