Skin Indurations in Response to Tuberculin Testing in Patients

Mantoux results were examined for 29 children with culture-proven nontuberculous mycobacterial lymphadenitis, and 4 species were isolated: Mycobacterium avium-intracellulare complex (from 14 patients [48%]), Mycobacterium haemo-philum (from 12 [41%]), Mycobacterium simiae (from 2 [7%]), and Mycobacterium scrofulaceum (from 1 [3%]); the median indurations for each species were 15.5 mm, 14.5 mm, 20 mm, and 23 mm, respectively, and in 17 cases (59%), they were 15 mm. In regions with a low incidence of tubercu-losis, lymphadenitis thought to be due to nontuberculous mycobacteria should be managed as such, regardless of Man-toux results, thereby avoiding antituberculosis treatment. Nontuberculous mycobacteria are ubiquitous organisms that can cause various clinical syndromes. The most common mani-festation in children is cervical lymphadenitis; bone, joint, skin, soft-tissue, pulmonary, catheter-related, and disseminated in-fections are much less common [1]. A definitive diagnosis re-quires isolation of nontuberculous mycobacteria from a sterile site. However, presumptive diagnoses are often made on the combined basis of clinical findings (e.g., cervical lymphade-nitis), epidemiological features (e.g., population with low prev-alence of tuberculosis), and positive results of tuberculin skin testing. Nontuberculous mycobacterial infections are usually asso-ciated with an induration of 3–15 mm on the standard intra-dermal tuberculin test (5 TU) [1], because purified protei