# Nontuberculous Mycobacteria Infections in Children: A Clinical Overview of Diagnosis and Management

## TL;DR

This paper reviews the diagnosis and treatment of nontuberculous mycobacteria infections in children, highlighting challenges in distinguishing them from tuberculosis and the need for better tools and guidelines.

## Contribution

The paper provides a comprehensive clinical overview and identifies key challenges and research priorities for managing NTM infections in children.

## Key findings

- Cervicofacial lymphadenitis is the most common NTM infection in immunocompetent children.
- Diagnosis of NTM infections is complicated by overlapping symptoms with tuberculosis.
- Treatment is hindered by prolonged drug courses, drug intolerance, and lack of child-friendly formulations.

## Abstract

Nontuberculous Mycobacteria (NTM), often referred to as environmental or atypical mycobacteria, are opportunistic pathogens phylogenetically as well as clinically distinct from both the Mycobacterium tuberculosis complex and Mycobacterium leprae. In the pediatric age group, NTM disease manifests with a diverse range of clinical phenotypes. Cervicofacial lymphadenitis stands out as the most common presentation among children who are immunocompetent. Conversely, skin and soft tissue infections, pulmonary disease and disseminated infections constitute less prevalent, yet clinically important, disease forms. Accurate identification is paramount, as differentiating NTM infections from tuberculosis (TB) remains challenging based solely on clinical symptoms, initial laboratory analyses, or standard radiological findings. This distinction is critical because treatment protocols for NTM infections differ substantially from those for tuberculosis. This narrative review offers a comprehensive and up-to-date summary of NTM infections in children. It examines the spectrum of clinical presentations and their prevalence, addresses the complexities of diagnosis and therapy, and underscores the importance of differential diagnosis against tuberculosis. Furthermore, we explore current diagnostic strategies, available therapeutic options, and the link between specific clinical syndromes and tailored management, pointing out existing knowledge gaps and suggesting priorities for future research. The absence of rapid, species-specific diagnostic tools often results in delayed initiation of targeted treatment, while overlapping clinical features with TB can lead to misdiagnosis. Therapeutic management is complicated by the necessity for prolonged drug courses, frequent occurrences of drug intolerance, limited availability of child-appropriate formulations, and the rising tide of antimicrobial resistance. Successfully tackling these issues demands enhanced surveillance, precise species-level identification, the creation of child-friendly drug formats, and the development of evidence-based treatment guidelines specifically designed for the pediatric population.