Diagnostics, Management and Outcomes of Pediatric Nontuberculous Mycobacterial Infections: A 12-year Retrospective Study

Background: Pediatric nontuberculous mycobacterial (NTM) infections present diagnostic and therapeutic challenges. Clinical features may mimic malignancy, and although prognosis is favorable, treatment is often prolonged and may result in cosmetic sequelae. Methods: We described the clinical characteristics, management and treatment outcomes of children diagnosed with NTM infections in the Central Denmark Region between 2011 and 2023. Children were identified using mycobacteriologic data and ICD-10 diagnostic codes. Detailed clinical information was extracted from hospital records, and descriptive analyses were performed. Results: Eighty children were included, corresponding to annual incidence rates of 0.7–3.3 per 100,000. The median age at presentation was 2 years, and 55% were female. Lymphadenitis was the most common presentation (92.5%), and fever was reported in 28% of cases. Mycobacterium avium was the predominant species (78.8%). Management strategies varied considerably: 47% of the children received no treatment, and both surgical and antibiotic interventions declined over time. Despite favorable clinical outcomes, cosmetic sequelae were common, including scarring (76%), residual discoloration (30%), fistulation or suppuration (12%). The median hospital admission was 2 days, and the median in-hospital follow-up was 236.5 days. Conclusions: The incidence of pediatric NTM infections remained stable, but the clinical burden was considerable due to prolonged disease course and frequent cosmetic sequelae. Management practices varied widely, with decreasing use of active interventions over time. The apparent lack of consensus on treatment further emphasizes the importance of interdisciplinary collaboration and the development of evidence-based guidelines to standardize care and improve outcomes.