Pediatric Dental Clinic–Associated Outbreak of Mycobacterium abscessus Infection

Summary We describe the clinical presentation, management, and medical and surgical outcomes and associated morbidities of 24 school-aged children with invasive odontogenic Mycobacterium abscessus infections that occurred after municipal water exposure during a restorative dental pulpotomy procedure...

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Bibliographic Details
Published in:Journal of the Pediatric Infectious Diseases Society 2017-09, Vol.6 (3), p.e116-e122
Main Authors: Hatzenbuehler, Lindsay A, Tobin-D’Angelo, Melissa, Drenzek, Cherie, Peralta, Gianna, Cranmer, Lisa C, Anderson, Evan J, Milla, Sarah S, Abramowicz, Shelly, Yi, Jumi, Hilinski, Joseph, Rajan, Roy, Whitley, Matthew K, Gower, Verlia, Berkowitz, Frank, Shapiro, Craig A, Williams, Joseph K, Harmon, Paula, Shane, Andi L
Format: Article
Language:English
Subjects:
Acute Kidney Injury
Administration, Intravenous
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Dental Clinics
Disease Outbreaks
Facial Nerve Diseases
Female
Fibrosis
Georgia - epidemiology
Hearing Loss
Humans
Liver - pathology
Male
Morbidity
Multiple Pulmonary Nodules
Mycobacterium abscessus - drug effects
Mycobacterium abscessus - isolation & purification
Mycobacterium abscessus - pathogenicity
Mycobacterium Infections, Nontuberculous - diagnosis
Mycobacterium Infections, Nontuberculous - epidemiology
Mycobacterium Infections, Nontuberculous - pathology
Mycobacterium Infections, Nontuberculous - surgery
Neck - diagnostic imaging
Neutropenia
Osteomyelitis - epidemiology
Pediatric Dentistry
Pulpotomy
Tomography, X-Ray Computed - methods
Tooth Loss
Tuberculosis, Lymph Node
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Summary:Summary We describe the clinical presentation, management, and medical and surgical outcomes and associated morbidities of 24 school-aged children with invasive odontogenic Mycobacterium abscessus infections that occurred after municipal water exposure during a restorative dental pulpotomy procedure at a pediatric dental practice. Abstract 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.
ISSN:2048-7193
2048-7207
DOI:10.1093/jpids/pix065