God made dirt…and dirt don’t hurt!

This popular saying has justified how we have encouraged our children to not be afraid to get dirty.  Whether on the little league field sliding for home or scooping out worms to go fishing with grandpa, getting dirty has always been synonymous with growing up. 

While exposures to dirt seem harmless enough, as the evidence frequently washes off with a little soap and water, there can be things lurking in the dirt that can cause problems for your kids.  Atypical, or nontuberculous, mycobacteria are organisms that live in our water and soil.  Younger children are affected most commonly by these organisms, particularly during the teething years.  This is felt to be secondary to the amount of time these children spend with their hands in their mouths.  Unfortunately, the kids aren’t washing their hands before they put their dirty hands in resulting in potential exposures.

The organisms of concern are from the same family of organisms that cause tuberculosis.  Don’t worry!  They do not cause the same type of infection as tuberculosis.   M. avium has replaced M. scrofulaceum as the leading cause of infections in children.  These infections typically cause a swelling of the lymph nodes (glands) in the neck.  The typical course of the infection after exposure is a gradual swelling of the lymph nodes of the neck.  Other systemic features are rare.  In a study from Australia, the incidence of infection was less than 1 in 100,000 children.  The route of transmission is thought to be from a cut or break in the skin or mucosa.

These infections typically progress because they do not cause a lot of systemic symptoms.  There is usually no fever and, until the neck lymph nodes get really large, they are typically not observed.  Some infections present with a discoloration of the skin, and some even present with a wound in the skin with a cottage cheese consistency drainage.

Treatment usually involves multiple components.  If the infection is caught early, antibiotics (clarithromycin/Biaxin) may be enough to treat the infection.  Frequently, though, surgical intervention is needed.  Studies suggest curettage and surgical excision are the 2 primary modes of treatment.  The recurrence rate is high with reports as high as 23%.  In the literature, surgical excision is preferred if possible to remove the node and not injure important surrounding structures.

Keep this in mind if you see swelling of the lymph nodes which doesn’t go away after a cold.  Ask your doctor about the possibility of this, and, if a neck lymph node persists, consider an evaluation by your local pediatric ear, nose, and throat doctor.  We work together with our infectious disease doctors to give you a team approach to the care of your child.

While it is impossible to keep your child’s hands out of their mouth, particularly during teething time, fortunately these infections are rare.  Try to keep their hands clean, but kids will be kids.