Mycobacterium mageritense submandibular lymphadenitis in children: diagnostic challenges and the role of metagenomic next-generation sequencing: two case reports and literature review.
4 affiliations
- 1Department of Infectious Diseases, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China.
- 2Department of Hematology and Oncology, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China.
- 3Department of Thoracic Oncology, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China.
- 4Department of Ultrasound, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Abstract
Mycobacterium mageritense is an extremely rare, rapidly growing nontuberculous mycobacterium (NTM). Pediatric cases are rarely reported worldwide, and the non-specific clinical manifestations, low sensitivity of conventional microbiological tests, and limited specimen volume from children often lead to diagnostic delays. We describe the clinical data of two immunocompetent children with submandibular lymphadenitis caused by Mycobacterium mageritense, both diagnosed by metagenomic next-generation sequencing (mNGS). We also systematically reviewed the relevant literature and performed a pooled analysis of 36 eligible cases (the two new paediatric cases from the present study included). Case 1 involved a 6-year-old girl with dental caries and acute fever who was initially misdiagnosed with common bacterial infection and received ineffective empirical antibiotics for over two weeks; mNGS of aspirated pus confirmed the diagnosis. Case 2 involved a 9-year-old girl with dental caries who presented only with submandibular lymphadenopathy and normal laboratory findings, with a diagnostic delay of up to two months; mNGS of lymph node tissue identified the pathogen. Literature-pooled analysis of 36 patients revealed a mean diagnostic delay of 4.69 months (median 2.00 months, IQR: 0.81-5.75 months). Conventional culture had low sensitivity, often requiring prolonged incubation (≥96 h) or special media to obtain positive results. Initial misdiagnosis occurred in 17.6% of cases. Patients diagnosed by NGS achieved more rapid and accurate pathogen identification. This report suggests that mNGS, as a culture-independent, unbiased pan-pathogen detection technique, shows clear advantages in identifying rare and fastidious pathogens such as M. mageritense. For pediatric patients with dental caries, fever, and cervical lymphadenopathy unresponsive to conventional therapy, clinicians should suspect Mycobacterium mageritense infection, and mNGS is an effective tool for its rapid and accurate diagnosis.
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BibTeX
@article{li2026mycobacterium,
title = {{Mycobacterium mageritense submandibular lymphadenitis in children: diagnostic challenges and the role of metagenomic next-generation sequencing: two case reports and literature review.}},
author = {Li Li and Zhijie Xing and Liyan Liu and Xiao Mu and Yunpeng Zhai and Shengwei Luan and Jian Li and Qingwei Guo},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1936269},
url = {https://europepmc.org/article/MED/42908641},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mycobacterium mageritense submandibular lymphadenitis in children: diagnostic challenges and the role of metagenomic next-generation sequencing: two case reports and literature review.
AU - Li Li
AU - Zhijie Xing
AU - Liyan Liu
AU - Xiao Mu
AU - Yunpeng Zhai
AU - Shengwei Luan
AU - Jian Li
AU - Qingwei Guo
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1936269
UR - https://europepmc.org/article/MED/42908641
AB - Mycobacterium mageritense is an extremely rare, rapidly growing nontuberculous mycobacterium (NTM). Pediatric cases are rarely reported worldwide, and the non-specific clinical manifestations, low sensitivity of conventional microbiological tests, and limited specimen volume from children often lead to diagnostic delays. We describe the clinical data of two immunocompetent children with submandibular lymphadenitis caused by Mycobacterium mageritense, both diagnosed by metagenomic next-generation sequencing (mNGS). We also systematically reviewed the relevant literature and performed a pooled analysis of 36 eligible cases (the two new paediatric cases from the present study included). Case 1 involved a 6-year-old girl with dental caries and acute fever who was initially misdiagnosed with common bacterial infection and received ineffective empirical antibiotics for over two weeks; mNGS of aspirated pus confirmed the diagnosis. Case 2 involved a 9-year-old girl with dental caries who presented only with submandibular lymphadenopathy and normal laboratory findings, with a diagnostic delay of up to two months; mNGS of lymph node tissue identified the pathogen. Literature-pooled analysis of 36 patients revealed a mean diagnostic delay of 4.69 months (median 2.00 months, IQR: 0.81-5.75 months). Conventional culture had low sensitivity, often requiring prolonged incubation (≥96 h) or special media to obtain positive results. Initial misdiagnosis occurred in 17.6% of cases. Patients diagnosed by NGS achieved more rapid and accurate pathogen identification. This report suggests that mNGS, as a culture-independent, unbiased pan-pathogen detection technique, shows clear advantages in identifying rare and fastidious pathogens such as M. mageritense. For pediatric patients with dental caries, fever, and cervical lymphadenopathy unresponsive to conventional therapy, clinicians should suspect Mycobacterium mageritense infection, and mNGS is an effective tool for its rapid and accurate diagnosis.
SN - 2296-858X
ER -