Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS.

The utility of bone marrow aspiration and biopsy (BMAB) as a diagnostic tool in patients with HIV/AIDS and fever of unknown origin (FUO) is a subject of debate. Because highly active antiretroviral therapy has reduced incidence of opportunistic infections, it is important to reassess the efficacy of BMAB for this diagnostic purpose. To our knowledge, no such studies have been performed in Harris County which has the highest incidence of HIV in the state of Texas.
We reviewed all BMABs from patients with HIV/AIDS and FUO or persistent cytopenia(s) from 2007 to 2011.
Of 57 evaluable patients, BMAB was positive in 24 samples by acid fast bacilli (AFB) or Gomori methenamine silver (GMS) stains (17.5%), presence of granuloma and/or lymphohistiocytic aggregates (31.6%), culture (21.0%) or a combination. Cultures demonstrated Mycobacterium avium/intracellulare (4), M tuberculosis (2), M gordonae (1), Histoplasma capsulatum (3) and Cryptococcus neoformans (2). There were three cases in which a pathogen was grown in culture but that had a negative of 'direct examination' on tissue sections (negative AFB and GMS special stains, no morphological evidence of granuloma/lymphohistiocytic infiltrates).
This study supports the use of diagnostic BMAB as a rapid decision-making tool in patients with HIV and FUO in the proper clinical setting. BMAB demonstrated infection-related evidence prior to positive bone marrow culture in 75% of cases. Special stains and blood cultures had similar diagnostic yield, but BMAB offers faster results. Thus, this procedure assists in clinical decision making and the refinement of treatment in a more timely manner.
AuthorsAndrés E Quesada, Ashok Tholpady, Audrey Wanger, Andy N D Nguyen, Lei Chen
JournalJournal of clinical pathology (J Clin Pathol) Vol. 68 Issue 3 Pg. 241-5 (Mar 2015) ISSN: 1472-4146 [Electronic] England
PMID25589792 (Publication Type: Evaluation Studies, Journal Article)
CopyrightPublished by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
  • AIDS-Related Opportunistic Infections (diagnosis, etiology, immunology, microbiology, pathology)
  • Adult
  • Bacteria (isolation & purification)
  • Bacterial Infections (diagnosis, etiology, immunology, microbiology, pathology)
  • Bacteriological Techniques
  • Biopsy
  • Bone Marrow (immunology, microbiology, pathology)
  • Bone Marrow Examination
  • Cryptococcosis (diagnosis, etiology, immunology, microbiology, pathology)
  • Cryptococcus neoformans (isolation & purification)
  • Female
  • Fever of Unknown Origin (diagnosis, etiology, immunology, microbiology, pathology)
  • HIV Infections (complications, diagnosis, immunology)
  • Humans
  • Immunocompromised Host
  • Leukopenia (etiology)
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reproducibility of Results
  • Texas
  • Young Adult

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