Utility of bone marrow biopsy for rapid diagnosis of febrile illnesses in patients with human immunodeficiency virus infection.

Luther JM, Lakey DL, Larson RS, Kallianpur AR, D'Agata E, Cousar JB, Haas DW
South Med J. 2000 93 (7): 692-7

PMID: 10923958

BACKGROUND - Histochemical staining of bone marrow biopsy samples for microorganisms may provide a presumptive diagnosis weeks before culture.

METHODS - To identify predictors of histochemical positivity, we reviewed 161 bone marrow biopsies from febrile patients with human immunodeficiency virus (HIV) infection.

RESULTS - By multivariate analysis, both hematocrit value <30% and white blood cell count <4,000/mm3 predicted biopsy positivity by culture or staining, but only anemia predicted histochemical stain positivity. Of cases with serum lactate dehydrogenase (LDH) levels >600 U/L, histoplasmosis was diagnosed in 31.6% versus 7.8% with lower LDH levels. Among histoplasmosis cases, staining showed fungi in all, with LDH levels >600 U/L versus 44.4% with lower levels.

CONCLUSIONS - Bone marrow biopsy will most likely provide a rapid diagnosis in patients with anemia. Markedly elevated LDH levels suggest stain positivity for Histoplasma capsulatum. Histopathologic patterns may also guide empiric therapy.

MeSH Terms (28)

Adult AIDS-Related Opportunistic Infections Anemia Biopsy Bone Marrow Bone Marrow Examination Chi-Square Distribution Coloring Agents Female Fever Forecasting Hematocrit Histocytochemistry Histoplasma Histoplasmosis HIV Infections Humans L-Lactate Dehydrogenase Leukocyte Count Logistic Models Lymphoma, AIDS-Related Male Microbiological Techniques Multivariate Analysis Mycobacterium avium-intracellulare Infection Pneumonia, Pneumocystis Prospective Studies Retrospective Studies

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