title: Bone marrow examination for the diagnosis of mycobacterial and fungal infections in the acquired immunodeficiency syndrome.
abstract: In a series of 342 bone marrow examinations from 314 patients with human immunodeficiency virus infection, 70 examinations (20%) detected opportunistic mycobacterial or fungal infections. One hundred eleven of the 314 patients had such infections, and, hence, 63% (70/111) were detected by bone marrow examination. Special stains for microorganisms detected 16 (32%) of 50 Mycobacterium avium complex infections, 10 (22%) of 45 Mycobacterium tuberculosis infections, eight (73%) of 11 Histoplasma capsulatum infections, and five (83%) of six Cryptococcus neoformans infections. Bone marrow cultures detected 36 (72%) of the 50 M avium complex infections, 13 (29%) of the 45 M tuberculosis infections, and 63% of the fungal infections. Marrow examination revealed infection in only one of the 70 specimens (1%) collected to evaluate thrombocytopenia alone or hematologic malignancy, but in 69 (25%) of 274 with fever, neutropenia, anemia, or miscellaneous other indications for marrow examination. Granulomas were detected in 102 (30%) of the biopsy specimens, including 71 (64%) of those in cases with mycobacterial or fungal infection. The granulomas showed caseous necrosis in nine cases, all in patients with tuberculosis, and the 27 cases with tuberculosis-associated granulomas tended to show large, tightly cohesive granulomas. The presence of granulomas correlated with opportunistic infection in 82 (80%) of 102 cases. Without granulomas, special stains were positive in only eight (3%) of 240 specimens. These results suggest that (1) bone marrow granulomas are a common and valuable histologic clue to opportunistic infection; (2) without them, special stains may not be a cost-efficient way to diagnose such infection; and (3) bone marrow examination can be a useful method of diagnosing opportunistic mycobacterial and fungal infections in patients with fever, anemia or neutropenia, and underlying human immunodeficiency virus infection.
authors.affiliation: Department of Pathology, Los Angeles County-University of Southern California Medical Center 90033.
authors.forename: L
authors.initials: L
authors.lastname: Nichols
authors.forename: B
authors.initials: B
authors.lastname: Florentine
authors.forename: W
authors.initials: W
authors.lastname: Lewis
authors.forename: F
authors.initials: F
authors.lastname: Sattler
authors.forename: M U
authors.initials: MU
authors.lastname: Rarick
authors.forename: R K
authors.initials: RK
authors.lastname: Brynes
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000382:microbiology; D001855:Bone Marrow Diseases / Q000382:microbiology; D001856:Bone Marrow Examination / Q000379:methods; D006099:Granuloma / Q000382:microbiology; D006801:Humans; D009164:Mycobacterium Infections / Q000150:complications / Q000175:diagnosis*; D009181:Mycoses / Q000150:complications / Q000175:diagnosis*; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis*