The role of tissue studies in facilitating early initiation of antimycobacterial treatment in AIDS patients with disseminated mycobacterial disease.
METHODS
The question of whether aggressive investigations are useful in diagnosis and initiation of treatment in AIDS patients with disseminated mycobacterial disease (DMD) is still under debate.


OBJECTIVE
To define the role of tissue studies in facilitating early initiation of antimycobacterial treatment and in establishing diagnosis in AIDS patients with DMD.


METHODS
From July 1994 through June 1997, 167 AIDS cases with fever were evaluated by stepwise investigation using a standardized protocol. Data of DMD cases were analyzed to define the role of tissue studies.


RESULTS
A total of 40 cases of culture-proven DMD were identified. Antimycobacterial treatment was initiated due to positive acid-fast bacilli smears of sputum in only five cases. In the remaining cases, positive pathologic findings from tissue biopsies (lymph node, bone marrow or liver) facilitated early initiation of treatment in 60% (21/35). In 50% of all cases (20/40), the diagnosis could not have been established if cultures of tissue biopsies had not been performed. Both the pathologic examinations and mycobacterial cultures from liver biopsies had positivity rates of more than 50% (53.8% and 69.2%, respectively).


CONCLUSIONS
Tissue studies were useful in facilitating early initiation of treatment and establishing diagnosis at least in half of the AIDS cases with DMD. Liver biopsy is worthwhile if the cause of fever is not discovered using less invasive investigations.
Hsieh
S M
SM
Department of Internal Medicine, National Taiwan University Hospital, Taipei.
Hung
C C
CC
Chen
M Y
MY
Hsueh
P R
PR
Chang
S C
SC
Luh
K T
KT
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D011379:Prognosis; D012680:Sensitivity and Specificity; D013183:Sputum / Q000166:cytology / Q000382:microbiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
D000995:Antitubercular Agents