Utility of bone marrow biopsy for rapid diagnosis of febrile illnesses in patients with human immunodeficiency virus infection.
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.
Department of Medicine, Vanderbilt University Medical Center and the Nashville Veterans Administration Medical Center, Tenn 37212, USA.
J M
JM
Luther
D L
DL
Lakey
R S
RS
Larson
A R
AR
Kallianpur
E
E
D'Agata
J B
JB
Cousar
D W
DW
Haas
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D000740:Anemia / Q000382:microbiology / Q000473:pathology; D001706:Biopsy; D001853:Bone Marrow / Q000382:microbiology / Q000473:pathology*; D001856:Bone Marrow Examination; D016009:Chi-Square Distribution; D004396:Coloring Agents; D005260:Female; D005334:Fever / Q000175:diagnosis*; D005544:Forecasting; D015658:HIV Infections / Q000150:complications; D006400:Hematocrit; D006651:Histocytochemistry; D006658:Histoplasma / Q000145:classification; D006660:Histoplasmosis / Q000175:diagnosis / Q000201:enzymology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D016015:Logistic Models; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis; D008297:Male; D008828:Microbiological Techniques; D015999:Multivariate Analysis; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D011446:Prospective Studies; D012189:Retrospective Studies
D004396:Coloring Agents; D007770:L-Lactate Dehydrogenase