title: Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS.
abstract: 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.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Andrés E
authors.initials: AE
authors.lastname: Quesada
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Tholpady
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Wanger
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Andy N D
authors.initials: AN
authors.lastname: Nguyen
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D001431:Bacteriological Techniques; D001706:Biopsy; D001853:Bone Marrow / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D001856:Bone Marrow Examination; D003453:Cryptococcosis / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013781:Texas; D055815:Young Adult
keywords: BONE MARROW; CRYPTOCOCCUS; HISTOPLASMOSIS; HIV; MYCOBACTERIA