title: Bone marrow aspirate microscopy v. bone marrow trephine biopsy microscopy for detection of Mycobacterium tuberculosis infection.
abstract: BACKGROUND
  Tuberculosis (TB) remains a global health problem. According to the 2013 Global Report on Tuberculosis, 8.6 million people developed TB in 2012 and 1.3 million died from the disease. An estimated 13% of people who developed TB in 2012 were HIV-positive, and 75% of these lived in Africa. While pulmonary TB is the commonest form of Mycobacterium tuberculosis infection, extrapulmonary TB is increasingly being detected in HIV-positive patients. Definitive diagnosis of disseminated TB is a challenge owing to atypical presentations and diagnostic difficulties (negative chest radiograph and sputum microscopy and culture). A rapid diagnosis of disseminated TB is desirable, as early initiation of treatment can reduce mortality. Although TB culture is the gold standard for diagnosis of TB, it has a long turnaround time (up to 6 weeks).
  
  
  OBJECTIVE
  To identify a potentially faster and more effective diagnostic strategy for disseminated TB.
  
  
  METHODS
  A retrospective 18-month review, conducted at a tertiary hospital, comparing histological findings of an auramine O-stained bone marrow aspiration (BMA) smear and a bone marrow trephine (BMT) biopsy specimen with the gold standard of TB culture.
  
  
  RESULTS
  Microscopic examination of BMA smears and BMT biopsy specimens offers a rapid diagnostic strategy, with results available on the same day for the former and within 4 days for the latter. BMT histological examination had a significantly higher detection rate than BMA auramine O staining compared with TB culture.
  
  
  CONCLUSIONS
  We recommend that BMT biopsies remain an essential part of the diagnostic work-up for disseminated TB.
authors.affiliation: Haematopathology Department, National Health Laboratory Service, Chris Hani Baragwanath Hospital, Johannesburg, South Africa. docqanita@gmail.com.
authors.forename: Qanita
authors.initials: Q
authors.lastname: Sedick
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vaughan
authors.forename: T
authors.initials: T
authors.lastname: Pheeha
authors.forename: Nazeer A
authors.initials: NA
authors.lastname: Alli