Brook MG, Ayles H, Harrison C, Rowntree C, Miller RF; International Conference on AIDS.
Int Conf AIDS. 1996 Jul 7-12; 11: 119 (abstract no. Mo.B.1367).
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Objectives: To assess the effectiveness of bone marrow sampling in the diagnosis of the causes of PUO in HIV- positive patients. Methods: Patients who had undergone bone marrow sampling as one of the investigations for PUO between 1987 and 1995 were identified. From patient records and computer data the value of the marrow samples in achieving a diagnosis of the cause of the PUO was assessed. Results: 117 patients had 121 marrow aspiration and 113 marrow trephine samples. Microscopic examination of the marrow revealed the cause of the pyrexia in 33 (27%) of patients from 30 (27%) trephine and 4 (3%) aspiration samples. The diagnoses made were: mycobacterial infection (25), lymphoma (7) and toxoplasmosis (1). Factors more commonly found in patients with positive marrow samples than those with negative samples were low haemoglobin (mean 8.5 g/dl Vs 9.9 g/dl, p is less than 0.05), low CD4 count (mean 0.06 Vs 0.102 x109/1, p is less than 0.05) and recent significant fall in any of the haemoglobin (less than 8g/dl), white cell (less than 2x109/1) or platelet count (less than 80x109/1) (18/33 [55%] Vs 27/88 [31%] of patients with diagnostic and non-diagnostic samples respectively, p is less than 0.05). When mycobacterial infection was diagnosed by microscopy of a marrow sample, this was achieved a mean (range) of 25 (8-60) days earlier than the first positive culture. Marrow trephine samples had a sensitivity of 25/39 (64%) for the detection of mycobacterial infection. Conclusion: Marrow sampling, especially marrow trephines, contributed significantly to the early diagnosis of the cause of PUO. This success was due to the detection of mycobacterial infection, lymphoma and disseminated toxoplasmosis. Samples were most likely to be positive in patients with anaemia, low CD4 count or recent fall in platelet, red or white blood cell count.
Publication Types:
Keywords:
- Anemia
- Bone Marrow
- Bone Marrow Diseases
- Bone Marrow Examination
- CD4 Lymphocyte Count
- Fever
- Fever of Unknown Origin
- HIV Seropositivity
- Humans
- Mycobacterium Infections
- Sensitivity and Specificity
- Toxoplasmosis
- diagnosis
- etiology
Other ID:
UI: 102217329
From Meeting Abstracts