Comparison of bone marrow studies with blood culture for etiological diagnosis of disseminated mycobacterial and fungal infection in patients with acquired immunodeficiency syndrome.

The role of bone marrow examination in the diagnosis of prolonged fever in patients with human immunodeficiency virus infection remains controversial. This study compared the results of bone marrow examination and blood culture in the evaluation of opportunistic infections in 100 patients with acquired immunodeficiency syndrome who presented with prolonged fever and/or pancytopenia from November 1995 through August 1998. Bone marrow and blood specimens were routinely submitted for bacterial, mycobacterial, and fungal cultures, and histopathological examination of the bone marrow specimens was also performed. A total of 33 cases of disseminated mycobacterial infections and 17 cases of disseminated fungal infections were identified. Fifteen cases of mycobacterial infection and 8 cases of fungal infection were identified by using bone marrow culture. The causative organisms included Mycobacterium avium complex (9 isolates), Mycobacterium tuberculosis (4), Mycobacterium chelonae (1), Mycobacterium kansasii (1), Cryptococcus neoformans (3), and Penicillium marneffei (5). Granulomas were seen in only 8 of 33 disseminated mycobacterial infections, and acid-fast bacilli were detected in only 4 patients. Although bone marrow culture did not provide a significantly higher diagnostic yield than blood culture, bone marrow culture plus histopathological examination had a higher diagnostic yield than blood culture alone for patients with disseminated mycobacteriosis. This study demonstrated that bone marrow examination provides an additional aid in the diagnosis of disseminated mycobacterial or fungal infections in patients with human immunodeficiency virus who had prolonged fever.