Diagnostic yield of bone marrow examination in HIV associated FUO in ART naïve patients

Abstract

A bone marrow (BM) aspiration and biopsy is often believed to be a much needed diagnostic procedure in the work up of patients with fever of unknown origin (FUO), especially in the setting of AIDS. Is it worthwhile to proceed with this invasive diagnostic method? The usefulness of a BM aspiration or biopsy to assist in the diagnosis of FUO or prolonged fever in AIDS patients has been reported previously to range from 4% to 40%. The purpose of this study was to assess the usefulness of a BM aspiration and biopsy in diagnosing the cause of FUO in patients with AIDS and to identify the utility of the procedure for the diagnosis of malignancies/other hematological disorders resulting in the FUO. In this study, comprising of 30 patients, we have tried to find the diagnostic yield of bone marrow examination in finding the etiology of "FUO associated with HIV infection". Though similar studies have been reported in the literature but it is lacking from eastern India. The majority of BM examination in this series revealed infections followed by hematological disorders. Our study showed the diagnostic yield of bone marrow examination in "HIV associated FUO" to be 26.7%. It was found to be positive in 33.3% of the patients, who had the final diagnosis of an infective etiology and 100% of the patients, who had a final diagnosis of an underlying hematological etiology.

Diagnostic Value of Percutaneous Liver Biopsy in Fever of Unkown Origin in Patients with Human Immunodeficiency Virus Infection

“…In addition, the diagnostic yield obtained in this series was much higher than that reported in non-HIV patients (20). As compared to bone marrow studies, which have a reported diagnostic yield of 5-38z for FUO in HIV-infected patients (12,13,(21)(22)(23), the corresponding diagnostic yield of percutaneous liver biopsy in our study was 62z.…”

“…The relevance of different diagnostic modalities in these patients has been an active area of research (11)(12)(13)(14)(15)(16). Percutaneous liver biopsy has been shown to be useful diagnostic tool in some earlier studies (14,15).…”

The diagnostic utility of bone marrow examination in an infectious disease ward

“…The finding of positive results in 48.3% of cases was marginally higher than previous studies in which diagnoses made on BME accounted for 25% – 47% of cases. 3,4,5,8,9,10,12,13,14,21 In the current study, 23.6% of diagnoses made were unique to the BME. This finding was similar to the 24.9% unique diagnoses on BME found by Karstaedt et al 3 ; furthermore, this is also higher than international studies in which the prevalence of unique diagnoses has ranged between 8% and 10%.…”

“…Other unique diagnoses found in the current study, which were similarly found in other studies, were disseminated MAC, haematological malignancies and disseminated cryptococcosis. 11,14,21 Most international studies, however, found the prevalence of MAC to be higher than that of MTB, reflecting differing disease profiles of mycobacterial infection in developing countries like SA in which MTB is predominant versus the developed countries in which MAC appears to be a more common diagnosis on BME. 22…”

Diagnostic Methods for Histoplasmosis: Focus on Endemic Countries with Variable Infrastructure Levels

“…Although H. capsulatum grows more slowly than T. marneffei, and thus appropriate fungal diagnosis may be missed [83, 85], antifungal treatment regimens for both infections are identical. Like-wise, in India, many cases of PDH may go unrecognized, as indicated in two recent studies that described the infrequency of bone marrow examination and culture [86, 87]. …”