Bone marrow biopsy in the diagnoses of infectious and non-infectious causes in patients with advanced HIV infection

Instituto de Infectologia Emílio Ribas, São Paulo, Brazil. <>
The Journal of infection (Impact Factor: 4.44). 05/2007; 54(4):362-6. DOI: 10.1016/j.jinf.2006.06.007
Source: PubMed


Fever and peripheral blood abnormalities in patients with advanced acquired immunodeficiency syndrome are usually due to disseminated opportunistic infections. The objective of this study was to evaluate the diagnostic yield of histopathological and microbiological investigations of bone marrow samples from HIV-infected patients with fever and/or cytopenias.
The diagnostic utility of bone marrow aspiration, biopsy and culture was retrospectively examined in 82 patients with HIV/AIDS (median CD4 count 51 microL(-1), range 1-430 microL(-1)) with peripheral cytopenias and/or fever attended at a large tertiary care hospital in Brazil during a one-year period. The diagnostic yield of bone marrow biopsy was 34.1% (28 cases) in contrast to only 8.5% (eight cases) attained by the bone marrow smear. Opportunistic pathogens were isolated from bone marrow cultures in 26.8% of patients.
Bone marrow biopsy has value in diagnosis of opportunistic infections, malignancies or other conditions in one-third of adult patients with advanced AIDS and fever or cytopenias and should be considered in this patient group.

1 Follower
26 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The job shop scheduling problem (JSP) deals with the sequencing operations of a set of jobs on a set of machines with minimum cost. The flexible job shop scheduling problem (FJSP) is a generalization of the JSP, which is concerned with both the assignment of machines to operations and the sequencing of the operations on the assigned machines. The paper first presents an extension of the geometric approach for solving a two-job shop problem, when there is one flexible job and the second job is a job shop job. Based on this extension and the notion of the combined job, an integrated greedy heuristic that simultaneously deals with the assignment and the sequencing subproblems is developed to solve the general case with more than two jobs. The results obtained by the greedy heuristic on existing benchmarks from the literature are promising
    Systems, Man, and Cybernetics, 2001 IEEE International Conference on; 02/2001
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The causes of fevers of unknown origin (FUOs) are diverse and may be the result of infectious rheumatic or inflammatory, neoplastic, or miscellaneous disorders. This article reviews the focused diagnostic approach to FUOs, emphasizing relevant history, physical examination, and selected laboratory tests using a clinical syndrome approach. Laboratory tests should be guided by the most likely diagnoses based on the presenting clinical syndrome. Considered in concert, nonspecific laboratory tests may provide important diagnostic clues. Using a sequential diagnostic approach, a focused evaluation diagnoses all but the rarest or most obscure causes of FUO.
    Infectious Disease Clinics of North America 01/2008; 21(4):1137-87, xi. DOI:10.1016/j.idc.2007.09.004 · 2.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fever of unknown origin (FUO) still remains a diagnostic challenge, while diagnosis may remain obscure for several weeks or months. The role of tissue biopsy is crucial in the diagnostic approach. We report a series of 130 consecutive patients with FUO who had undergone a bone marrow biopsy (BMB). Among 280 consecutive nonimmunocompromised patients hospitalized between 1995 and 2005 for a febrile illness of uncertain cause, lasting at least 3 weeks, with no diagnosis after an appropriate minimal diagnostic workup, 130 underwent BMB. Overall, a specific diagnosis was achieved by BMB and histological examination in 31 cases (diagnostic yield, 23.7%). Three types of diseases were found: hematological malignant diseases in 25 cases, including 19 patients with malignant lymphoma, 4 with acute leukemia, 1 with hairy cell leukemia, and 1 with multiple myeloma; infectious diseases in 3 cases; systemic mastocytosis in 2 cases; and disseminated granulomatosis in 1 case. Thrombocytopenia (odds ratio, 4.9; 95% confidence interval, 1.04-9.30) and anemia (odds ratio, 3.24; 95% CI, 1.13-9.34) were the most reliable predictive factors regarding the usefulness of BMB. Bone marrow cultures had very limited value in our cohort. Finally, corticosteroid use did not seem to affect the yield of BMB. Bone marrow biopsy is a useful technique for the diagnosis of prolonged fever in immunocompetent patients. Thrombocytopenia and anemia seem to be correlated with the value of this test.
    Archives of internal medicine 11/2009; 169(21):2018-23. DOI:10.1001/archinternmed.2009.401 · 17.33 Impact Factor
Show more

Similar Publications