Bone marrow cultures for the diagnosis of mycobacterial and fungal infections in patients infected with the human immunodeficiency virus

SETTING: University medical center. OBJECTIVE: To determine the value of bone marrow cultures for mycobacteria and fungi in patients infected with the human immunodeficiency virus (HIV). DESIGN: Retrospective review of charts and laboratory records. RESULTS: From 1992-1996, 1225 bone marrow specimens were submitted for mycobacterial and fungal cultures. The number of specimens submitted declined sharply from 435 in 1992 to 94 in 1996 (P = 0.002 for trend), The yield remained stable. Thirty-one of 1225 specimens grew mycobacteria or fungi; 26 isolates were from 24 HIV-infected patients. These 24 patients were infected with Mycobacterium avium complex (19), M. tuberculosis (one),M, chelonae (one), Histoplasma capsulatum (two), and Cryptococcus neoformans (one). All 24 HIV-infected patients bad a culture submitted from at least one other site within 4 weeks of the positive bone marrow culture. The identical organism was grown from another site (usually blood) in 18 of these 24 patients. The bone marrow culture provided the only positive result in six patients and the first positive result in eight patients. CONCLUSIONS: Utilization of bone marrow cultures for mycobacteria and fungi declined at our institution. Bone marrow and blood cultures were highly concordant. However, the majority of positive bone marrow cultures provided useful information.