The utility of bone-marrow examination in HIV-infected adults in South Africa

被引:14
作者
Karstaedt, AS
Pantanowitz, L
Omar, T
Sonnendecker, HEM
Patel, M
机构
[1] Chris Hani Baragwanath Hosp, Dept Med, ZA-2013 Johannesburg, South Africa
[2] S African Inst Med Res, Dept Pathol Anat, ZA-2000 Johannesburg, South Africa
[3] Univ Witwatersrand, Johannesburg, South Africa
来源
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS | 2001年 / 94卷 / 02期
关键词
D O I
10.1093/qjmed/94.2.101
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We retrospectively reviewed a consecutive case series of 257 adults with HIV infection who had undergone a bone-marrow examination with trephine bone biopsy, to assess the diagnostic usefulness of bone-marrow examination and evaluate possible predictors of a diagnostic examination. Bone-marrow examination was positive in 97 (38%) patients and gave a unique diagnosis in 61 (24%). The diseases were tuberculosis (83 patients), Mycobacterium avium complex infection and cryptococcosis (four patients each), and haematological malignancies (eight patients). The yield of the examination was significantly increased, by univariate analysis, in patients with wasting, oral thrush, leukopenia, CD4 less than or equal to 100/mm(3), and granuloma formation on histopathology. Granulomata were present in 113 (44%) patients, of whom 28 (25%) had no specific cause identified. Granulomata occurred in 22 (25%) of 89 patients with CD4 >100/mm(3) compared to 36 (51%) of 70 patients with CD4 less than or equal to 100/mm(3) (OR 0.3; 95% Cl 0.15-0.62). Of 48 patients with CD4 < 50/mm(3), 25 had granulomata, including 15 with caseation necrosis. The yield of bone-marrow examination was considerable in our setting. Expanding access to modern blood culture techniques for mycobacteria to primary care level could limit the number of bone-marrow examinations required.
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页码:101 / 105
页数:5
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