Nichols L, Florentine B, Lewis W, Sattler F, Rarick M U, Brynes R K
Department of Pathology, Los Angeles County-University of Southern California Medical Center 90033.
Arch Pathol Lab Med. 1991 Nov;115(11):1125-32.
In a series of 342 bone marrow examinations from 314 patients with human immunodeficiency virus infection, 70 examinations (20%) detected opportunistic mycobacterial or fungal infections. One hundred eleven of the 314 patients had such infections, and, hence, 63% (70/111) were detected by bone marrow examination. Special stains for microorganisms detected 16 (32%) of 50 Mycobacterium avium complex infections, 10 (22%) of 45 Mycobacterium tuberculosis infections, eight (73%) of 11 Histoplasma capsulatum infections, and five (83%) of six Cryptococcus neoformans infections. Bone marrow cultures detected 36 (72%) of the 50 M avium complex infections, 13 (29%) of the 45 M tuberculosis infections, and 63% of the fungal infections. Marrow examination revealed infection in only one of the 70 specimens (1%) collected to evaluate thrombocytopenia alone or hematologic malignancy, but in 69 (25%) of 274 with fever, neutropenia, anemia, or miscellaneous other indications for marrow examination. Granulomas were detected in 102 (30%) of the biopsy specimens, including 71 (64%) of those in cases with mycobacterial or fungal infection. The granulomas showed caseous necrosis in nine cases, all in patients with tuberculosis, and the 27 cases with tuberculosis-associated granulomas tended to show large, tightly cohesive granulomas. The presence of granulomas correlated with opportunistic infection in 82 (80%) of 102 cases. Without granulomas, special stains were positive in only eight (3%) of 240 specimens. These results suggest that (1) bone marrow granulomas are a common and valuable histologic clue to opportunistic infection; (2) without them, special stains may not be a cost-efficient way to diagnose such infection; and (3) bone marrow examination can be a useful method of diagnosing opportunistic mycobacterial and fungal infections in patients with fever, anemia or neutropenia, and underlying human immunodeficiency virus infection.
在对314例人类免疫缺陷病毒感染患者进行的342次骨髓检查中，70次检查（20%）检测到机会性分枝杆菌或真菌感染。314例患者中有111例发生了此类感染，因此，通过骨髓检查检测到了其中的63%（70/111）。针对微生物的特殊染色检测到50例鸟分枝杆菌复合群感染中的16例（32%）、45例结核分枝杆菌感染中的10例（22%）、11例荚膜组织胞浆菌感染中的8例（73%）以及6例新型隐球菌感染中的5例（83%）。骨髓培养检测到50例鸟分枝杆菌复合群感染中的36例（72%）、45例结核分枝杆菌感染中的13例（29%）以及63%的真菌感染。骨髓检查显示，在仅为评估血小板减少症或血液系统恶性肿瘤而采集的70份标本中，只有1份（1%）检测到感染，但在因发热、中性粒细胞减少、贫血或其他各种骨髓检查指征而采集的274份标本中，有69份（25%）检测到感染。在活检标本中，102份（30%）检测到肉芽肿，其中包括分枝杆菌或真菌感染病例中的71份（64%）。9例肉芽肿出现干酪样坏死，均为结核病患者，27例与结核病相关的肉芽肿往往表现为大的、紧密聚集的肉芽肿。在102例病例中的82例（80%）中，肉芽肿的存在与机会性感染相关。没有肉芽肿时，240份标本中只有8份（3%）特殊染色呈阳性。这些结果表明：（1）骨髓肉芽肿是机会性感染常见且有价值的组织学线索；（2）没有肉芽肿时，特殊染色可能不是诊断此类感染的经济有效的方法；（3）骨髓检查对于诊断发热、贫血或中性粒细胞减少且伴有潜在人类免疫缺陷病毒感染的患者的机会性分枝杆菌和真菌感染可能是一种有用的方法。
