骨髓穿刺/活检在 AIDS 患者不明原因发热评估中的应用。

Bone Marrow Aspiration/Biopsy in the Evaluation of Fever of Unknown Origin in Patients with AIDS.

机构信息

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.

National Drug and Alcohol Research Center, University of New South Wales (UNSW), Sydney, Australia.

出版信息

Infect Disord Drug Targets. 2021;21(3):394-398. doi: 10.2174/1871526520666200705212903.

DOI:10.2174/1871526520666200705212903

PMID:32628601

Abstract

BACKGROUND

HIV can interrupt the normal development of bone marrow cell lines. Bone marrow aspiration/biopsy (BMA/B) has been described as a diagnostic tool in AIDS patients with fever of unknown origin (FUO). In this review, we aimed to study patients with AIDS who had undergone a BMA/B to investigate FUO and describe the pathologies diagnosed in the biopsy.

METHODS

Thirty-four BMA/B samples were collected from AIDS patients admitted for work-up of FUO to the infectious disease ward of a tertiary referral HIV center in Tehran, Iran, between September 2014 and September 2015. Data including age, sex, duration of disease, CD4 cell counts, hepatitis B (HBV) and C (HCV) coinfection, the primary presentation of AIDS, and the treatment history were retrieved and analyzed. Patients underwent BMA/B. An expert pathologist reviewed the BMA/B specimens.

RESULTS

The mean age of the patients was 37.5 years (range, 26-56), and 27 (79%) were men. Twenty-seven (79%) patients contracted HIV from injection drug use, and 7 (21%) via sexual transmission. Only 3 (9%) of the BMA/B examinations were normal. Hypocellular bone marrow was diagnosed in 22 (65%) patients. Other pathologies included granulomas in 6 (18%), hematologic malignancies in 2 (6%), and leishmaniasis Aspergillosis, each in 1 (3%) patient. Six (17%) of the specimens were found to have tuberculosis infections.

CONCLUSION

Hypocellular bone marrow was the most common pathology on BMA/B examinations, followed by the presence of granulomas. Tuberculosis, Aspergillosis, and Leishmaniasis the opportunistic infections diagnosed on BMA/B specimens. Our results support BMA/B as an appropriate diagnostic tool for early diagnosis of opportunistic infections and malignancies in AIDS. BMA/B is indispensable in the armament of diagnostic tools of the physicians managing AIDS patients.

摘要

背景

HIV 可干扰骨髓细胞系的正常发育。骨髓抽吸/活检（BMA/B）已被描述为 AIDS 患者不明原因发热（FUO）的诊断工具。在这项研究中，我们旨在研究接受 BMA/B 的 AIDS 患者，以调查 FUO 并描述活检中诊断出的病变。

方法

2014 年 9 月至 2015 年 9 月，我们从伊朗德黑兰一家三级转诊 HIV 中心的传染病病房中，对因 FUO 就诊的 AIDS 患者进行了 34 次 BMA/B 样本采集。我们收集了包括年龄、性别、疾病持续时间、CD4 细胞计数、乙型肝炎（HBV）和丙型肝炎（HCV）合并感染、AIDS 的初始表现和治疗史在内的数据，并进行了分析。所有患者均接受了 BMA/B 检查。一位专家病理学家对 BMA/B 标本进行了评估。

结果

患者的平均年龄为 37.5 岁（范围为 26-56 岁），其中 27 人（79%）为男性。27 例（79%）患者因注射吸毒而感染 HIV，7 例（21%）患者因性传播而感染 HIV。仅有 3 例（9%）BMA/B 检查正常。22 例（65%）患者骨髓细胞减少。其他病变包括 6 例（18%）肉芽肿、2 例（6%）血液系统恶性肿瘤和 1 例（3%）利什曼病和曲霉病。6 例（17%）标本发现结核感染。