Riley U B, Crawford S, Barrett S P, Abdalla S H
Diagnostic Bacteriology Department, St Mary's Hospital, London.
J Clin Pathol. 1995 Aug;48(8):706-9. doi: 10.1136/jcp.48.8.706.
To investigate the value of bone marrow biopsy in the diagnosis of mycobacterial infection.
The culture results of 433 bone marrow samples taken between 1983 and 1992 were reviewed. The histopathology reports on bone marrow trephine specimens of culture positive samples and all those on HIV positive patients sent in 1992 were also reviewed.
Fifty one specimens yielded Mycobacterium spp, 47 were obtained from HIV positive patients. Of the isolates, 42 were Mycobacterium avium-intracellulare (MAI), five were M tuberculosis (MTB), and the remaining four comprised a variety of atypical mycobacteria. All MAI positive samples were obtained from HIV positive patients, with the bone marrow being the only culture positive specimen in one third. Bone marrow yielded MTB only in patients from whom it was also isolated in other specimens. Eleven of 47 trephine specimens from positive bone marrow showed granulomata and nine showed acid-fast bacilli. No acid-fast bacilli were seen in the absence of granulomata.
Bone marrow biopsy for mycobacterial culture should be reserved for severely immunosuppressed patients and should not be advocated for immunocompetent patients with suspected tuberculosis. Bone marrow biopsy still has a role in the investigation of pyrexia of unknown origin in HIV positive patients, despite the advent of mycobacterial blood culture techniques, particularly if these can be processed safely in automated systems.
探讨骨髓活检在分枝杆菌感染诊断中的价值。
回顾了1983年至1992年间采集的433份骨髓样本的培养结果。还回顾了培养阳性样本的骨髓环钻活检标本的组织病理学报告以及1992年送检的所有HIV阳性患者的报告。
51份标本培养出分枝杆菌属，其中47份来自HIV阳性患者。分离出的菌株中，42株为鸟分枝杆菌-胞内分枝杆菌（MAI），5株为结核分枝杆菌（MTB），其余4株为多种非典型分枝杆菌。所有MAI阳性样本均来自HIV阳性患者，其中三分之一患者的骨髓是唯一培养阳性的标本。骨髓仅在其他标本中也分离出MTB的患者中培养出MTB。47份骨髓阳性的环钻活检标本中，11份显示有肉芽肿，9份显示有抗酸杆菌。无肉芽肿时未见抗酸杆菌。
骨髓活检进行分枝杆菌培养应仅用于严重免疫抑制患者，不建议用于疑似结核病的免疫功能正常患者。尽管出现了分枝杆菌血培养技术，但骨髓活检在HIV阳性患者不明原因发热的调查中仍有作用，特别是如果这些样本能够在自动化系统中安全处理。
