Supervía A, Knobel H, Pérez-Vila E, Abellá M E, Salvado M, Mellibovsky L, Díez A
Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar, Barcelona.
An Med Interna. 1996 Aug;13(8):374-7.
AIDS is the first cause of opportunistic infections. The objective of the present study was the evaluation of the efficiency of bone marrow aspirate (BMA) for diagnosis of opportunistic infections in HIV infected patients with prolonged fever. Charts from 92 patients with BMA from 1992 to 1994 were reviewed. Diagnosis was achieved in 14.1% of cases. Diagnosis cannot be made by other methods in six leishmaniasis and in two disseminated tuberculosis. The sensibility was of 33.3% for mycobacterial infections, the sensibility of hemoculture was of 50%. The hemoglobin level was lower for patients with diagnostic BMA than for patients with not diagnostic BMA (77 g/l vs 97 g/l, p < 0.0004). The WBC counts was not different in both groups of patients, and platelets counts was greater in patients with BMA diagnostic (165 x 10(9)/l vs 102 x 10(9)/l, p < 0.001). In the patients with hemoglobin lower than 100 g/l the diagnostic efficiency was 18.6% (11 of 59 cases). The BMA was unprofitable in HIV infected patients with prolonged fever without hemocytopenias. Profitability increase in patients with hemoglobin lower than 100 g/l. The BMA in useful for leishmania identification. The hemoculture has greater sensitivity than BMA for the diagnosis of mycobacterial disseminated infection.
艾滋病是机会性感染的首要病因。本研究的目的是评估骨髓穿刺抽吸物(BMA)对长期发热的HIV感染患者机会性感染的诊断效率。回顾了1992年至1994年92例接受BMA检查患者的病历。14.1%的病例得以确诊。在6例利什曼病和2例播散性结核病患者中,无法通过其他方法做出诊断。分枝杆菌感染的敏感性为33.3%,血培养的敏感性为50%。确诊BMA的患者血红蛋白水平低于未确诊BMA的患者(77g/l对97g/l,p<0.0004)。两组患者的白细胞计数无差异,BMA确诊患者的血小板计数更高(165×10⁹/l对102×10⁹/l,p<0.001)。血红蛋白低于100g/l的患者诊断效率为18.6%(59例中的11例)。BMA对无血细胞减少的长期发热HIV感染患者无诊断价值。血红蛋白低于100g/l的患者诊断价值增加。BMA对利什曼原虫鉴定有用。血培养对分枝杆菌播散性感染的诊断比BMA具有更高的敏感性。