Benito N, Núñez A, de Górgolas M, Esteban J, Calabuig T, Rivas M C, Fernández Guerrero M L
Division of Infectious Diseases and Hematology (Department of Medicine) Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.
Arch Intern Med. 1997 Jul 28;157(14):1577-80.
Fever is commonly observed in patients with human immunodeficiency virus (HIV) disease and frequently eludes diagnosis. The role of bone marrow biopsy in the diagnosis of fever of unknown origin in patients infected with HIV remains controversial.
One hundred twenty-three consecutive patients with 137 episodes of fever lasting 10 or more days without diagnosis after 1 week of hospitalization were evaluated by bone marrow biopsy.
Overall, a specific diagnosis was achieved in 52 episodes by means of culture and histopathological examination (diagnostic yield, 37.9%). Three types of disease were found: mycobacterial infections (n = 36, 69% of documented episodes), including 18 patients with disseminated tuberculosis and 14 with Mycobacterium avium-intracellulare complex infections; non-Hodgkin lymphomas (n = 12, 23%); and visceral leishmaniasis (n = 4, 8%). Although bone marrow cultures were more sensitive than microscopic examination with special stains for the diagnosis of mycobacterial infections, the pathological examination of bone marrow led to a more rapid diagnosis of disease. In addition, the histopathological examination of bone marrow alone led to the diagnosis of a specific condition in 43 episodes (31.3% of all episodes).
Bone marrow biopsy is a useful procedure for the diagnosis of fever in patients with advanced HIV disease, particularly in areas where tuberculosis and leishmaniasis are prevalent. Involvement of the marrow may be the first indication of the existence of extranodal non-Hodgkin lymphoma. For Mycobacterium avium-intracellulare complex infection, blood cultures were more sensitive than bone marrow biopsy.
发热在人类免疫缺陷病毒（HIV）感染患者中很常见，且常常难以诊断。骨髓活检在诊断HIV感染患者不明原因发热中的作用仍存在争议。
对123例连续住院1周后仍有137次发热持续10天或更长时间且未确诊的患者进行了骨髓活检评估。
总体而言，通过培养和组织病理学检查在52次发热中明确了诊断（诊断率为37.9%）。发现了三种类型的疾病：分枝杆菌感染（n = 36，占确诊病例的69%），包括18例播散性结核病患者和14例鸟分枝杆菌复合群感染患者；非霍奇金淋巴瘤（n = 12，23%）；以及内脏利什曼病（n = 4，8%）。虽然骨髓培养在诊断分枝杆菌感染方面比特殊染色的显微镜检查更敏感，但骨髓病理检查能更快地诊断疾病。此外，仅骨髓组织病理学检查就在43次发热中（占所有发热的31.3%）明确了特定病情的诊断。
骨髓活检对于晚期HIV感染患者的发热诊断是一种有用的方法，特别是在结核病和利什曼病流行的地区。骨髓受累可能是结外非霍奇金淋巴瘤存在的首要迹象。对于鸟分枝杆菌复合群感染，血培养比骨髓活检更敏感。
