Volk E E, Miller M L, Kirkley B A, Washington J A
Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Clin Pathol. 1998 Aug;110(2):150-3. doi: 10.1093/ajcp/110.2.150.
Bone marrow cultures (BMCs) and blood cultures (BCs) are frequently obtained in the evaluation of fever of unknown origin (FUO). However, the low yield of clinically significant isolates leads to questions about their cost-effectiveness. We retrospectively compared BMC with BC and studied the usefulness of bone marrow trephine biopsy (BMTB) histopathology in detecting infection in an unselected population of 61 patients with FUO, among whom 215 BMCs had been performed. For patients who had undergone BMTB, the histopathology was evaluated for granulomas and microorganisms. Only 1 BMC had a clinically significant isolate, Mycobacterium avium complex (MAC), which was also identified by BC. Rhodotorula rubra was found in the BMC of another patient and classified as a contaminant. Both patients had HIV infection. No growth occurred in BCs for the other 59 patients. Culture results for all 26 BMTB specimens were negative; 4 contained nonnecrotizing granulomas, including the case with MAC. BMCs are probably not justified for routine initial evaluation of FUO, but may be valuable after culture results for blood and easily obtainable tissues have been negative. Bone marrow histopathology and special stains for microorganisms in the absence of granulomas were noncontributory.
在不明原因发热（FUO）的评估中，经常会进行骨髓培养（BMC）和血培养（BC）。然而，具有临床意义的分离株检出率较低，这引发了对其成本效益的质疑。我们对骨髓培养与血培养进行了回顾性比较，并研究了骨髓活检（BMTB）组织病理学在61例未经挑选的FUO患者群体中检测感染的效用，这些患者共进行了215次骨髓培养。对于接受了骨髓活检的患者，评估其组织病理学中的肉芽肿和微生物情况。只有1次骨髓培养获得了具有临床意义的分离株——鸟分枝杆菌复合群（MAC），血培养也鉴定出了该菌。在另一名患者的骨髓培养中发现了深红酵母，并将其归类为污染物。这两名患者均感染了HIV。其他59例患者的血培养均未生长。所有26份骨髓活检标本的培养结果均为阴性；4份标本含有非坏死性肉芽肿，其中包括MAC感染的病例。对于FUO的常规初始评估，骨髓培养可能并无必要，但在血液和易于获取的组织培养结果均为阴性后，骨髓培养可能具有价值。在没有肉芽肿的情况下，骨髓组织病理学和微生物特殊染色并无帮助。
