Diagnostic Utility of Bone Marrow Biopsy/ Bone Marrow Culture in Pyrexia of Unknown Origin: A Ten-Year Retrospective Analysis

Authors

  • Sehar Khaliq
  • Haider Ali

Keywords:

Pyrexia, Bone marrow biopsy, Bone Marrow Culture, PUO, Bone Marrow Aspirate, Mycobacterium Tuberculosis

Abstract

Objective: This study was carried out to assess the diagnostic utility of BMB and BMC in patients with PUO.

Methodology: This retrospective cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi. The clinical, laboratory and radiological records from January 2012 - December 2021 were retrieved from our hospital management information system for this study. Data from 63 patients with PUO were analyzed according to Petersdorf criteria.

Results: Out of 63 patients with PUO, BMB was diagnostic in 25 (39.68%) patients. The leading cause of PUO was infectious disorders (mycobacterium tuberculosis, visceral leishmaniasis, malaria), followed by inflammatory disorders and hematological malignancies. In 38 (60.31%) patients, BMB could not detect any underlying pathology. BMC showed growth in only 03(4.76%) patients, and the diagnostic yield of BMC was meagre.

Conclusion: BMB is essential in establishing a diagnosis in patients with PUO. Infectious diseases are the leading cause of PUO, and BMC should not be included as a routine investigation in the initial evaluation of a patient with PUO.

 

References

Beresford RW, Gosbell IB. Pyrexia of unknown origin: causes, investigation and management. Intern Med J. 2016; 46 (9): 1011-1016. doi: 10.1111/imj.13180.

Bosilkovski M, Baymakova M, Dimzova M. Fever of Unknown Origin (FUO): Towards a Uniform Definition and Classification System. Erciyes Med J. 2020; 42(2): 121–126. doi: 10.14744/etd.2020.56667.

Cunha, BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. Am J Med. 2015; 128(10), 1138.e1-1138.e15.

doi: 10.1016/j.amjmed.2015.06.001.

Wright WF, Auwaerter PG. Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. Open Forum Infect Dis. 2020; 7(5): ofaa132.

doi: 10.1093/ofid/ofaa132.

Hot A, Jaisson I, Girard C, French M, Durand DV, Rousset H et al. Yield of Bone Marrow Examination in Diagnosing the Source of Fever of Unknown Origin. Arch Intern Med. 2009; 169(21): 2018-2023. doi: 10.1001/archinternmed.2009.401.

Bharuthram N, Feldman C. The diagnostic utility of bone marrow examination in an infectious disease ward. South Afr J HIV Med. 2019; 20(1): 974.

doi: 10.4102/sajhivmed.v20i1.974.

Quesada AE, Tholpady A, Wanger A, Wanger A, Nguyen AN, Chen L. Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS. J Clin Pathol. 2015; 68(3): 241-5. doi: 10.1136/jclinpath-2014-202715.

Ahmed S, Siddiqui AK, Mehrotra B. Diagnostic yield of bone marrow examination in fever of unknown origin. Am J Med. 2003; 115(7): 591-2. doi: 10.1016/s0002-9343(03)00450-9.

Arya A, Naithani R. Futility of Performing Bone Marrow Cultures in Pyrexia of Unknown Origin. Indian J Hematol Blood Transfus. 2017; 33(1): 142-143.

doi: 10.1007/s12288-016-0705-8.

Wright WF, Mulders-Manders CM, Auwaerter PG, Bleeker-Rovers CP. Fever of Unknown Origin (FUO) - A Call for New Research Standards and Updated Clinical Management. Am J Med. 2022; 135(2):173-8. doi: 10.1016/j.amjmed.2021.07.038.

Jha A, Sarda R, Gupta A, Talwar OP. Bone marrow culture vs. blood culture in FUO.

J Nepal Med Assoc. 2009; 48(174): 135-8.

Hong FS, Fox LC, Chai KL, Htun K, Clucas D, Morgan S et al. Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context. Intern Med J. 2019; 49: 850-854. doi: 10.1111/imj.14147.

Gupta R, Setia N, Arora P, Singh S, Singh T. Hematological profile in pyrexia of unknown origin: role of bone marrow trephine biopsy vis-à-vis aspiration. Hematology. 2008; 13(5): 307-312. doi: 10.1179/102453308X343446.

Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003; 163: 545-551.

doi: 10.1001/archinte.163.5.545.

Ben-Baruch S, Canaani J, Braunstein R, Perry C, Ben-Ezra J, Polliack A et al. Predictive parameters for a diagnostic bone marrow biopsy specimen in the workup of fever of unknown origin. Mayo Clin Proc. 2012; 87(2): 136-42. doi: 10.1016/j.mayocp.2011.08.002.

Memon WR, Hashami U, Khaskheli AM, Ahmed A, Qureshi KA, Khan BB. The Diagnostic Usefulness of Bone Marrow Examination and Bone Marrow Culture in Patients with Pyrexia of Unknown Origin. J Pharmaceut Res Int. 2021; 33(59A): 144-9. doi: 10.9734/jpri/2021/v33i59A34258.

Oliver SAC, Bove BV, Bradvica VV, Batista UN, Palacio PR, Guillrmo EC et al. Usefulness of myeloculture for the etiological diagnosis of bacterial infections. Rev Mex Patol Clin Med Lab. 2018; 65(1): 34-38.

Sharvit G, Schwartz D, Heering G, Shulman A, Avigdor A, Rahav G et al. Evaluation of the clinical impact of bone marrow cultures in current medical practice. Sci Rep. 2022; 12(1): 9664. doi: 10.1038/s41598-022-14059-3.

Downloads

Published

29-03-2023

How to Cite

1.
Khaliq S, Ali H. Diagnostic Utility of Bone Marrow Biopsy/ Bone Marrow Culture in Pyrexia of Unknown Origin: A Ten-Year Retrospective Analysis. J Liaq Uni Med Health Sci [Internet]. 2023 Mar. 29 [cited 2024 Nov. 15];22(01):40-3. Available from: http://121.52.154.205/index.php/jlumhs/article/view/1007

Issue

Vol. 22 No. 01 (2023): Journal of Liaquat University of Medical & Health Sciences

Section

Original Articles

License

Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Submission of a manuscript to the journal implies that all authors have read and agreed to the content of the undertaking form or the Terms and Conditions.

When an article is accepted for publication, the author(s) retain the copyright and are required to grant the publisher the right of first publication and other non-exclusive publishing rights to JLUMHS.

Articles published in the Journal of Liaquat University of Medical & health sciences are open access articles under a Creative Commons Attribution-Noncommercial - Share Alike 4.0 License. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. This is in accordance with the BOAI definition of open access. In addition to that users are allowed to remix, tweak and build upon the work non-commercially as long as appropriate credit is given and the new creations are licensed under the identical terms. Or, in certain cases it can be stated that all articles and content there in are published under creative commons license unless stated otherwise.