ABSTRACT
OBJECTIVE: Bone marrow examination (BME) is an important modality for investigation of case of pyrexia of unknown origin (PUO). However, its yield in the diagnosis of infections has not been extensively studied and its role has not been well established. The aim of the study was to investigate the usefulness of BME and to evaluate the etiological and clinico-hematological profile in cases of bone marrow infections. MATERIAL AND METHOD: This was a retrospective study where bone marrow cases were retrieved and a review of bone marrow findings with an infectious etiology from July 2014 to June 2018 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Clinico-hematological correlation using descriptive statistics was performed. RESULTS: The study included 55 cases, on analysis of which the maximum number of infections were those of leishmaniasis accounting for 35%, followed by HIV (29%) and tuberculosis (15%). Other etiological agents included fungal infections (histoplasmosis and aspergillosis), Enteric fever, Scrub typhus, parvovirus, falciparum malaria and filariasis. The most common clinical presentation was fever (80%) and the most common clinical finding was splenomegaly (66%). CONCLUSION: Bone marrow examination is an important diagnostic tool to delineate etiological diagnosis in infectious conditions, particularly those presenting with PUO. Moreover, it is particularly important if urgent diagnosis is required or if alternate diagnostic modalities have not revealed a reason for PUO.
Subject(s)
Bone Marrow Examination , Bone Marrow/pathology , Communicable Diseases/pathology , Fever of Unknown Origin/etiology , Adolescent , Adult , Aged , Child , Child, Preschool , Communicable Diseases/complications , Female , Fever of Unknown Origin/diagnosis , Host-Pathogen Interactions , Humans , Infant , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Tertiary Care Centers , Virus Diseases , Young AdultABSTRACT
BACKGROUND: Leishmaniasis is the prevalent in tropical and subtropical regions of the world. Demonstration of Leishman-Donovan (LD) bodies in the bone marrow aspirates (BMA) is vital to diagnosis of visceral leishmaniasis (VL). In the present study, we studied the clinicohematological parameters encountered in VL and correlated them with parasite load on BMA. METHODS: Retrospective analysis over 3 years was done; clinical details, biochemical profile, complete hemogram with peripheral smear findings, and BMA smears were reviewed and average parasite density (APD) calculated in each case. Multivariate analysis and tests of significance were applied. RESULTS: The study included 28 patients. Splenomegaly showed a positive trend with APD. rK39 antigen detection test was 100% positive in select cases. A strong negative correlation was observed between albumin to globulin ratio and grade of APD. BMA revealed hemophagocytosis (HPS) in 78.57% cases and it had a significant strong correlation with APD (P = 0.014). A significant correlation was also observed between APD and bone marrow plasma cell percentage (P = 0.01). LD bodies were noted in unusual locations such as within myelocytes (14.2%), plasma cells (7.1%), and megakaryocytes (10.7%). CONCLUSION: HPS and bone marrow plasmacytosis were two statistically significant findings, which showed positive correlation with parasite load. The presence of these two findings should prompt hematopathologists for more focused search of hemoparasites in BMA to arrive at a definitive diagnosis. This will avoid unnecessary workups and improve the prognosis. To the best of our knowledge, a statistical correlation between APD and clinicohematological parameters has never been previously studied.