The Diagnostic Usefulness of Bone Marrow Examination and Bone Marrow Culture in Patients with Pyrexia of Unknown Origin

Introduction: Bone marrow cultures (BMCs) are usually obtained in the diagnosis of pyrexia of unknown origin (PUO). In the effort to identify the cause of systemic infection, BMCs are often performed in addition with blood cultures (BCs) and cultures of other body fluids and tissues. The practice of performing BMC and Blood cultures is long-standing, but the medical importance is questionable. Given the importance of cost effectiveness, such practices must be assessed on the basis of their cost-benefit to patient outcomes. In this study we compared the value of BMC with BC and studied the usefulness of the histopathological features of bone marrow trephine biopsy specimens in detecting the cause of systemic infections in selected patient population with PUO. Objective: To determine the usefulness of bone marrow culture for the diagnosis of different causes of pyrexia of unknown origin. Study Design: Descriptive Cross-sectional study Place and Duration of Study: This study was conducted at Peoples University of Medical and Health Sciences for Women Nawabshah Pakistan from June January 2020 to January 2021. Materials and Methods: A total 150 patients were included in this study who fulfilled the criteria of pyrexia of unknown origin. The bone marrow aspiration, biopsy, and blood cultures specimens were obtained using standard techniques and bone marrow culture send for microbial analysis. Results: 1.5% of patients had hematomas, one diagnosed with Behcet disease, other patients with acute leukemia. The bone marrow aspiration results exhibited that 23 patients (15.3%) diagnose with a hemophagocytic syndrome where 3 cases of infection, 3 cases with hematological malignant disorder, and 7 cases with hemophagocytosis, and repercussion of bone marrow aspiration diagnosed 5 acute leukemia and 2 with visceral leishmaniasis. The usefulness of BMB was determined through an odd ratio of few parameters including thrombocytopenia with odd ratio 4.59 and 95% CI (1.07-8.4), anemia odd ratio 3.17, and CI (1.09-12.92) were considered most associated factors for the usefulness of BMB. BMC in 13 (8.66%) patients out of 150 were found with bacterial growth and 2 (1.33%) cases with bacterial growth were observed in blood culture. There was no fungal and mycobacterial growth observed. In the BMC analysis 2 cases of E. coli, 3 cases with Staphylococcus aureus, 2 cases of Enterococcus sps. while 4 cases of Salmonella typhi and 2 cases of Salmonella paratyphi-A were diagnosed in blood culture analysis. Conclusion:  The obtained data indicate that blood culture did not divulge bacterial growth without the bone marrow culture. Therefore bone marrow culture was found to be an important diagnostic modality and correlation was found for thrombocytopenia and anemia. Bone marrow biopsy is deemed a useful method to diagnose pyrexia of unknown origin.