Abstract

Background: Diagnosis of Pyrexia of unknown origin (PUO) remains challenging despite availability of modern diagnostic techniques. PUO may result from various etiologies among which infectious diseases are largely responsible. Many diagnostic approaches are currently applied. A detailed history with complete general physical examination followed by base line investigations with other specific tests like imaging, microbiological tests and biopsies are employed for diagnosis of PUO. This study aimed to evaluate the effectiveness of bone marrow biopsy in the diagnosis of PUO and highlighted the existing spectrum of diseases involved in PUO.

Methods and Methodology: This Cross sectional study was conducted in Dr Ishrat ul Ebad Khan Institute of Blood Diseases, DUHS; Karachi from 2015 to 2018 evaluated the records of patients who had bone marrow aspiration and biopsy Patients included in this study had a history of Pyrexia of Unknown origin and met the Petersdorf and Beeson criteria for PUO i.e. fever for a duration of more than 3 weeks before diagnosis. An informed consent was taken from all patients.

Results: We analysed medical histories of 67 patients (48 males and 19 females) who were recommended bone marrow biopsy and aspiration for the assessment of PUO. The mean age was 38 years. Most common clinical symptoms were fever, hepato-splenomegaly followed by abdominal pain and weight loss. Anaemia was the most common haematological parameter found in this study. Most frequent diagnosis was Non-Hodgkin’s Lymphoma in about 25% of patients.

Discussion: Number of factors influenced the diagnosis of pyrexia of unknown origin (PUO) which makes it difficult to compare patients suffering from it. As bone marrow biopsy is a highly invasive and painful procedure it is not considered a first line tool for the diagnosis of PUO. Numbers of studies suggested bone marrow biopsy as a routine test for PUO. Our findings were supported by many studies.

Conclusion: Bone marrow biopsy is an important investigation and can supplement other laboratory investigations for the diagnosis of Pyrexia of unknown origin.

Keywords: Pyrexia of Unknown Origin; Bone Marrow Biopsy; Bone Marrow Aspirate

References

1. Zhao J., et al. “[Significance of Bone Marrow Unclassifiable Cells in Diagnosis of Fever of Unknown Origin]”. Zhongguo Shi Yan Xue Ye Xue Za Zhi6 (2019): 1845-1849.
2. Ben-Baruch S., et al. “Predictive parameters for a diagnostic bone marrow biopsy specimen in the work-up of fever of unknown origin”. Mayo Clinic Proceedings2 (2012): 136-142.
3. Hajiabdolbaghi M., et al. “Bone Marrow Aspiration/Biopsy in the Evaluation of Fever of Unknown Origin in Patients with AIDS”. Infectious Disorders - Drug Targets (2020).
4. Petersdorf RG and Beeson PB. “Fever of unexplained origin: report on 100 cases”. Medicine 40 (1961): 1-30.
5. Durack DT and Street AC. “Fever of unknown origin--reexamined and redefined”. Current Clinical Topics in Infectious Diseases 11 (1991): 35-51.
6. Knockaert DC., et al. “Fever of unknown origin in adults: 40 years on”. Journal of Internal Medicine3 (2003): 263-275.
7. Bharucha T., et al. “Pyrexia of unknown origin in clinical practice”. British Journal of Hospital Medicine10 (2016): 579-583.
8. Galanakis E., et al. “Fever of unknown origin”. Lancet9088 (1997): 1401-1402.
9. Arnow PM and Flaherty JP. “Fever of unknown origin”. Lancet9077 (1997): 575-580.
10. Kilby JM., et al. “The yield of bone marrow biopsy and culture compared with blood culture in the evaluation of HIV-infected patients for mycobacterial and fungal infections”. The American Journal of Medicine2 (1998): 123-128.
11. McGregor AC and Moore DA. “Infectious causes of fever of unknown origin”. Clinical Medicine3 (2015): 285-287.
12. Kumar V., et al. “Role of Bone Marrow Examination in the Evaluation of Infections: Clinico-Hematological Analysis in a Tertiary Care Centre”. Turk Patoloji Dergisi 1 (2020): 17-22.
13. Bleeker-Rovers CP., et al. “A prospective multi-centre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin”. European Journal of Nuclear Medicine and Molecular Imaging5 (2007): 694-703.
14. Mourad O., et al. “A comprehensive evidence-based approach to fever of unknown origin”. Archives of Internal Medicine 5 (2003): 545-551.
15. Kejariwal D., et al. “Pyrexia of unknown origin: a prospective study of 100 cases”. Journal of Postgraduate Medicine 2 (2001): 104-107.
16. De Kleijn EM., et al. “Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group”. Medicine6 (1997): 401-414.
17. Diebold J., et al. “Bone marrow manifestations of infections and systemic diseases observed in bone marrow trephine biopsy review”. Histopathology3 (2000): 199-211.
18. Basu D., et al. “Granulomas in bone marrow--a study of fourteen cases”. Indian Journal of Pathology and Microbiology1 (2005): 13-16.
19. Vilalta-Castel E., et al. “Significance of granulomas in bone marrow: a study of 40 cases”. European Journal of Haematology 1 (1988): 12-16.
20. Gupta R., et al. “Hematological profile in pyrexia of unknown origin: role of bone marrow trephine biopsy vis-a-vis aspiration”. Hematology5 (2008): 307-312.
21. Hong FS., et al. “Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context”. Internal Medicine Journal 7 (2019): 850-854.
22. Hot A., et al. “Yield of bone marrow examination in diagnosing the source of fever of unknown origin”. Archives of Internal Medicine 21 (2009): 2018-2023.
23. Tshabalala WS., et al. “Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa”. African Journal of Laboratory Medicine 1 (2020): 1028.
24. Larson EB., et al. “Fever of undetermined origin: diagnosis and follow-up of 105 cases, 1970-1980”. Medicine5 (1982): 269-292.

Citation

Citation: Mehwish Sajjad., et al. “Effectiveness of Bone Marrow Biopsy for the Diagnosis of Pyrexia of Unknown Cause (PUO)". Acta Scientific Microbiology 3.12 (2020): .

Copyright

Copyright: © 2020 Mehwish Sajjad., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.