Bone marrow culture for diagnosis of mycobacterial and fungal infections in febrile patients.

The perception and evaluation of patients with fever are constantly evolving. Due to sophisticated technology and financial constraints, increasing numbers of tests are performed earlier in patient evaluation. One is bone marrow culture for mycobacteria and fungi. To assess the yield of this procedure, we reviewed the results of cultures performed from 1982-1986 at Shands Hospital at the University of Florida. There were 124 patients so evaluated. No fungal cultures were positive. Four mycobacterial cultures were positive: three Mycobacterium avium-intracellulare, all in patients with AIDS (Acquired Immune Deficiency Syndrome), and one Mycobacterium tuberculosis in a patient with disseminated disease. Three patients ultimately found by other means to have disseminated mycobacterial infection were culture negative. We conclude that this procedure is of very low yield and only warranted in the patient with severe immunocompromise or the patient with strong clinical evidence of disseminated tuberculosis.