DETECTION OF MYCOBACTERIUM-AVIUM-INTRACELLULARE COMPLEX IN BONE-MARROW SPECIMENS OF PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Thirty-seven bone marrow core biopsy specimens from 21 human immunodef iciency virus-infected patients with Mycobacterium avium-intracellular e complex bacteremia were stained using rabbit polyclonal antibodies a gainst Mycobacterium bovis strain Bacillus-Calmette-Guerin (BCG) and M ycobacterium duvalii, as well as Kenyon and Fite stains, to compare se nsitivities of these techniques and evaluate possible response to ther apy. The patients in this study had participated ina phase I/II trial of liposome-encapsulated gentamicin therapy. Two biopsy specimens had inadequate tissue for evaluation. Thirtytwo specimens demonstrated bac illi with anti-M duvalii, 33 with anti-BCG, 20 with Kenyon, and 23 wit h Fite. Two were negative with all stains. Fifteen biopsy specimens ha d epithelioid granulomas, 12 had histiocytic granulomas, and 1 had a g ranuloma of indeterminate type. The remaining seven biopsy specimens h ad no granulomas. Four of these seven demonstrated bacilli with anti-M duvalii, 5 with anti-BCG, 1 with Kenyon, and 2 with Fite. The number of M avium-intracellulare organisms per milliliter of blood decreased in 14 of 21 patients after liposome-encapsulated gentamicin therapy. H owever, none of the 11 patients whose pre- and posttherapy bone marrow core biopsy specimens were both evaluable demonstrated a reduction in the number of M avium-intracellulare organisms. The authors concluded that anti-M duvalii and anti-BCG are more sensitive than acid-fast st ains for identifying M avium-intracellulare infection in bone marrow c ore biopsy specimens of patients who have acquired immunodeficiency sy ndrome (AIDS) with M avium-intracellulare bacteremia. Bone marrow core biopsy specimens may provide a perspective on ill avium-intracellular e infection in AIDS patients that differs from the one provided by blo od cultures.