The role of tissue studies in facilitating early initiation of antimycobacterial treatment in AIDS patients with disseminated mycobacterial disease

SETTING: The question of whether aggressive investigations are useful in di agnosis and initiation of treatment in AIDS patients with disseminated myco bacterial disease (DMD) is still under debate. OBJECTIVE: TO define the role of tissue studies in facilitating early initi ation of antimycobacterial treatment and in establishing diagnosis in AIDS patients with DMD. DESIGN: From July 1994 through June 1997, 167 AIDS cases with fever were ev aluated by stepwise investigation using a standardized protocol. Data of DM D cases were analyzed to define the role of tissue studies. RESULTS: A total of 40 cases of culture-proven DMD were identified. Antimyc obacterial treatment was initiated due to positive acid-fast bacilli smears of sputum in only five cases. In the remaining cases, positive patho-logic findings from tissue biopsies (lymph node, bone marrow or liver) facilitat ed early initiation of treatment in 60% (21/35). In 50% of all cases (20/40 ), the diagnosis could not have been established if cultures of tissue biop sies had not been performed. Both the pathologic examinations and mycobacte rial cultures from liver biopsies had positivity rates of more than 50% (53 .8% and 69.2%, respectively). CONCLUSIONS: Tissue studies were useful in facilitating early initiation of treatment and establishing diagnosis at least in half of the AIDS cases wi th DMD. Liver biopsy is worthwhile if the cause of fever is not discovered using less invasive investigations.