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The objective of this study was to evaluate the usefulness of blood culture in the diagnosis of disseminated mycobacteria (DMB). This prospective study included all blood cultures done for patients with fever and under suspicion of having DMB between January 1991 and July 1992. Fifty-seven blood samples from 16 patients were cultured; 14 (87.5%) patients were HIV positive and all were diagnosed as having DMB. The cultures were processed by lysis-centrifugation and identification of mycobacteria was by hybridization with a DNA probe. Mycobacterial growth was detected in 5 cultures (8.7%) from 4 patients (25%) (3 HIV positive). M. tuberculosis was isolated in 3 and M. avium in 1. Mean time until isolation was 46 days. In all cases mycobacteria were isolated in other samples before they were found in cultures: M. tuberculosis was isolated in 2 bronchial aspirates (BAS), 2 in liver tissue (L), 2 in spleen tissue (S), one in alveolar bronchial lavage, one in sputum, one in spinal fluid (SF) and one in urine. M. avium was isolated in sputum and ALB. The three patients in whom M. tuberculosis was found died 1.4 and 32 days after admission. In samples from the 12 DMB patients with negative cultures (11 HIV positive, 92%), M. tuberculosis was isolated in 100% of ganglion and S samples, 90% in urine, 69% in sputum, 67% in ABL and LB, 63% in BAS and 33% in SF. None of these patients died in hospital. We find blood culture to be of little use in the diagnosis of DMB. Analysis of other samples leads to faster diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)