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. 2018 Aug 1;13(8):577-581.
doi: 10.12788/jhm.2981. Epub 2018 Jun 27.

Diagnosing the Treatment

Sarah A McGuffin  1   2 , Robert L Trowbridge  3   4 , Ann M O'Hare  5   6 , Andrew P Olson  7   8   9
Affiliations

Diagnosing the Treatment

Sarah A McGuffin et al. J Hosp Med. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

The authors have no financial or other conflicts of interest that might bias this work

Figures

Figure 1
Figure 1
Blood cultures showing acid-fast bacteria on Kinyoun stain at low (A) and higher (B) power. The mycobacteria bacilli in the patient’s cultures assembled in an end-to-end serpentine arrangement known as “cording.” Cord formation is characteristic of mycobacteria and due to a specific cell wall glycolipid, trehalose 6, 6’-dimycolate or cord factor, that has been shown to contribute to mycobacterial virulence, granuloma formation, and humoral and cellular immune responses. The tendency to aggregate in cords actually disappeared in the attenuated form of Mycobacterium bovis cultured by Calmette and Guerin, suggesting that our patient had been exposed to, and thus subsequently infected with a more virulent form of BCG. (C) Auramine stain of blood cultures growing Mycobacterium bovis, again showing similar serpentine cord formation. (D) Bone marrow biopsy with multiple granulomas consisting of histocytes and Touton-type giant cells consistent with BCG infection.
See this image and copyright information in PMC

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