Chimera Mwera is 11 years old, short for his age and underweight. He has lived with his grandmother since his parents died 2 years ago. His father died of chronic cough (probably undiagnosed AIDS related TB) and his mother of a sudden fever (she was probably HIV positive too). He is an only child, his only other sibling died some years back. His Granny loves him dearly and he loves her. He was admitted to our wards about a month ago with a cough, fever and a bad chest. He was very ill and his chest x-ray showed pneumonic changes in both lungs. He had fluid on one lung too. He was put on antibiotics, tested for TB with a skin test (Mantoux test) and sputum sent for TB testing. After counselling his granny agreed that he be tested for HIV. The tests for TB were negative but the HIV test was positive.

[Note from Dr Peter Davies, TB Alert UK: The golden standard for diagnosing TB is to look at sputum for the presence of acid fast bacilli (AFBs) which are the cause of TB. Adults have the type of lung TB that forms abscesses and they produce lots of sputum, lots of AFBS and can hawk it up to be tested. Children do not have lung abscesses and cannot produce sputum to easily test for AFB’s. Many ways of trying to get sputum such as stomach aspirations (for swallowed sputum), nose aspiration, inducing sputum from the lungs with an inhaler are variably successful and quite difficult to do properly. X-rays very often do not confidently confirm the diagnosis. To make matters more complex, the Mantoux test in children can often be falsely negative if the patient is HIV+ because the HIV suppresses the immune response to the test. A contact history, a skin test, X-ray findings all have to be assessed in the light of a good clinical examination.]

Despite the antibiotics Chimera continued to cough and appear unwell. His fever, though slight, did not settle. In the second week of admission he was put on TB treatment. Almost immediately he started to gain weight, appear brighter, cough less and began to play with other children on the ward. Granny and Chimera will go home this week. He will be followed up in clinic to complete his TB treatment. More importantly he will be assessed for going on to HIV treatment. Chimera will live with HIV for the rest of his life but now he can do just that - LIVE. He didn't die of TB, and if he can get HIV drugs he may live a long time. Granny is proud of him.  So are we.

Margaret Mwandama  holds her child Ganaza, who is suffering from TB in the spine.  The nurse, one of those whose salary comes from the TBA grant – is Joyce Maganga.  With our help Joyce  can make sure that Ganaza grows up healthy and is not crippled for life from his early brush with TB.

M is eight years old. Two years ago M's uncle stayed with the family and during that time the uncle was found to have sputum positive TB. 

For 6 months M had a growing ulcerated area on his nose. He was too miserable and embarrassed to go to school. He lost weight and became very thin. His eyes were red and sore and he constantly rubbed them.His mother had tried various medicines recommended by the local clinic and pharmacist, but nothing helped and lastmonth he was sent to us with a diagnosis of 'tumour of the nose'.

We decided to do a Mantoux test (which checks for TB). The test confirmed our suspicion of TB, and we started him on treatment.  Within weeks the sore started to get smaller. As he gets older the scarring will fade.  Without treatment the sores would have caused him great pain and disfigurement, and the infection could have spread, eventually leading to death.