The following morning Grace is seen on rounds.

She is now afebrile and her nausea is improved. She remains dyspenic, and her pulse ox shows A saturation of 88% with A pulse of 112. Luckily, she had the $1.50 for a chest X-ray, which is found stuffed under the mattress of her bed. Click here for a larger image. The film shows Bilateral infiltrates and Marked left hilar adenopathy.

Photo courtesy of Government of Hong Kong Health Department.

Grace has pulmonary tuberculosis with a superimposed mild case of malaria.

• The worsening of her symptoms probably resulted from her malaria.
• The diagnosis of TB should be confirmed by identification of AFB in her sputum.
• This case emphasizes two importance features of medicine in Kenya
• The great frequency of malaria, and
• The fact that malaria may not be the only
• If Grace's hemogram had showed a low lymphocyte count, she would need to be worked up for AIDS
• She should be treated with quinine (oral) for 7-10 days.
• For TB, she should receive 4-drug therapy (INH, Rifambin/PZA plus ethambutol).

Naomi is waiting to be seen. She complains of cough, fatigue and weight loss.