The name of the child in this story has been changed to protect confidentiality.
Molahlehi was fifteen years old, and weighed just 73 pounds, when he was referred to treatment in an MDR-TB program. Having first been treated for TB when he was 11, he had already received two previous, ineffective courses of first-line anti-TB treatment. Molahlehi had lost his mother, father, and brother to TB while they were receiving the same first-line treatment.
Molahlehi’s new clinicians realized that his family members had probably had MDR-TB. As such, they began Molahlehi on MDR-TB treatment immediately. Three months later, Molahlehi’s culture-based drug susceptibility testing surprisingly revealed that his TB was actually still susceptible to four of the main first-line anti-TB drugs. However, these results could not be confirmed because of difficulties in obtaining further positive cultures. Because Molahlehi had such extensive damage in both lungs (including fibrosis and cavitary lesions), his doctors continued administering second-line drugs, and added three first-line drugs.
Molahlehi suffered many adverse effects from his treatment, including vomiting; joint pain; low potassium levels in his blood; hypothyroidism; and damage to his kidneys, ears and nerves. At one point, Molahlehi’s lung collapsed, and he required a chest tube. His clinicians monitored him closely and addressed these concerns as quickly as possible.
In addition to the painful and invasive procedures, and the difficulties of tolerating multiple toxic drugs, Molahlehi experienced severe depression and social isolation. It turned out that the depression was due to his hypothyroidism, and his mood improved immediately when he was started on thyroxine replacement therapy. Molahlehi’s aunt had been taking care of him before his diagnosis of probable MDR-TB, but she abandoned him when he received his diagnosis. After some discussion between his physicians and his family, the aunt eventually took him back into her care, but she made him stay outside of the house, even after he was not contagious. Molahlehi dropped out of school; he couldn’t stand his classmates making fun of how thin he was.
But Molahlehi was strong, and stuck with his MDR-TB treatment for all 20 months until he was cured. With support from a nongovernmental organization, he began income-generating activities, including making and selling jerseys, rearing and selling rabbits, and gardening. Molahlehi has returned to school, and now supports his aunt and his cousins with his hard-earned income.