When Husham, a 6-year-old boy, came to the National Tuberculosis (TB) Institute’s drug-resistant TB (DR-TB) clinic in Baghdad in November 2022 he appeared frail and underdeveloped. Husham had a persistent cough, high fever, lethargy and had lost all interest in playing.

His family had already been deeply affected by TB. One of Husham’s sisters had been diagnosed with TB lymphadenitis and tragically passed away after relapsing with TB of the spine that was unresponsive to standard first-line treatment. A second sister, also diagnosed with TB lymphadenitis, began to improve only after being treated for clinically diagnosed DR-TB.

Husham, too, had received a TB lymphadenitis diagnosis. His condition deteriorated rapidly – he was constantly coughing, refused food and showed signs of emotional withdrawal. The standard anti-TB regimen produced no improvement, and his family had exhausted all local resources.

Diagnosing TB in young children is especially challenging due to the difficulty of producing sputum samples and the overlap between TB symptoms and those of other common pediatric illnesses.

After a thorough evaluation and review of the family’s medical history, Husham was diagnosed with DR-TB. He was immediately started on an individualized treatment regimen that included the newer-generation drugs bedaquiline and delamanid, known for their efficacy and safety in treating pediatric DR-TB cases.

Follow-up and supportive care were provided throughout the treatment course. Husham’s condition was carefully monitored with clinical assessments and imaging, including chest X-rays. Family members were also evaluated for TB.