Ward round in Moyo House: Management issues in malnourished children with HIV and tuberculosis (TB).

Case 1 GB is a 4 month old male currently living with his aunt. His mother is deceased and nothing is known about the mother’s health or the birth history. Over the last 4 weeks, GB developed worsening watery non-bloody diarrhea and felt warm to his caregivers. Over the last week his oral intake decreased significantly; he is being fed formula and phala (soft maize porridge). On examination, GB appears very wasted and is irritable. His weight is 2.8 kilograms; his length is 58 centimeters which calculates to a weight for height Z score (WHZ) of -4.0. His temperature is 34.6 C. His heart rate is 180/min. Respiratory rate is 60/min. His skin hangs loosely and he has very little muscle mass. In his oropharynx he has thick white plaques covering his tongue and his mucous membranes are dry. His lungs are clear and he has minimal retractions. His heart exam is notable for a prominent visible heart pulsations due to his thin body habitus. There are no appreciable murmurs or gallops. He has good bowel sounds, with a liver edge palpable 2 centimeters below the right costal margin and a palpable spleen tip. He also has diffuse lymphadenopathy. The infant is admitted and management is started for his malnutrition. The doctor also orders an HIV test which comes back reactive.