The woman had been in close contact with a confirmed index TB case in her family. The index case experienced five months of coughing prior to diagnosis and started anti-TB chemotherapy in July 2008. The household comprised of five other family members: three adults and two children (nine and two years old). The woman also had regular contact with about 100 students in her class at the university. During the three months she experienced TB symptoms she attended full time classes spending about six hours in class for four to five days each week.
The woman used herbal medicine given to her by a traditional healer in the first month of onset of symptoms without much relief. A few weeks later, she sought care from a private provider in a drug store where she received anti-malarial and pain treatment with only mild relief of symptoms. No laboratory investigations were performed to confirm her diagnosis. At the time she was identified by the community active case finding survey team, she noticed her chest symptoms worsening but was not planning to seek further care until she started her university holiday recess.
During the survey, two sputum samples were collected, a tuberculin skin test (TST) was placed, and a rapid HIV test with same day results was performed. Smear microscopy using the Ziehl Neelsen acid-fast bacilli staining method and culture were performed. The woman was HIV negative, TST skin test positive at 18.6 mm after 48 hours, both sputum smears were positive (grade 3 + ), and sputum culture positive. After confirmation of active TB, the patient was started on standard TB treatment that she completed successfully.