Case 1

A 5 month old Asian girl who had not been vaccinated for tuberculosis was seen as a contact of her grandmother, who had fully sensitive pulmonary tuberculosis. She was well at this time and after one negative result on Heaf testing (grade 0) was given a BCG vaccination and discharged.

Six weeks later she presented to her general practitioner with fever, poor feeding, and vomiting. She was referred to hospital. On examination she was pale and unwell and tachypnoiec, with widespread crepitations on auscultation, but no hepatosplenomegaly. A chest x ray film showed extensive miliary shadowing, with a small opacity in the right mid zone. Miliary tuberculosis was diagnosed. A nine month course of triple antituberculous chemotherapy produced a full recovery.

Case 2

A 6 year old white girl was screened as a contact of an aunt who had fully sensitive smear positive pulmonary tuberculosis. Two Heaf tests six weeks apart gave negative results, and she was given a BCG vaccination. Two weeks later she presented at her local hospital with a history of cough, headaches, weight loss, and fever. A chest x ray film showed right middle lobe consolidation. The family history of tuberculosis was not volunteered or asked …