Primary Complex Thread 2

[killbill]

@killbill:
Pasok pa ba sa 48 to 72 hours? That is the time kasi where PPD reading should be made. After that, whatever reaction that may occur will be insignificant.
Best to ask clarification from your pedia pa rin since she was the one who made the initial reading.

Thanks Doc. Galing na kami sa pedia niya yesterday, tama po kayo ganun din ang sabi niya. insignificant na nga daw yun, matagal lang talaga mawala yung pantal. na praning lang ako talaga kasi akala ko baka delayed reaction lang.

[fysai]

marami pong salamat doc lelet! may God gave you more strength and wisdom so that you can continue with what you are doing. you've been such a great help.. thanks a lot!

[leletmd]

You're welcome.

@killbill:
PPD is considered a delayed type skin test kaya it can take 2 to 4 weeks for the mark to disappear.

[lindseigh]

hi doc lelet its me again, just want to ask, we had just finished 9 mos medication last oct, then at the end this nov. pedia said that the pc has recurrence over my daughter, bakit po kaya ganon kabilis nman mag recurrence ang pc? pina xray po uli sya and findings is no changes daw from her last xray w/c is july. is it ok to have xray 3x this year ang bata? and one thing, suspected source was medicated already. i was really upset when i knew it, right now di nwawala ang cough nya but the cough is i think from her throat naman, should i seek 2nd opinion? need your advise, thanks

[leletmd]

Lindseigh:
There is such a thing as radiologic lag wherein x-ray results show no change but clinically there is already improvement/healing. This is the reason why hindi routine ang pagpapax-ray at 6 month of treatment kasi nga pwede pa rin may findings sa x-ray pero magaling na ang bata or patient.
Bakit pinaulit ang x-ray ng July and Nov? Clinically speaking, how is your child? May weight gain ba? Good activity? Pagliit ng lymph nodes, etc?
Wala bang ibang mahanap na possible cause for the recurrence of the cough? Cough ba talaga or throat clearing?
Kung recurrence man, sobrang bilis. Baka better to label it as not yet fully treated rather than recurrence? What was your pedia's basis for stopping the treatment at 9 months?
Maybe it would be better for you to bring your child to a pedia pulmo or an infectious disease specialist para maclear kung may recurrence talaga.

[lindseigh]

hi doc lelet,
after 6 mos of medication (pc was diagnoss  January 2010) repeat x-ray by july, pedia said to continue 3 more mos. bec as per x-ray minimal clearing shows, 3 mos. was ended Oct2010. Then this end of Nov. nga nag dry cough sya and high fever. Nung pinacheck up ko sya sabi may naririnig daw sya kaya she requested to xray my child, then ayun nga po no changes since last July. My child is magana nman kumain, she weighs 17 kl at age 3, yung cough lang talaga sya nahihirapan.Pedia again prescribe pc meds again + ambroxol+co-amoxiclav. Maybe doc i should seek pedia pulmo (can you recomend?) para hanggat maaga malaman namin what is the root cause of it. Thank you so much!

[leletmd]

@lindseigh:
2010 or 2011? Please clarify...
I suggest you ask your pedia directly for a pedia pulmo referral para maayos ang palitan ng information regarding your child's case. You can just tell your pedia that you would like to know the reason behind the failure of treatment and what you can do pa to help your child.

[lindseigh]

@doc Lelet,

sorry doc its 2011 pala, nalilito na ko . Thanks po

[leletmd]

^ Masyadong mabilis para sabihin na recurrence. Ilang PC meds ang ibinigay and how many months daw ulit ang treatment?
Anyway, better to have her checked up na lang by a pedia pulmo or infectious disease specialist para maclarify ang need for additional treatment.

[swt_fem]

Hi Doc Lelet and mga sis,

Share ko lang po, tapos na kami sa PC treatment ng 1yr4m son ko. 6 months lang kami nag treatment. Nag positive sya sa PPD test pero negative sa X-ray noon. On the 6th month, nag-stop na kami sa meds. Hindi narin ni-require ni pedia-pulmo to repeat PPD test and x-ray.

Sa mga sis na tapos narin, hindi narin ba kayo umulit sa tests?

[lindseigh]

doc lelet, she gave the 3 meds for 3 months except pyrazinamide w/c is 2 mos only. Pacheck up ko n [textspeak!] sya sa pedia pulmo. Thanks a lot doc for your advise. 

[leletmd]

swt_fem:
 Nahanap niyo ang source of exposure?
Were you able to ask your pedia why 3 meds were given when the chest x-ray was negative and only the PPD was positive?
Hindi routine ang pag-ulit ng chest x-ray after 6 months of treatment kasi pwede nga na magkaroon ng radiologic lag, which means delayed ang pagtanggal ng findings on chest x-ray even if the child is already cured of PC. We rely on clinical findings (good weight gain, return of good activity and good appetite, decrease in size of lymph nodes, improvement in cough, etc.) rather than on a repeat chest x-ray.
Hindi rin nirerepeat ang positive na PPD since it can remain positive for a period of 3 years. If the PPD is repeated, it might produce a hyper - response. Mas lalaki ang reading compared to the previous reading.

[pumngold]

My baby is for xray na, kasi raw may lymph nodes and ang babang timbang niya.

[swt_fem]

swt_fem:
 Nahanap niyo ang source of exposure?
Were you able to ask your pedia why 3 meds were given when the chest x-ray was negative and only the PPD was positive?
Hindi routine ang pag-ulit ng chest x-ray after 6 months of treatment kasi pwede nga na magkaroon ng radiologic lag, which means delayed ang pagtanggal ng findings on chest x-ray even if the child is already cured of PC. We rely on clinical findings (good weight gain, return of good activity and good appetite, decrease in size of lymph nodes, improvement in cough, etc.) rather than on a repeat chest x-ray.
Hindi rin nirerepeat ang positive na PPD since it can remain positive for a period of 3 years. If the PPD is repeated, it might produce a hyper - response. Mas lalaki ang reading compared to the previous reading.

Hindi namin nalaman kung kanino nya nakuha, we were all negative. I suspect it was his first yaya. I didn't ask narin po his pedia why 3 meds were given. Kung clinical findings naman, I'd say ok na talaga baby ko. He's gaining weight na every month not like nung untreated pa yung PC na no weight gain for 3 months. Good appetite narin, sobrang siba na nga eh. Hehe. Hindi super laki ng weight gain nya monthly kasi nagkakasakit, recently he was confined due to acute gastroenteritis (napaka-sakitin parin nya actually), hopefully wala na talaga si PC.

[pumngold]

how to deal with PC of your child? may extra care ba sila? natatakot na ko baka magpositive nga baby ko sa Primary complex.

[pumngold]

We got already her xray, and negative result for PC. But we will still opt for PPD. Anung process nun? ilang days dapat bumalik sa doctor after the procedure with the skin test?

[emv555]

merry christmas mga momsies and doc lelet. just wanna ask if na experience [textspeak!] na po ang sakit na amoebiasis. my daughter 1 y.o last dec 24 we rushed to e.r kc high grade fever. at first tonislitis findings. on dec 25, no development sa fever 39 to 40 temp. nag chill na we rushed her again sa nearby hosp. pna iv na ng pedia traumatic sa kanya parang nadudurug puso ko habang knakabitan ng iv sobrang iyak nya. then aftr the labs lumabas na may amoebiasis kc dark brwn the stool na w abscess na. we just got home yesterday. d pa din cya magana magfid ng liquid kc may mouth sores and swollen gums. may PC din kc cya but aftr 2 months ng med we stopped last dec 24 kc bka masobrahan sa iniinum na gamot. she is nw taking metrononidaxole and cotrimoxazole. has anyone experienced this? how fast was the recovery tnx po

[swt_fem]

We got already her xray, and negative result for PC. But we will still opt for PPD. Anung process nun? ilang days dapat bumalik sa doctor after the procedure with the skin test?

You have to return 48 hours after the PPD test kasi makikita na result nun, ime-measure ni pedia ang circumference ng redness or swollen na spot kay baby. Kapag more than 11 mm ata, positive, I can't remember na. Basta yung sa son ko 14mm eh, parang kasing laki ng 25c.

[pumngold]

Ok thanks. Im still hoping na negative siya of having PC. Ang hirap kasi working mom ako.and di ko maasahan yaya niya.

[leletmd]

@emv555:
There is an amoebiasis thread. Maybe it would be better to post your concerns regarding amoebiasis on that thread para hindi OT.
Pasensya na, but stopping the PC meds mid - treatment is not recommended. Stopping the PC meds mid-treatment and then resuming it again after a few days may lead to increased risk of medication resistance and allergies. Is your pedia aware that you stop the PC meds? Also, aware ba ang doctors who gave antibiotics to your child that your child has PC and is taking PC meds? Dapat kasi nabigyan ka ng advice regarding the medications.

@pumngold:
If Chest x-ray negative and found to be PPD positive, then positive lang sa exposure and not active infection so dapat 1 to 2 meds lang ang ibibigay. Those 1 to 2 meds should be given on an empty stomach for better absorption.
No special care needed. No need to isolate since hindi naman nakakahawa ang kids. No need to separate plates, utensils, etc since hindi naman nabubuhay ang TB bacilli sa inanimate objects or fomites, unlike the flu/cold virus.
Best to find the source if found to be PPD positive kasi para ka magkaroon ng positive PPD, that means na-expose ka sa isang adult na may TB infection.
PPD is injected under the skin. Area injected should not be scratched nor should topical steroids be placed on the PPD site since it might cause unreliable PPD reading. Pwedeng wash with soap. Reading should be done after 48 to 72 hours.
For BCG vaccinated patients, PPD reading greater than 10 mm is considered positive.