Primary Complex Thread 2

[leletmd]

@mommylala:
What was the reason why your child was started on Isoniazid? What were the PPD and chest x-ray findings? May history of exposure ba siya sa person with PTB? Or were you able to find the source of the exposure?
Pasensya na, but I will highly suggest that you come clean and admit to your pedia that you stopped your child's treatment. Honesty is very important in any doctor - patient relationship. If you do not disclose to us important information, it will affect our management and baka, maling advise or maling diagnosis/treatment ang maibigay.
I also suggest that you disclose your fears regarding the medications para ma-guide ka or ma-enlighten ka.

[mommylala]

opo he underwent to an xray, ang findings po ay suspect daw po for ptb. kaya po pinag PPD. after 3days pinabalik po kami and 8mm daw po ang result ng test. Sabi ng pedia niya negative daw po yun but since its too close na para maging positive she prescribed for prevention daw po  which is isoniazid for 6months. every morning niya po tine take niya yun before breakfast. Hindi ko po tlaga alam san niya nakuha yun. So we started july 21, 2011 so dapat po hanggang jan 21 pero instop ko na po ng dec 2nd week sa pag-aakalang bka maapektuhan na liver niya. (naiinis po ako sa sarili ko ngayon)

Doc sa tingin niyo po ba i-eexray po ba ulit siya at ppd? Hindi po ba masama yun na pangalawang beses na gagawin sa kaniya yun? 1year and 3months po baby ko ngayon. salamat po.

[leletmd]

@mommylala:
What were the exact chest x-ray findings? What was written on the x-ray report?
PPD kasi is negative so I am wondering as to why Isoniazid was started.
I think it would be better for you to seek a 2nd opinion before you resume Isoniazid. Since you said you have a new pedia, maybe it would be better to tell your new pedia about the findings of the old pedia para ma-assess if there is a need for treatment.

[babyko_14]

@leletmd:: sis, thank you for your reply. God Bless

[leletmd]

^ You're welcome. God bless you, too.

[mommylala]

@mommylala:
What were the exact chest x-ray findings? What was written on the x-ray report?
PPD kasi is negative so I am wondering as to why Isoniazid was started.
I think it would be better for you to seek a 2nd opinion before you resume Isoniazid. Since you said you have a new pedia, maybe it would be better to tell your new pedia about the findings of the old pedia para ma-assess if there is a need for treatment.

based on his baby book dated july 16, 2011 eto po yung remarks ng pedia:

A> Pneumonia > no Khocks' infection

PPD reading after 2days

then nung bumalik po kami, the reading is 8mm, the pedia says negative for primary complex and she prescribed meds for prevention since medyo malapit na daw po mag positive. yun nga po yung isoniazid for 6months which he took only for more than 5months na hindi namin natapos dapat 6months...

yes po this afternoon ipapa check up ko na siya kase since tue pa yung on/off low grade fever with cough only at night pero sa daytime naman po wala siyang sinat.

[leletmd]

@mommylala:
If we will base it on the chest x-ray result which says "no koch's infection" (meaning no PC or TB) and the negative PPD result, then I would have to say that, at that time the tests were done, there was no reason to start Isoniazid, unless there was a clear source of infection (a household contact known to have PC). I hope you can bring it up with your new pedia so you can find out if there is a need to repeat the tests...

[eileenmayv]

@doclelet,
Good day po. My son diagnosed with pc has been taking kids kit 3 for 1 month now. Kaso wala pa ring weight gain ((22 pounds  pa rin 2 yo) . Me appetite naman pero bat di pa rin po tumataba? Thank you

[babyko_14]

@leletmd::

sis may tanong ulet ako. 3 kasi ang kids ko. yung 2 kids( 7 & 2 1/2 y.o)  meron ng PC at nag start na sila sa kanilang medicines last week. si bunso ko ay 3 months old.yung pedia nya nag prescribed ng comprilex sa kanya kasi may exposure na daw sya sa may ptb. the other day dinala ko si baby sa pedia pulmonary ( ito yung nag prescribed ng meds sa 2 kids ko na may pc. lumipat kasi ako sa specialist kasi tagal ng ubo ng 2 kids hindi gumagaling. nung pinatignan ko sa specialist, 1 wk lang gumaling sila) kasi may konti ubo na may plema si baby. naikwento ko na din kay pulmo pedia na may 3 mos old ako kaya sabi nya pa x-ray ko na daw. ni read ni pulmo pedia yung film xray, sbe nya meron daw maliit na kulani pero ayaw nya pa bigyan gamot kasi masyado pa daw baby. pina stop nya din yung comprilex na bigay ni pedia. sabi nya after 6 months ipa xray daw ulet si baby kasi pwede din daw lumiit na kulani pwede din daw lumaki na.
yung comprilex po stop ko na. ok po ba na itigil yun?
sa overseas po talaga kami naka base,umuwi lang ako pinas para manganak. dadalhin na lang namin mga meds ng mga bata at duon na tuloy gamutan. sabi ni pedia pulmunary, hanap daw kami filipino doctor at i endrse nya yung 2 kids ko. (meron na po nakta na filipino doctor ang asawa ko)

Thanks in advance sa reply. pasensya na po at napahaba.

[leletmd]

@eileenmayv:
What was the basis for the PC diagnosis? What were his symptoms prior to diagnosis? Chest x-ray results? PPD result? Were you able to find the source of infection?
Are the meds given regularly? Isoniazid and Rifampicin are best given first thing in the morning, 30 minutes before the 1st meal para sure na empty ang stomach at ma-absorb ng maayos.
These are things you have to consider when assessing response to the meds.
What is your pedia's assessment regarding the lack of weight gain?

@babyko_14:
How long have you been here in the Philippines? Were you exposed to your dad while pregnant?
Was BCG given to your baby? How fast did he get a bcg scar? Within 1 week ba nagkascar na or within 1 month pa? Pag within 1 week kasi nagkaBCG scar na kaagad, that means accelerated BCG response yun and na-expose na si baby sa TB while he was in your womb.
Kapag more than 1 month ang scar formation, then possible wala pang enough exposure to develop disease.
It all boils down to how long your baby was exposed to your dad. Hindi naman kasi siya mahahawa sa mga siblings niya kasi hindi naman nakakahawa ang bata sa bata.

[babyko_14]

@leletmd::
sis, more than 6 months na po kami dito. When i was pregnant, i don't talk to my dad that often kasi he is smoking and hate na hate ko amoy ng sigarilyo. sa umaga sa house ng sis ko kami nag stay ng mga kids tapos sa gabi lipat kami sa house ng father ko para matulog.
Yes, BCG was given to my baby when she was 7 day old. he got a bcg scar parang more than 1 month pa yata. kasi parang ang tagal nung nana sa scar nya.

[leletmd]

^ Ok, if you have been here for 6 months already, then there's really a chance na may exposure ka sa dad mo.
May valid point kasi ang pedia mo since there is already a known source of infection and technically, your baby will fall under Category 1: patients who have a known source of infection, negative PPD and no symptoms so pwede talaga siyang bigyan ng Comprilex for prevention.
Kapag kasi may 1 person in a household diagnosed to have PTB, pwedeng bigyan ng Isoniazid or comprilex ang household contacts na negative for Tb but constantly exposed to the patient, to prevent infection.
May mga doctors who don't follow this because based on their assessment of family dynamics, they think risk to infection is low. So what they do is to closely monitor the household contacts. I guess this is what your pedia pulmo wants.
It's a judgement call so it would depend on which doctor knows your baby and your family's case well enough to give you a better opinion of what to do.
My suggestion is to have good follow up with the pedia abroad para ma-monitor ang case ng kids mo.

[babyko_14]

^ diba doc lelet, yung kulani is sign na ng infection? kasi meron daw maliit na kulani si baby sabi ni pedia pulmo. (nakita nya sa xray film). pwede pa din ba sya mag comprilex kahit meron na syang kulani?

i guess sundin ko si pedia, kasi sya na ang pedia ni baby nung nanganak ako. my baby is premature. (35 weeks) pero mature na ang lungs nyakaya hindi sya naiwan sa hospital  kasi naalagaan ako ng ob. ilang beses ako nabigyan ng dexta maagang nag oopen cervix ko.

Thanks po ulet doc lelet.

[leletmd]

^ When was the x-ray taken? Was it taken at the time that your baby had cough and colds? Kasi if it was taken at the time that your baby had cough and colds, the enlarged lymph nodes seen on x-ray may be due to the ongoing infection (the cause of the cough and colds) of your baby.
Hindi kasi specific ang enlarged lymph nodes with PC. Any infection, be it viral, bacterial, fungal or mycobacterial (as in the case of TB), and any thing that warrants production of antibodies (our lymph nodes produce antibodies) such as allergies, wounds, dental caries can cause enlargement of lymph nodes.
To check if he is already infected, it would be better to have the chest x-ray repeated 2 to 4 weeks from the time na wala siyang cough and colds (walang confusing factors, etc.). If the enlarged ymph nodes are still present, then possible na na-infect na siya and would warrant treatment.

[marssie]

^hi Doc Let, pabalik balik din ubo ng son ko, he was exposed sa mother ko nung baby pa siya nung time na may PTB ang nanay ko at di pa nagagamot.  Pinapacheck ko son ko for PTB kaso sabi ng pedia di naman daw need kasi nga overweight ang son ko.  Last Dec nagantibiotics son ko dahil sa ubo, tapos naulit nung january, antibiotics nanaman, tapos last thursday sobra taas fever ng son ko at dinala ko doctor ulit, nagtest at sa result mataas daw infection kaya antibiotics nanaman.. napapaisip tuloy ako, dapat po ba ipatest ko rin siya? Kasi pabalik balik ang ubo niya since november, or pwede rin kaya sa panahon? Tag lamig kasi dito sa Middle East ngayon, Nov dec, tapos January nasa Pinas kami na mainit naman, tapos pagbalik namin dito malamig nanaman.. pwede rin po kayang naninibago lang?

Ano po ba ang dapat gawin pangpalakas ng resistensya to fight cough and colds sa mga bata?

[leletmd]

^ Does the cough go away with the giving of antibiotics? Or tuloy tuloy pa rin despite antibiotics? How is his activity? Does he have persistent lymphadenopathy (lymph nodes that remain enlarged for a long period of time, even with treatment with antibiotics)?
Wala ba siyang Asthma or Allergic rhinitis (diseases that are usually triggered during cold seasons)? How was he last Nov 2010 to Jan 2011? Madalas din ba siya magkacough and colds then?
Has he ever had a chest x-ray done? If yes, what were the results?
Marami kasing factors to consider whether to test or not.

[marssie]

^After antibiotics, nawawala then after a month or two, nagkakaubo nanaman. Last xray niya was January 2010, nung nagkabroncho siya, naconfined siya sa hospital nun. Wala naman namention about ptb. He was exposed with my mother 2007-2009, then 2009 nagstart magamot ang nanay ko.. And yes, lagi po siyang may ubo at sipon, every other months, minsan magkasunod na buwan.  Sabi nung nakausap kong pedia "mukha" naman daw walang ptb ang anak ko kasi daw taba taba at overweight naman.. enough na po bang reason yun para maging worry free kami?

[babyko_14]

@leletmd ::

yes doc, my baby had her xray when she had cough. sana nga yung kulani na nakita ay dahil lang may ubo sya.

doc, if ang isang adult na may ptb na nag gagamot na eh naninigarilyo pa din, tatalab ba yung medicines na take nya. curios lang po kasi ang father ko hindi pa din maawat sa pag sigarilyo eh.

maraming salamat po ulet.

[leletmd]

^ The smoking will not affect the ability of the medications to get absorbed, but it doesn't mean he should not stop smoking.
The smoking might weaken his immune system and make him more prone to other lung diseases later on.

@marssie:
For your peace of mind and since matagal tagal din ang exposure niya sa mother mo, you can have your son evaluated for PTB. If it is negative, have the pedia look for other possible causes of recurrent cough like allergic disoders, etc.

[babyko_14]

^ thank you again for your reply doc lelet.