Primary Complex Thread 2

[leletmd]

@sweety_paige:
For infection to take place, dapat na-expose ka for a long time kaya nga ang 1st suspects are the adult household contacts because they are the ones na madalas kasama ng bata. So, very unlikely kapag sinabi na nakuha sa mall or sa labas, kasi para ma-infect ka after 1 exposure lang, dapat nangyari ito sa enclosed space with poor ventilation na room.
It takes around 2 to 12 weeks from the time of exposure for the PPD to be positive. Active disease may develop anytime within weeks to 2 years from the time of exposure. Not everyone who is exposed will get the disease. Some are able to fight off the infection within weeks from exposure.
There are those naman na after treatment of primary complex gets the infection again once re-exposed. This happens when there are TB organisms that remain dormant in the body despite treatment.

[sweety_paige]

^Thanks Sis =D

[foxy_girlfriend]

subscribing to this thread...

recently my daughter was diagnosed with PC. she's healthy, active at malakas kumain at 20months. nung 17 to 18 months sya 100 grams lang weight gain nya kasi nagkapneumonia siya, naka 3 kinds antibiotic siya before it cleared mid January. first ever na grabeng sakit nya yun. Late this March inubo ulit at may halak na naman and after magAmox ayaw na naman. Clarithromycin agad pero after 7days of Clarithro meron pa din kaya nagpaskin test ayun 12mm. tapos positive din sa Xray.

We are now looking for the source. Start na din meds niya buti na lang may TB DOTS ang DOH for free meds for the entire 6months of treatment at mapakinabangan ko naman ang tax ko.

[concerned mama]

Hi Doc Let,

My 1.4  yr old baby's PPD test recently showed positive po. 12mm daw po. Although wala siyang chronic cough and colds, within normal yung range ng kanyang weight as of now. Tapos nag x-ray na po sya and ang impression ay hilar adenopathy. Yung AP view nga lang po ay hindi malinaw "The lung fields are clear. There is fullness of the hila, as seen on lateral view. The hila are not well evaluated on AP view because of the overlying mediastinal structures."

1. Ano po pala ang importance ng AP view?

Saka doc yung yaya namin na nagalaga sa baby ko, nagkaroon ng kulani sa kilikili tapos medyo nangayayat din at nagrereklamo na parang may sakit sya. Although, wala naman syang ubo't sipon pero years ago sya raw nag alaga sa tatay nya sa ospital na nag pass away due to TB. We had her chest x-ray tapos negative naman, clear sya sa x-ray.

2. possible ba na may dormant tb bacteria sya na na transmit sa baby ko ?

Also, doc ano po ang mangyayari if we stick to comprilex lang for 9 months, may mga risks involved ba. Kasi I consulted 2 doctors eh, one says kelangan bigyan ng 3 meds within 6 mos ang bata if hindi cleared ang x-ray. Yung isang doc naman na mas senior, sabi ay try daw mag comprilex muna for 9 months tapos saka tingnan uli kasi baka dahil lang sa bcg nag positive ang ppd nya at saka kasi non-specific daw yung andenopathy.

3. Ano sa tingin nyo doc, ulitin ko ba yung x-ray dahil hindi clear lateral view? lito ako kung may TB b sya?

[leletmd]

@concerned mama:
What was the reason for the TB work up of your child?
Regarding the yaya, I would suggest that you have her undergo a PPD skin test to determine immune response to PTB brought about by her exposure to her dad. The armpit lymph nodes may be due to some other infection, though, since if PTB, hindi naman yung area na yon ang nagkakaroon ng immune response/antibody production leading to enlargement of the lymph nodes.
Medyo na-confuse ako regarding which view is not clear, kasi sa first part ng post mo, you were saying that the AP view was not clear, but sa last part, yung lateral view naman. Also, when was the x-ray taken? Please clarify na lang.
Anyway, sa AP view, usually magnified ang heart at other mediastinal structures and kapag pangit ang hinga during the take, minsan hindi clear ang kuha. Sa lateral view, mas madaling makita ang lymph node enlargement.
To treat or not to treat would depend on several factors: why your child had a TB work up in the first place, if he/she fulfilled 3 out of the 5 criteria for TB treatment, etc. Since the first x-ray showed confusing/not clear results, I would suggest a repeat x-ray to determine if there really is a need to treat or not.
You may want to consult with an Infectious disease specialist for clarification.

[concerned mama]

Hi Doc Letlet,

The maid has already left us because she says she wants to be with her mother as she is getting older too, just turned 37 last month. Yesterday we met and she says her consultation with the docs in their health center showed negative naman daw, her TB results and sputum negative. But she has not done a PPD.

As for my baby, I meant the AP view of the x-ray was not clear because it seems it was taken on exhalation rather than inhalation but the lateral view showed 3 kulani said the radiologist and doctor. hilar adenopathy daw. Although sabi nung doc non-specific daw ang adenopathy.

So I don't know whether it would be better to do another skin test/ppd for my baby as well as another x-ray?

Thanks doc,
Pam

p.s. by the way doc where is your clinic and how do we contact you if we want to also consult you personally. Please pm me

[leletmd]

@concerned mama:
Rather than repeating the PPD, do a repeat Chest AP lateral instead (about 2 to 4 weeks from the first x-ray) and have the plates compared. If the lymphadenopathy was due to a different infection like a viral infection, then it would most likely clear up on the repeat x-ray.
Repeating the PPD would be useless especially if it was just done recently (like in the past 3 months). Hindi magiging reliable ang result.

[pumngold]

my baby is 5months old and she has low gain weight, She looks thin and nakaka 6 bottles of 5oz a day of formula lang siya ( 30oz per day). She is not coughing / has no colds naman. pero naisip ko baka may primary complex cya. Pwede kaya she has PC?kasi payatin and pawisin ang head nya kahit naka aircon especially when drinking milk. My brother says she may have PC??

[leletmd]

@pumpngold:
What is your baby's birth weight? How much is her average weight gain/month?
Does she have a bcg scar? How soon after BCG vaccination did she develop a scar?
Is there somebody in your household who had TB or is being treated for TB? Did you get exposed to someone with TB while you were pregnant?
What is your pedia's explanation regarding the low weight gain? Does she have any other symptoms like frequent reflux?

[pumngold]

Hi Doc Lelet,
Her birthwight was 3.4kg,height 53cm. Around 0.6kg lang average weight gain nya per month.
BCG scar now medyo lumiit ngayon as compared on her early months. Siguro after 2weeks she had a lump sa BCG nya, then after that nagka pimple like [textspeak!] BCG area nya.Then parang nagkabutas. Pero, now it is smaller.

ABout TB sa household, wala naman po ata during my pregnancy kasi kami lang naman ng husband ko sa house noon. And now, im not sure lang, kasi she stays kasi sa mom ko on weekdays, they have new maid and her yaya now na galing sa tita namen. Na di na namen pina x ray.

Her pedia gave her heraclene for a month,medyo lumakas lang ng konti sa milk. She takes 30oz per day lang now she is 5months. Her weight on last check up was 6.34kg.Sabi ng pedia baka ganon lang talaga built nya pahaba, her height is 69cm (5months).
Wala naman siyang frequent reflux only when nadadapa siya after feeding. Pero other than that bihira siya mag reflux.

[leletmd]

@pumngold:
The average weight gain per month for 0 to 6 months of age is 600 grams/month. Pag 6 months to 12 months, the average weight gain is 500 grams/month.
If based on birth weight, the ideal weight of your baby for her age is 6.4 kgs so konti lang naman ang kailangan niyang habulin.
Baka there are other factors to consider, other than TB. If her weight doesn't improve by the time she's 6 months of age, you can ask your pedia to check also for anemia since this is one of the common causes of poor weight gain in infants.

[pumngold]

thanks Dra! Ill talk to her pedia about it. sana naman mag gain na baby ko.

[cloudcean]

hello doc lelet,
 my twins just had ppd yesterday. They are 8 1/2 months old and their current weights are 7.5 kgs each. They are premature babies, they are both 2kgs when they were born. We were advised by our pedia to have ppd since my twins often had coughs and colds. My hubby and I also had PPD test. I was just want to ask if how would i know if the PPD is positive, if it exceeded 10 mm does it mean that my twins are likely to have primary complex? tia

[leletmd]

@cloudcean:
If ppd reading (induration area and not the just the surrounding redness) at 48 to 72 hours is more than 10 mm, then they would be positive for TB exposure. Next step is to do a chest x-ray to check if they have the disease. 

To diagnose PC/TB, you need to fulfill 3 of the 5 following criteria:
1. Clinical features suggestive of PC/TB like enlarged lymph nodes in the neck area, prolonged cough that doesn't resolve with treatment, low grade afternoon fever, weight loss, loss of appetite, etc.
2. history of exposure to an adult with proven PTB
3. positive PPD or tuberculin test
4. x-ray findings suggestive of PC/TB like hilar infiltrates, hilar lymphadenopathy, etc.
5. AFB sputum smear culture positive (rarely done in kids because of their low sputum load)

[cloudcean]

thanks doc

[lindseigh]

hi doc lelet, my 2 kids has done 6 months of medication, pina xray uli sila ng pedia,tha results are minimal clearing & moderate clearing, d pedia advise to extend the med for 3 more mos., wala po b tong side effects sa bata since may youngest start at 6 mo. old?, naawa na [textspeak!] ko sa knila . babalik po b ang infection if di ko icontinue ang 3 more mo.s? thanks po!

[leletmd]

@lindseigh:
As long as the dose given is based on weight, there should be no problems with regards to overdosing or extending treatment to 3 more months.
Iba ang side effects vs sa pag-extend ng treatment or overdosage. Side effects may occur at any time of treatment (during the 1st 6 months or sa next 3 months) depending on how the body's metabolic systems react to the meds.
Yes, there would be danger of recurrence if hindi mo ituloy ang treatment and hindi pa talaga sila totally cured.
How are they clinically speaking (nawala ba ang symptoms, nagka-weight gain ba?, appetite gain, etc.)? Also nahanap ba ang source of infection nila?

[joyce09]

doc lelet, doc yung adult ba if ever na may inactive tb ay nakakahawa din ba. or yung may exposure sa tb adult may possible ba na mahahawaan ang close contact person sa kanya lalo na ang kids? maraming salamat doc in advance.
 

[lemonade]

hi, dra. lelet! my 7-year-old daughter was diagnosed with PC last march. she started her medication last march 29, so she's now on her 4th month of treatment. since she started drinking the meds, and all throughout summer vacation, she only had the occasional cough. but now that she's back in school, biglang inubo na naman ng matindi. what should i do? should i give her cough medicine (like ascof) in addition to rimaped and comprilex? thank you so much for answering all our questions here. God bless you. 

[leletmd]

@joyce09:
Kung nagtreat at inactive na ang TB, then dapat hindi na siya contagious. If, however, during the time na hindi pa siya nagtretreat at active pa ang TB niya ay nakahawa siya sa close contacts niya, then dapat mag-treat din ang close contacts. Yes, pwedeng mahawa ang kids.
Kaya if somebody in the household gets diagnosed with PTB, dapat lahat ng close contacts (adults and kids) ay magpatest to see if they were also infected. 

@lemonade:
I suggest that you bring her back to her pedia for evaluation of her cough. Baka kasi there's another cause to it, like allergic rhinitis or asthma.
The pedia would be able to determine what meds to give after examining your daughter.