Primary Complex Thread 2

[pumngold]

Doc lelet, thank you. I still have question. You said, kung positive sa ppd ,expose si baby sa may TB. Kylangan kompa paalisin sa bahay yung source, let sya her yaya has it. Or pwede naman namin ipatreat?

Another is if she is negative on xray and positive on ppd, is this the cause of her low weight? She is now 12 mos, weight is 8.3kg. She takes around 6 to 8 bottles of 6oz of milk a day. Pero super konti mag solids.

[emv555]

hi dra lelet yes po told her. sabi nya 2 months na din naman daw naka intake. kc my child wont feed a single drop. asctually we are admitted her last dec 27 until nw bec of this viral called herptic gingivostomatits? nag bleed gums nya and scattered all through out her tongue. she is nw taking anti viral. m so upset. thanks po

[joyce09]

@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.

Doc clarify ko lang po kasi sabi nyo pag with BCG then yung reading is greater than 10mm considered positive. What if nasa 10mm siya then w/o x-ray kaya di alam kung positive sa x-ray tapos nag 6mos treatment ang bata what would be the negative effect kung sakaling negative pala siya sa x-ray? thanks po doc.

[Princess_Chill]

Hi po doc

just want to ask what would happen if hindi pinagamot ang Primary ng bata?

[leletmd]

@emv555:
Sorry to hear about your child's recent hospitalization. I hope she gets better soon.
Maybe, it would be better to clarify with your pedia regarding re-treatment kasi we don't really advise stopping meds mid-treatment kahit na naka 2 months na. Did your pedia say if ibabalik pa ang PC meds after hospitalization?

@joyce09:
What was the basis for the PC diagnosis if borderline ang PPD test and no x-ray? Paano nadiagnose ang PC if no chest x-ray? Anong criteria ang nafulfill?
If no actual PC and meds were given, there's a risk for medicine resistance and allergy development later on.

@pumngold:
If PPD positive and negative on chest x-ray, then there's no active disease because the body was able to contain/stop the TB infection from developing. So, no, I wouldn't think that it is the cause of the low weight gain. Baka kailangan mag - evaluate ng other causes like checking for anemia, etc.
If sa yaya na-expose or any other adult in the house, pwede naman itreat lang ang yaya. Within 2 weeks from starting treatment, hindi na nakakahawa ang adult source.

@Princess_Chill:
If may PC talaga ang bata and hindi binigyan ng treatment, kung magaling magwork ang immune system niya, pwedeng macontain ang infection. Pero kung mababa ang resistensya niya (which happens in most cases), the PC can spread to other organs and cause infection so pwedeng magka TB of the bones, liver, meningitis, etc.
Madali lang naman ang treatment ng PC/TB and marami na ring DOT centers ang DOH for treatment of TB so better na na-itreat rather than hindi.

[joyce09]

@emv555:
Sorry to hear about your child's recent hospitalization. I hope she gets better soon.
Maybe, it would be better to clarify with your pedia regarding re-treatment kasi we don't really advise stopping meds mid-treatment kahit na naka 2 months na. Did your pedia say if ibabalik pa ang PC meds after hospitalization?

@joyce09:
What was the basis for the PC diagnosis if borderline ang PPD test and no x-ray? Paano nadiagnose ang PC if no chest x-ray? Anong criteria ang nafulfill?
If no actual PC and meds were given, there's a risk for medicine resistance and allergy development later on.

@pumngold:
If PPD positive and negative on chest x-ray, then there's no active disease because the body was able to contain/stop the TB infection from developing. So, no, I wouldn't think that it is the cause of the low weight gain. Baka kailangan mag - evaluate ng other causes like checking for anemia, etc.
If sa yaya na-expose or any other adult in the house, pwede naman itreat lang ang yaya. Within 2 weeks from starting treatment, hindi na nakakahawa ang adult source.

@Princess_Chill:
If may PC talaga ang bata and hindi binigyan ng treatment, kung magaling magwork ang immune system niya, pwedeng macontain ang infection. Pero kung mababa ang resistensya niya (which happens in most cases), the PC can spread to other organs and cause infection so pwedeng magka TB of the bones, liver, meningitis, etc.
Madali lang naman ang treatment ng PC/TB and marami na ring DOT centers ang DOH for treatment of TB so better na na-itreat rather than hindi.

@ doc lelet

Doc the only basis ni pedia was no weight gain for several months at may kulani daw siya. Di naman ata siya inuubo that time na nag ppd son ko. as far as i remembered di ko na sana ipa ppd kasi nagkaroon na siya ng weight pagbalik namin for my son's ppd test schedule yon na nga pagbalik namin for the reading positive daw siya 10mm ang sukat. sabi ni pedia it doesnt matter daw kung maliit or malaki once na positive kinunsider na niya na may pc son ko 8mos palang siya noon. kaya di na niya nirequest ang x-ray. kaya duda ako kung may pc talaga anak ko kasi pina x-ray anak ko nung nag turned 2yr old siya for other medical reason clear ang lungs niya im not sure dahil fully cured siya sa pc niya for 6mos na gamutan or talagang wala siyang pc..

Doc sa pc meds lang ba magkaroon ng resistance or sa lahat ng meds.. di kaya sa pag inom niya ng pc meds kaya nagkaroon ng AR anak ko.. kung talagang walang pc anak ko nun wala narin naman ako magagawa "the damage is done" di ko na pwedeng undo pa...

Thanks doc lelet...

[artemis26]

Before my daughter's first bday, she tested positive sa PPD, pero her x-ray was negative. Dr. Cabanila, a pedia-pulmo at PCMC, advised us to give her Isoniazid for 9mos. It was a choice between 2 meds na shorter, and 1 med na longer, and we choose the latter kasi suuppeerr hirap painumin ng gamot ang anak ko. So she was taking Isoniazid from Sept 2010 to June 2011. When we got her off Isoniazid, ay, ayan nagstart ang monthly cough and colds nya. Especially when the weather changes. Its like alternating between allergic rhinitis and common cough/colds. We took her to a different pedia before New Year. When the pedia examined her, she felt na may 2 kulani, one small, another bigger daw. Tapos yung almost monthly na sipon/ubo, and poor weight gain ( at 2 years and 3 mos, she's just 10.5kgs, bumaba pa nga kasi nun Nov she was already 11.5kgs). So right there, she said na may PC nga yung anak namin. However, when we brought our kid for her vaccination sa regular pedia nya, it was suggested na ipa-xray. The xray result was negative for PC.

Tanong ko lang, especially kay doc Lelet, kung anong gamot yung binibigay if PPD is positive, and Xray is Negative that would be most effective in treating PC? Should we consult this with our kid's regular pedia, or with her pedia-pulmo.

Another thing is: based on her last lab test, mababa ang hemoglobin count nya. Ano kayang best thing to do with anemia?
Hayy, balikan na naman kami sa pagpapainum ng gamot. 

[artemis26]

Tanong ko na din pala if advisable na magpa-skin test ulit, given na nag-PPD na yung anak namin last Sept 2010.

[Princess_Chill]

@doc letlet

medyo na bother ako, ganito kasi sitwasyon ng anak ko..ever since baby siya hindi talaga siya tabain then when she turned 1 i asked her pedia kung bakit meron siyang kulani sa batok banda so sinabi saamin na pa xray namin para lang sure (we only go to her pedia pag may vaccine schedule siya) thank God hindi sakitin baby ko..here's the thing nung lumabas [textspeak!] result ng xray niya may mga kulani daw siya sa baga then we conducted a skin test. nag positive din siya. (pulmo din pedia nya) so binilhan na namin siya ng gamot for primary [textspeak!] 3. 1st day ng pinainum namin siya nun sinuka lang niya then naging matamlay siya ( she's a very active baby and hindi naman siya inuubo at sinisipon once lang un) then 2nd day bigla na siya inapoy ng lagnat and bigla na siya nagka tigdas hangin.

we decided na mag asawa to stop na [textspeak!] meds since hindi naging maganda effect ke baby. my sis in law gave us advice na kung gusto namin stop nalang namin gamot and pakainin nalang ng healthy food si baby hindi naman mapili sa pagkain anak ko. up until now she's 2 na ok naman (i think) hindi naman siya inuubo or anything. hindi nga lang siya tumataba. saka may kakilala [textspeak!] family friend namin na nag take ng ganyan gamot and nasira [textspeak!] liver ng bata because of the meds. we also considered that kaya nag stop kami sa gamot kasi iba talaga effect sa kanya.

doc i need your advice po, ano po mga symptoms na hindi nalalabanan ng resistencya nya [textspeak!] bacteria? how would i know kung nagdedevelop ang PC?

im so torned..

[leletmd]

@joyce09:
That is why it is very important to follow the criteria in diagnosing any disease, such as PC. If the patient is suspected as having PC, kailangan talaga ng x-ray. Wag matakot sa x-ray kasi it has very little radiation. Sa chest x-ray mo kasi madedetermine if there is indeed active disease in the lungs.
Medication resistance can happen in any medication that is not appropriately given. It happens often with antibiotics. Yung mga madalas mag-antibiotics, pwedeng magkaresistance to the meds they frequently take and will need other stronger meds later on.
The tendency to develop allergic rhinitis is inherited. Maaring wala sa generation mo, but meron sa iba pang naunang generation. Or kung hindi naman AR ang meron sa elders, pwede namang may family history of Asthma or skin asthma. Risk factor lang sa pagkakaroon ng allergic disease ang ff: CS birth, early and frequent use of antibiotics, 1st born, etc.

@artemis26:
You cannot diagnose PC from having enlarged lymph nodes alone. Maraming other reasons kung bakit lumalaki ang lymph nodes. Any infection, sugat, allergic disorder, sirang ngipin can bring about pag-laki ng kulani.
Bakit lumalaki ang kulani? Kasi gumagawa sila ng antibodies to fight off the disease.
Lahat ng tao na may normal na immune system ay may kulani or lymph nodes all over their bodies.
Ang walang kulani ay tinatawag na immunodeficient dahil walang panlaban sa sakit.
Buti na lang nagpa-xray si regular pedia...
Natapos na ng anak mo ang 9 months of Isoniazid, right? Then she is already protected.
I would not suggest repeating the PPD since wala pang 3 years since it was last performed. If you repeat it now, chances are it will still be positive and would have a bigger size than before because of hyper - response. A repeat positive PPD does not mean na may PC pa rin ang anak mo.
Regarding the anemia, your regular pedia is the best person to give advice on that. Treatment would depend on your child's history. It could also be the reason for her slow weight gain.
Regarding the frequent cough and colds, I suggest you go back to her pulmo pedia for evaluation. Baka may ibang cause pa for that.

@Princess_Chill:
Is your pedia pulmo aware that the medications were stopped? Have you gone back to your pedia since the PC diagnosis?
Since it's been a year since the PC diagnosis, I suggest that you bring your baby back to her pedia for re-assessment. Better na ma-evaluate siya now para malaman kung talagang nagkaPC siya or not and kung kailangan niyang ma-treat ulit.
I also suggest that you be honest with your doctor regarding your fears and concerns para, at least, mabigyan ng chance ang doctor niyo na mag-explain. There are ways naman para maibigay ng maayos ang mga meds.

[joyce09]

@ doc lelet

Doc, di naman ako against sa x-ray kaya nga ako nagtaka kasi di siya pina x-ray ng pedia niya since ganun pala ang procedure para to confirm kung may pc ang bata... dito ko lang nalaman na dpat pala pina x-ray.. anyways, trusted naman ako sa pedia ng anak ko kaso narecall ko lang na hindi pina xray anak ko nung positive siya sa ppd which is nasa borderline siya 10mm. tapos may effect pala ang pag take ng pc meds pagwalang disease kaya naging concern ako sa effect sa anak ko ... hesitant narin ako itanong ulit sa pedia niya kung bakit kasi over a year na iyon....thank you doc for the clarification...

[Princess_Chill]

Doc Letlet

hindi namin sinabi sa doctor niya na we stopped the meds and we haven't gone back to him after that. Are there symptoms that i need to watch out?

[emv555]

@doc lelet
thank you very much po. nakauwi na rin kami fr weeklong hospitalization. grabe pala po [textspeak!] herpetic gingivostomatitis.

[joyce09]

@doc lelet
thank you very much po. nakauwi na rin kami fr weeklong hospitalization. grabe pala po [textspeak!] herpetic gingivostomatitis.

sis anong sakit yung herpetic gingivostomatitis? parang not common yung term. thanks.

[emv555]

@joyce09
hi sis joyce. mas malala cya sa singaw. it starts w high grade fever then parangnamumuti [textspeak!] dila and nagkakarun ng lesions after the gum bleeds lalabas na. hndi nga cya common sis viral daw un.

[leletmd]

@emv555:
Glad to know she is better na.
Sobrang painful ang oral lesions ng herpetic gingivostomatitis kaya better talaga to admit for hydration. Most often kasi, di makafeed ang bata.

@joyce09:
Sorry, I wasn't referring to you regarding the fear of x-rays. I meant it in general because there were previous questions on how important a chest x-ray is in diagnosing PC or TB, and there were also questions on its' safety. 

@Princess_chill:
Lelet po, not letlet 
Symptoms to watch out for include failure to gain adequate weight despite good appetite, persistent enlargement of lymph nodes on the neck and clavicle area, low grade fever in the late afternoon or at night, night sweats, persistent cough or cough that takes a long time to go away, etc.
Sorry, but I have to ask, since you mentioned you haven't gotten back to your pedia pulmo in about a year, does that mean your daughter has not had regular child development monitoring/vaccinations by any pedia during that time period? The reason I asked is because I think the best person to allay your fears regarding medications and the need for it is your pedia because she is the one knowledgeable about potential side effects, etc. If you changed pedias or if your daughter has a different pedia from the pedia pulmo you initially mentioned, then I suggest you go to your pedia, mention the previous diagnosis and ask for confirmation.

[joyce09]

@joyce09
hi sis joyce. mas malala cya sa singaw. it starts w high grade fever then parangnamumuti [textspeak!] dila and nagkakarun ng lesions after the gum bleeds lalabas na. hndi nga cya common sis viral daw un.

thank sis...... sana gumaling ng mabilis anak mo sis kasi wawa naman eh..

[joyce09]

@ doc lelet

doc, thank you po...

[emv555]

@dra lelet
thank you po we are lucky to have you in this forum. hope one day magkarun [textspeak!] ng get together w all the momsies. Godbless

@joyce09
yes sis recovering na cya with God's help. hope to see you soon with other momsies......God bless

[joyce09]

@dra lelet
thank you po we are lucky to have you in this forum. hope one day magkarun [textspeak!] ng get together w all the momsies. Godbless

@joyce09
yes sis recovering na cya with God's help. hope to see you soon with other momsies......God bless

thats good to know sis... kasi affected buong family and kawawa talaga kasi ang mga babies pag may sakit sila kasi we dont really know exactly how they feel....