Primary Complex Thread 2

[mommylala]

doc lelet, x-ray result
Conclusion
Pneumonia, both lower lobes.

sa ngayon po pinag antibiotic lang muna siya ni pedia (Zinnat) nalimutan ko lang po yung complete name nung antibiotic. he will take 2x a day 2.8ml, kapag daw po hindi na tolerate ng anak ko yung lasa at iniluwa, i-aadmit siya. Thank God hindi naman niya niluluwa. For 5 days po niya gagawin yun kase nakapag unasyn na sya unfortunately hindi natapos kase natakot ako nag diarrhea siya like 6 to 7 days. eh [textspeak!] pedia normal lang daw yun kc nag aantibiotic sya

[glamorosa_09]

For almost two months 17.6 lbs pa rin ang 1 year old ko. Ang hirap pakainin. For this month pag hindi nag-improve ang weight nya, chest x-ray na... reading the posts here, mukhang challenging magpainom at ang schedule ng gamot if postive sa PC.

A part of me, parang gusto ko nang magparequest ng chest x-ray or skin test sa pedia ko. Pero wait na lang muna ko, three weeks pa naman. And hirap pakainin, so unlike before na kahit anong food ibigay mo kakainin nya.

I'm also considering na pwedeng kulang sya sa Iron, so take din sya ng Ferlin.

[leletmd]

thanks doc letlet- nag start na si ate ng kanyang medication- sabi dr empty stomach 1 hour before bfast, 1 hr b4 lunch and 1 hr before ng dinner ko sya pinapa inom- nag iisip ako pano kaya pag may pasok na-

hoping my 9 month old baby wala- incase papa chest xray kami lahat

Isoniazid and Rifampicin pwedeng ibigay 1 hour before breakfast. Both of these meds kasi need to be given on an empty stomach.
Baka kaya lang nakaspace out is para di masyado marami papainom mo at 1 time.

doc lelet, x-ray result
Conclusion
Pneumonia, both lower lobes.

sa ngayon po pinag antibiotic lang muna siya ni pedia (Zinnat) nalimutan ko lang po yung complete name nung antibiotic. he will take 2x a day 2.8ml, kapag daw po hindi na tolerate ng anak ko yung lasa at iniluwa, i-aadmit siya. Thank God hindi naman niya niluluwa. For 5 days po niya gagawin yun kase nakapag unasyn na sya unfortunately hindi natapos kase natakot ako nag diarrhea siya like 6 to 7 days. eh [textspeak!] pedia normal lang daw yun kc nag aantibiotic sya

Is this his 1st time to have Pneumonia? I hope he responds well to his meds. Suggest you bring him back to the pedia for follow up once the meds are completed para may re-evaluation na magawa at malessen ang chances na bumalik ito.

[mommylala]

@Doc Lelet: Yes po first time. We will have a follow up check-up on Monday. Were on our 4th day of antibiotic as of today. I think maganda naman response niya sa gamot. I dont know if this is con incidence but his milk and solid intake become ok. No diarrhea too compare to Unasyn before na nireseta din niya. According to the pedia, 5days lang yung antibiotic niya i-te-take kase po nag Unasyn na siya before (i discontinue nga lang po due to 6 to 7times soft and watery stool. Doc, after the meds po ba another x-ray po ba yung ganun? Thanks.

[leletmd]

@mommylala:
It will depend on the findings during the follow up if there is a need to repeat the chest x-ray pa so it would be best to ask your pedia regarding this.

[mommylala]

@mommylala:
It will depend on the findings during the follow up if there is a need to repeat the chest x-ray pa so it would be best to ask your pedia regarding this.

Ok po, thank you so much! God Bless.

[cristeta]

hi! I just want to ask regarding sa isa mga symptoms ng PC, yung may kulani sa leeg. Ma coconsider din ba na posibleng symptom is parang kulani sa bandang likod ng tenga?
I have a 7-month baby kasi na may parang maliit na bukol sa likod ng dalwang tenga at sa likod ng ulo mataas ng konti sa batok. Medyo low gain weight din kasi si baby and napansin ko parang every morning eh nauubo sya.  Dko sure kung  ubo ba talga or parang nasasamid lang.

HIndi  ko pa naconsult sa pedia nya next month pa ang  check ni baby eh.

Thanks in advance!

[leletmd]

@cristeta:
Usually kapag PC ang cause ng enlarged lymph nodes, the enlarged lymph nodes are located along the neck and shoulder (clavicle) area.
Kapag behind the ears located ang enlarged lymph nodes, usually it is due to either colds, ear infection or scalp infection.

[cristeta]

@doc lelet, thanks po. At least medyo narelax ako, ilang araw ko na rin kasing iniisip yun. Sa next check up ni baby i'll bring that up sa pedia nya.

Thanks a lot!

[babyko_14]

@leletmd:: doc, if kids are under PC medication, is there any possibility for them to have cough and colds? protected ba sila ng PC meds?
In the country that we are staying, cold season just started. Flu season na dito.  paranoid lang ako na baka ubo at sipon na naman sila eh nag gagamot pa sila

Thanks po in advance for your answer.

[leletmd]

babyko_14:
They may still get cough and colds even if they are taking PC meds because there are other causes of cough and colds that are not covered by the PC meds.
PC meds will protect against cough and colds caused by PC, but not by allergies, viral infections or bacterial infections.
The same way that the flu vaccine only protects against the flu infection and not for any other cause of cough or colds.

[babyko_14]

^Maraming salamat po ulet doc.

[nicky_kim]

Doc lelet,

Yung anak ko po nadiagnose ng PC nung 1 yrs old pa lang sya... tapos neresitahan po sya ng gamot... for 6 months... after that... gumaling naman... ang nag gain talaga siya ng weight. And now my son is 4yrs old... lagi walang gana, madalas nya isuka kinakain nya, at pumapayat na naman. then one time nahawakan ko leeg nya may nakapa ako na mga bukol...may chance ba bumalik ang PC? Do I have to bring him back to his pedia? sabi ng cousin ko., painomin ko daw ng gamot sa sipon at antibiotic, kasi daw baka may sipon sa loob na di mailabas. part of me agree kasi 4days before ko nakapa yung mga bukol sa leeg ng anak ko may sipon sya noon. pero hindi pa ako bumibili ng gamot... nagdadalawang isip pa rin kasi ako.

[leletmd]

^ Enlargement of lymph nodes can be brought about by infection(Viral, bacterial, fungal, etc.) wounds, allergic/inflammatory processes. The lymph nodes enlarge because they are producing antibodies.It doesn't necessarily mean that the PC is back but since you mentioned that your son has been losing weight and having feeding difficulties, then I suggest you bring your son back to the pedia for proper evaluation.
Is your cousin a doctor? Did she examine your son? If not, then with all due respect to her, I suggest that you do not follow her advice.
Medications should only be given after a thorough history and physical examination. This is also the reason why text consultations are being discouraged.

[nicky_kim]

Thank you Doc Lelet. i followed your advice. i bought my son to his pediatrician. neresetahan po sya ng cefalexin for 7 days. after that balik po kami ulet sa pedia if still meron pa rin or andoon pa rin po yung lymp nodes. sabi nung pedia skin test daw po yung son ko pag may lymph nodes pa rin.

[leletmd]

Ok, hope he responds to the medications given by your pedia.
Sometimes matagal lumiit ang lymph nodes kapag may infection kaya minsan may observation period pa.

[mrs divs]

Good morning.  My daughter had her xray last May 19, 2012 due to persistent cough for 2 weeks.  And the findings were:

Streaky densities are seen in both inner lung zones.
There is fullness noted at the paratracheal area.
Heart is not enlarged.
Hemidiaphragms, sinuses, soft tissues and visualized osseous structures are intact.

Impression: Consider interstitial pneumonia with probable nonspecific lymphadenopathy.

Based on this po, her pedia told us that IF she gets a cough again within the next month or two, we should start treating her for PC.  I think her assessment was also due to the fact that when my daughter was 2 months old, she had some kind of reaction to her BCG vaccine (based on the doc's diagnosis).  Her BCG vaccine was injected on her right butt cheek and a lymph node appeared sa right singit nya that became red, swelled and had pus later on.  She was given isoniazid because of possible TB exposure.  Although when we had everybody in the household checked including the lolas who were the only frequent visitors, all the chest xrays came back negative. So we were wondering that time how and from whom she was exposed since as a rule, we don't bring the baby outside our home except for monthly check-ups.

I backread from thread 1 to 2 po and i just have some clarifications po:

1) When someone is exposed to a person with TB and let's say, he doesn't get infected, can he pass on the infection to others as well? How long po ba "nabubuhay" ang bacteria outside the host before natin masasabi na di na ito pwede maka-infect? And kailangan po ba ma-inhale talaga ang bacteria at pumasok sa lungs before sya maka-infect? Pwede ba na it lives muna sa skin ng tao and then after some time ma-transfer sya sa lungs?

2) I also read that the bacteria may be dormant for even years before the carrier presents any symptom.  Does this mean that only active TB can be detected in the xrays? And can the carrier infect others even if his TB is dormant? Ang lungkot naman kung pwede pa rin i-transmit even if dormant at hindi madetect kasi kahit na vigilant tayo in having all members of the household including possible helpers xrayed to protect our family's health,e pwede pa rin tayo malusutan.

3) Lastly po (promise, sorry haba ng post), whom should we get a second opinion from to rule out possible PC infection: a pedia-pulmo or a pedia-infectious disease expert? And can you please recommend a good one affiliated with Manila Doctor's, PGH or Cardinal Santos.

Sorry po for the VERY long post.  I am one very worried mom kasi I'm 8 months pregnant now and worried about my possible exposure and the new baby's health also.  Our two helpers had their xrays done and both came back negative.  I haven't had my xray yet but hubby (who is abroad) and I plan to have this done as soon as I give birth. I have also urged both paternal and maternal relatives to have x-rays. Grabe, kapalan na talaga ng mukha pero I explained that this is for the good of everyone and I am praying that they listen.

[leletmd]

^ The initial BCG reaction at 2 months of age may or may not be due to PTB exposure. It can also be due to how the BCG was injected. The reason why sa right singit nagkaroon ng enlarged lymph node is because doon nagdradrain ang lymph nodes from the BCG site niya sa right buttock. If sa right shoulder ang injection site, pwedeng sa axilla or sa neck area mag-enlarge ang lymph node. Treatment will consist of Isoniazid as your pedia prescribed.
How old is your daughter now? Did she undergo PPD recently to check for TB exposure? Did any of the household contacts undergo PPD testing as well?

Regarding your questions:
1. The ability to infect others depend on the response of the immune system of the exposed patient. For example, if the immune system recognized the TB mycobacteria and was able to "contain" the infection, then it was just exposure. This would result in a positive PPD test, negative chest x-ray.
TB mycobacteria cannot live on inanimate objects. Thus, you don't need to separate the spoon, fork, plate, etc. of the infected person. You also cannot get it from shaking hands with an infected person.
You need to be able to inhale the TB mycobacteria in order to get infected. You inhale it from getting coughed on, sneezed on, spit on by someone who is a close contact and with prolonged exposure. If the sputum or spit is left on the floor and not cleaned up right away, the TB mycobacteria can remain alive for about 9 to 10 hours and can infect people, especially if enclosed space (small room).
Close and prolonged exposure in order for you to get infected...

2. Usually if dormant TB (there is exposure plus active infection but no symptoms), meron ka ng findings sa x-ray. Eto yung mga asymptomatic patients na nalalaman lang na infected sila kapag nagpa-chest x-ray sila.
In order to infect people though, you have to be in the infectious stage (may symptoms na of coughing, etc. ) Pag nagpacheck ng AFB sputum smear, ang findings: positive AFB smear.
If exposure lang, no infection: Positive PPD test, negative chest x-ray

3. I think you would benefit from a consult with a pedia infectious disease specialist or a pedia pulmonologist.
Aside from the cough and the BCG reaction, are there any other symptoms that point to a possible TB infection?
The chest x-ray findings kasi point to pneumonia. Even the non-specific lymphadenopathy point to pneumonia since lymph nodes enlarge due to any infection.
If it is due to PTB, even with disappearance of the cough, lalabas pa rin ang lymphadenopathy kapag nag-repeat ng chest x-ray. If it was due to pneumonia, the lymphadenopathy will not be visible after a month or so...
At PGH: Dr. Liza Gonzales, Dr. Anna Liza Ong Lim (not sure if they have clinic at the UP FMAB)
At MDH: Dr.  Melecia Velmonte (Room 402 if I am not mistaken)
At Cardinal Santos: Dr. Miguel Javier (Pedia pulmo, not sure of room)

[mrs divs]

thanks doc lelet. your reply settled most of my fears. i also suspected that the reaction may have been due to how the BCG vaccine was injected since everyone exposed to my baby at that time were xrayed and all came back negative. i came across an article in the web on possible reasons for reaction to BCG and, indeed, how the injection was done was mentioned.  If this really was the reason, can i request that the injection be done by the pedia doc herself or will this violate some hospital protocol or something? I wasn't able to ask who did the injection on my eldest and I will be giving birth at the same hospital. Gusto ko lang maiwasan na maulit ang nangyari.  It was tramautic for us as first-time parents kasi naawa kami sa anak ko na umiinom ng matapang na gamot plus it left an ugly scar sa thigh nya.

My daughter will turn 2 years and 10 months old this month. No, we did not undergo PPD recently kasi sabi nga ng doc nya, we will wait and see if magre-recur ang cough nya. She also has no enlarged lymph nodes sa neck area. My daughter wasn't really sickly when she was younger because she was breastfed until feb of this year. Even the doctor said ang linis nga ng baby book nya because except for vaccinations and well-baby check-ups, we seldom brought her to the doctor. Except that slow ang weight gain nya. She's only 12 kilos. Altho, yong build kasi ng family ng asawa ko, payatin talaga.

The first time she had a cough was december 2011 and the diagnosis was due to bronchitis. She responded well naman to her meds altho we had to nebulize. The next time was feb and then etong may na nga with the pneumonia findings.  This june she got sick with the colds kasi nahawa ko. But it lasted for only three days and magaling na sya ngayon.

So doc, the enlarged lymph nodes may be due to pneumonia.  I'm planning to get the xray plates from cardinal santos tom. And this weekend, punta kami sa infectious disease specialist for consult.

[leletmd]

^ The enlargement of lymph nodes is most probably due to the pneumonia that she had during the time the x-ray was taken. Merong pneumonia na due to TB pero iba ang findings noon sa x-ray and mas mahirap gumaling. For peace of mind, I think it would be best to get the opinion of a pediatric infectious disease specialist.
Regarding the BCG injection at birth, you may opt to talk to your pedia about your concerns. Baka sakaling pumayag siya na siya ang mag-inject. You can also try having it injected sa right deltoid area (as prescribed by WHO and PPS) para mas madaling i-inject.
BCG vaccination, though, really leads to scar formation within 1 to 2 months from vaccination. It is one way of knowing that the BCG vaccine was able to elicit a reaction from the immune system. The scar formation is one of the reasons why some pedias opt to inject it sa upper buttock area (para not visible).