Primary Complex Thread 2

[b3bang]

Last April when my son turned 5 month old, napansin ng pedia na poor gain weight at payatot si baby kahit na 4 vitamins na ang iniinom niya. Madalas rin siya magreflux. Nung kinapa yung head niya sa likod may na-detect na kulani. So niresetahan siya ng heraclene pampagana daw at hinde muna siya pina-skin test kasi wala pa daw 6 month. So nung Saturday yung follow up check up ni Baby .5 kg lang ang gain niya sa weight at pina-skin test siya ni doc. Pinababalik kami on next day for reading. Kahapon (monday) bumalik kami ulit sa pedia and sad to say... 12mm ang result ng skin test niya which is positive for PC. Niresetahan kami ng 3 gamot. Hinde ko lang matandaan lahat, pero post ko bukas na brand names.
Dilemma ko ngayon, nakatira kasi kami ni hubby sa family niya. Marami sila.. at ngayon nire-required namin silang magpa-xray, kaso yung iba parang minasama pa yung gesture namin.. to think para sa kanila naman yun. Sabi ko kay hubby pag hinde lahat magpa-x ray dun kami sa amin titira habang nagpapagaling si baby.. ang concern ko naman eh pag nalaman ng family ko na nahawa ng TB baby ko sa family ng hubby ko.. hayz..
Iniisip ko pang lang painum yung 3 gamot kay baby nadudurog na puso ko. Ang bata pa niya para mag-gamot.. 

Doc lelet, hinde pa ni-require ng pedia niya mag Xray si Baby. Iniisip ko baka kasi may sipon siya at nag-aantibiotic so baka maapektuhan yung result ng xray. Sabi po niyo kasi pag +PPD +xray=3 medicines. pero pag +PPD at -XRAY=2 medicines. Hinde pa naman siya nakakapag-x ray pero pedia ni baby nagreseta na agad ng 3 gamot.

[leletmd]

^ I think it would be better if you clarify with your pedia as to why a chest x-ray was not done since mahirap mag-speculate and siya lang ang makaka-explain tungkol doon.
Based on the criteria I posted and from the history you gave, 2 lang ang criteria na nafulfill ni baby: poor weight gain and a positive PPD. You need a chest x-ray to determine disease activity.
With a positive PPD, definitely may exposure so talagang you have to look for the source.
If naman negative PPD and positive chest x-ray tapos may actual na source and there are signs and symptoms pointing to TB, then sa ganoong clinical scenario, you can still treat for disease (3 meds) kasi nakafulfill ng 3 out of 5 criteria kahit pa negative ang PPD. There are instances kasi na nagkakaroon ng false negative PPD. Kaya important talaga ang chest x-ray...
Why was he given 4 vitamins at ano ano ang 4 vitamins niya? Also, na-address ba yung reflux niya? Reflux can also cause poor weight gain kasi...
An infant 0 to 6 months of age would usually gain about 600 grams/month. How much ang nagagain ng baby mo? Just want to gauge how poor his weight gain is.

[b3bang]

^Doc Lelet nagstart na kami magpainom kay baby ng Kidz Kit 3 nung nakaraang araw June 20. Sa July pa ulit yung schedule check up namin sa Pedia niya. By the way baka kilala mo pedia niya sa Makati Medical Center, si Dr. Paguntalan. Magaling siyang Doctor. Kaya nga medyo nag-isip ako nung niresetahan na siya ng 3 medicines without X-Ray. Baka tawagan ko na lang siya at dun ako mag-inquire.
About dun naman po sa Vitamins na pinapainom ko sa baby ko: Ceelin, Growee, Ferlin at Taurex.
About naman sa reflux, matagal ko na po na-discuss sa kanya yan kasi madalas nga maglungad si baby or sumuka. Sabi niya sa posisyon lang daw yun. Dapat daw mataas ang ulo or nakaupo. Nagagawa ko naman yun, at effective naman. Pero hinde rin naman nawala yung paglungad niya. Yung previous weight po ni baby, May 26 nasa 6.4 kgs siya tapos heto ngang last check up niya (June) 6.9 lang. Before po nagkasakit rin sya (Ubo) kaya hinde nagbabago gain weight niya starting Mar (6.3), April (6.5).. dun lang naglalaro weight niya. Dami nga nakapansin na biglang pumayat siya.
Buti na lang etong 2 days na napainom na namin siya ng gamot, hinde naman pahirapan. Hinde pa niya sinusuka.. kasi makalat yung Rifampicin eh.

[leletmd]

^ Since na-start na ang treatment, try to clarify na lang with your pedia regarding the need for the 3 meds without the chest x-ray. She is the best person to explain her position on this. Baka kasi may nakita pa siyang criteria na magpoint to active TB infection.
I also suggest that you look for the source since positive ang PPD niya.
Were all those vitamins given all at the same time?
If parati pa rin siya naglulungad, maybe it would be better to have a pedia gastro consult. Nakaka-affect din kasi ng weight ang pag-lungad and it can also lead to respiratory problems kung nasasamid siya sa lungad niya.

[b3bang]

^doc leletmd -[textspeak!] po magtatanong ako sa Makati Med kung meron dun na gastro pedia. Ni-rerequire pa lang namin yung relatives ni hubby na magpa-xray, pero pahirapan nga kasi gusto ko kasama si Hubby eh hinde naman sumasang-ayon schedule niya sa work. so 2 lang nakapagpa-xray eh negative pareho, 7 pang adult ang hinde! Yung vitamins niya after lunch na lang namin pinapainom kasi yung anti-TB meds na 3 morning pagkagising niya. Sabi pa ng pedia na pag meron daw mag-positive ng TB an active, dadagdagan pa daw niya ng 1 gamot!! Pwede ba yun? Kaya parang matutuwa ba kaming mag-asawa pag nalaman na namin ang source tapos magiging 4 naman ang papainom namin???! hayz..

Pero in fairness Doc, pansin ko na mas malakas na siya mag-milk. Before hinde niya nauubos yung 5 onze na timpla ko in 1 feeding. Ngayon 6 onze na, ubos agad! So nakakatuwa rin isipin na mag-gagain na siya ng weight. Malakas na rin siya sa cerelac, dati ayaw niya at di inuubos. Combined with applesauce, minsan naman banana. He is turning 7 months today 

[leletmd]

^ Why daw 4 meds kapag may nag-positive?
Kasi if may nagpositive sa household contacts niya, then it would just fulfill 3 out of the 5 criteria: 1. poor weight gain (clinical criteria, assuming that this is one of her criteria), 2. positive PPD and 3. positive source so dapat doon pa lang magbibigay ng 3 meds...
As of now, 2 pa lang ang criteria na nafulfill niya kaya dapat sana nagawa ang chest x-ray.
I suggest you clarify na lang with your pedia or visit an Infectious disease specialist for clarification...

[b3bang]

^doc. un nga rin kaya medyo nag-aalanganin ako. Hinde ko pa nakakausap pedia niya pero gusto ko sana ma x-ray din si baby kasi baka naman exposed lang siya at 1 lang ang pwede niyang i-take na meds instead 3. May kilala po ba kayo sa Makati Med or San Juan De Dios na Infectious Disease Specialist? IF ever po na hinde nagawa yung X-ray at nag-gagamot siya ng 3 meds may masama bang implication yun?
Nga po pala hinde lang si baby ko ang bata sa bahay. 2 nasa elementary na at 2 babies na halos same age niya lang (6months and 4 months both BF) Sinabihan ko na parents nila na magpa-PPD rin kasi nagpositive anak ko.. ayaw naman nila.. parang in denial! Eh on and off na mga ubo at sipon din ng mga babies. Kawawa naman. Pero kung ayaw nila wala naman ako magagawa. Kasi yung isang nanay pinacheck up niya yung baby niya at sabi nung Doctor Rosales, tiga paranque (general Doctor po ito at hinde Pedia) na may allergies lang daw. Binentahan pa sila ng gamot. Eh nag-rereseta yun ng mali eh! kasi na-experienced ko na rin magpacheck up dun! nagreseta ng pang-UTI kasi may lagnat daw baby ko without having his urine test first! Naku! Hinde ko nga sinunod at kumuha ako 2nd opinion. Wala ako tiwala sa Doctor na yun eh!  (Sorry Napahaba)

[leletmd]

San Juan de Dios: Dr. Lulu Bravo (magaling siya; head of the infectious disease section of UP PGH)
Sorry, don't know any IDS consultant at Makati Med.
If hindi kailangan ng 3 meds and the 3 meds were already started, there is a risk of resistance and allergies kapag dumating yung time na kailangan niya talaga magtake ng 3 meds.
Try niyo hanapin ang source from the close household contacts first before asking other family members to have their x-rays. Mahirap kasi talagang mag-convince pag ganyan at nagiging source of misunderstanding among family members.

[mae_s]

^Hi Doc! Joining this thread na rin kasi yung baby ko (11 months) is suspected of having PC. It started kasi June 11 nagkaron sya ng cough and colds and sinat (kasi ang temp nya po nun is 36.+ lang). June 11 lang yung sinat Doc then nawala na. But yung cough and colds nandun pa din po. Hindi rin po nag effect yung prescribed ng pedia na meds like Xelent and Alnix. As in natapos na namin i take lahat ng meds nya pero di po sya gumaling. So binalik ko po sa pedia. Nag prescribe po ulit yung pedia ng new meds (Ilosone and Disudrin), after naman po ng pagtake nun eh gumaling naman po si baby. Pero the pedia suggested pa rin na ipa xray si baby and ppd test. Sa xray po wala naman nakita, ang impression is "consider pneumonia". Sa ppd test nya its 8mm-9mm daw po. Sabi ng pedia she cannot say na it's negative kaya under observation po si baby. Pagka daw po inubo ulit within 3 months, possible daw po na ulitin yung skintest. Masigla naman po si baby, magana din kumain ng solids and mag milk. Nag gagain naman po ng weight. Ok din po pagtulog nya sa gabi, tuloy tuloy naman po. Ang concern ko lang Doc last Thursday sinipon nanaman sya, then ito po medyo naririnig ko po inuubo na. Pero yung ubo nya po is hindi naman persistent, siguro po mga less than 10x a day kung umubo. Possible nga kaya doc na may PC ang baby ko? Btw, tom po namin makukuha yung mga xray result ng adults sa house namin. Thanks po in advance!

[leletmd]

^ Actually, hindi sinat ang 36 degrees.. Normal temp siya.
Low grade fever = 37. 6 - 38.4
Fever >/= 38.5 degrees

Chest x-ray results show possible pneumonia, PPD test is negative so medyo equivocal siya. It is possible na may ibang infection like Bronchiolitis (starts with colds then leads to cough and may even lead to pneumonia later on; affects kids 3 months - 2 years of age usually during the wet season) or even just the common cold that is affecting your baby. Rainy season na kasi so maraming respiratory infections.
What are the lung findings during her check up? May inflamed lymph nodes ba na nakapa si pedia na hindi lumiit even after 2 rounds of antibiotics? Ano exact description sa chest x-ray bukod sa nakasulat na possible pneumonia?

[mae_s]

^ Doc, sorry, the temp pala ni baby last June 11 is 37.+. Basta po not more than 37.8 yun tanda ko. So nag low grade fever po sya ng 1 day.

Usually nga po ganon ang nangyayari kay baby, colds muna tapos magkakaron na ng cough. Wala naman daw pong nakapa na inflamed lymph nodes yung pedia, Doc. Ngayon po nag uubo nanaman si baby. Nag start yung colds last June 28, pinainom ko po sya ng Disudrin as per advice ni pedia. Then nagstart na po yung ubo ng July 2. Advice ng pedia to nebulize him lang 3x a day with Multivent. Discontinue Disudrin and switch to Alnix. I'll post po later yung ibang findings sa xray ni baby, Dra. I'm in the office po kasi. Anyway, thanks a lot Doc.

[leletmd]

^ Sounds like the symptoms are related to the weather rather than PC. Maraming viral infections right now.

[sasieyayad]

Hello  Doc at hello sa lahat ng mga mommy. Newbie po ako dito. Itatanong ko [textspeak!] po regarding sa Broncofen pwede po bang uminom ang bata na walang kain 6am kasi dapat ang intake ng med nia then 12pm at 6pm. late na kasing gumising ang anak ko. [textspeak!] po ang dapat kong gawin? Help po.

[leletmd]

@sasieyayad:
Pasensya na but the question is OT since this is the Primary Complex thread and bronchofen is not a medication related to PC. Baka mapagalitan kasi tayo ng moderators.
Anyway, perhaps you can ask your pedia if pwede mo iadjust yung schedule ng pag-inom since late na magising ang anak mo.

[drex]

good day doc lelet,just want to have some info bout PC..my kid was diagnosed PC last wk..his xray was positive but his PPD was negative..still his pedia prescribed him the 3 meds for PC..he has a cough for almost a month now..and were taking the meds for 3 days na..im confused bcoz untill now he has still this cough so bad with so much pleghm..before we take the 3 meds(isoniazid,rifampicin,pyrazinamide) his pedia also prescribed  him salbutamol+guaifenesin..it is okay to tke this with this 3 meds??thank you so much in advance...im so glad i've subscribed to female network...more power!!

[leletmd]

@drex:
Salbutamol/guiafenesin may be taken with the 3 PC meds.
How old is your son? What is his weight? If medyo thin siya, there is a chance na mag-false negative ang PPD.
What were the exact Chest x-ray findings? Size of the PPD? Have you started looking for the source?

[teejiko]

Ngayon ko lang nakita tong thread na to.. may question lang ako. My daughter was diagnosed with PC I think mga 8mos palang sya (she's 10 now) pero mga 3mos lang siya nagtake. Anong effect nito? Should she start it again? Bihira naman syang sipunin at ubohin.

[leletmd]

@teejiko:
Incomplete treatment may lead to progression of the disease. Another scenario is if her immune system was strong enough to fight the infection with just 3 months of treatment, there is a chance of early recurrence if she gets exposed to TB again. If she gets re-exposed, there is a chance for medication resistance and allergies.
Was your pedia aware that you stopped treatment at just 3 months? Did you follow up monthly during the treatment? Why was treatment stopped?
I suggest that you have her assessed by her pedia before starting any treatment because as I said, if her immune system was strong enough to fight off the infection with just 3 months of treatment, then there is a chance that she doesn't need treatment now. If she is symptomatic (with poor weight gain, frequent cough, enlarged lymph nodes, etc.), she still needs to get evaluated (possible repeat X-ray and PPD) prior to resuming treatment. 

[teejiko]

^Thank you doc leletmd for the reply. No she was not aware that we stopped the medication due to financial problems that time ang dami ng meds and we can't keep up with it that time talaga. Di rin kami nakapag follow up until now wala na din kasi sya sa dito. Can I get a new pedia to check her regarding this? Payat sya pero she hardly had cough or sipon in the past years.

[1choi_ko9]

1choi_ko9:
Where you able to find the source of his 1st PC infection? Nagtreat ba ang source? Proven ba talaga na nag-relapse ang PC niya?
Ongoing ba ang repeat treatment niya for PC?
Pneumonitis just pertains to viral infection that causes lung inflammation. It is not related to PC.
Regarding the enlarged lymph nodes at the back of the ears and head, it usually happens kapag may sipon or may ear infection. Usually kapag PC, nasa neck area ang enlarged lymph nodes.
Hindi lahat ng paglaki ng kulani ay dahil sa PC.

thanks doc. well as per investigation namin, lahat ng househelp sa bahay napa xray na...wala naman trace na pwede mahawaan. If ever doc, paano po nahahawa ang bata? through kissing po ba? pag kiniss bata? kase we were thinking na baka nakuha nya pag dinadala sa inlaws.

As of now malapit na matapos treatment nya. Sana gumana na sya kumain.

Doc, napapansin ko na wala pa rin syang gana kumain malapit na matapos treatment nya yet same pa rin sya? When po kaya namin makita progress?

Thank you so much doc.