Primary Complex Thread 2

[leletmd]

@luveeduvs:
Pneumonitis just means she has inflammation of the lung tissue. This is just due to a viral infection and should resolve on its' own. However, the radiologist was unable to rule out a possible primary complex. So, dapat ma-correlate ang chest x-ray findings with the history and physical examination of the patient. Your pedia is the best person to say whether or not, there is a need to treat for PC.

[luveeduvs]

thanks doc lelet, kanina kasi nagpa PPD kami ng daughter ko, sabi kasi if mag negative mag isoniazide parin daw daughter ko, may iba naman na doctor na nagsasabi na wag naman daw kasi kawawa naman bata if mat take ng anti tb drugs kahit wala naman daw. And another question ko po is kapag po ba may nakita na lymph nodes sa x-ray meaning positive na sa primary? thank u.

[leletmd]

@luveeduvs:
Kapag PPD positive or meron talagang known source of Tb and the chest x-ray is negative, saka lang kailangan bigyan ng Isoniazid for prophylaxis/protection ng bata na hindi ito mahawa sa tao na naka-expose sa kanya.
In the case of your daughter, meron chest x-ray findings na pointing to possible PC so in my opinion, eto yung dapat iclarify. Are the infiltrates due to TB or just due to pneumonitis? In some cases, nagpapa-repeat kami ng xray para malaman if TB ba talaga or hindi kasi kung pneumonitis lang ang problem, then dapat sa repeat x-ray (usually done 2 to 4 weeks after), clear na.
TB is not the only cause of lymphadenopathy on chest x-ray (or lymph nodes seen on chest x-ray). Basically, any infection, injury, inflammation (like cancer) can cause enlargement of the lymph nodes. It would depend lang on the site where the lymph nodes were seen and on the history and physical examination of the patient.
I suggest you have your daughter checked by a pedia pulmo or a pedia Infectious disease specialist to be sure.

[luveeduvs]

thanks again doc lelet, negative po yung PPD ng daughter ko, gusto parin po bigyan ng isoniazide for 3 months. Yung result naman po ng x-ray hinde naman nilagay na positive sa TB, hinde ko po alam kung sino susundin ko sa 2 doctor , yung isa ayaw na bigyan samantalang yung isa gusto bigyan

[leletmd]

@luveeduvs:
Doon sa 2 doctors whom you've consulted, meron ba doon na pedia pulmo or pedia IDS? If wala, then I suggest you bring your daughter for consult with either a pedia pulmo or a pedia IDS. Bring lang the x-ray plates and the PPD reading result.

[luveeduvs]

hi! doc lelet, good day po. Kanina galing po kami sa pedia-pulmo, sabi nga po negative yung PPD, tapos yung sa x-ray naman po nya hinde ma rule out yung TB.,hinde direkta na sinabi na positive. since po nagka ubo daughter ko hinde din nilagnat, magana parin cia kumain and yung weight naman hinde din bumaba. Now po, prescribe na po yung pedia-pulmo na painumin na po cia ng medicine for tb for 6 months yung kids set po na forte.

DUn po sa isang pedia na hinde pedia-pulmo ang gusto yung isoniazide lang pa take sa kanya, pero this time po from pedia-pulmo lahat na po (kids set) . Naisip po namin ng husband ko na mag wait muna na maka 2-4 weeks para mapa x-ray muna namin then if hinde nagbago tsaka namin gawin yung medication. Tanong ko na lang din po doc, if ipa take ko po ba yung kids set for 6 months, let's say na negative po yung anak ko, may magiging problem po ba sa health nya? kasi yun lang po naiisip namin mag asawa, mag wait ng another x-ray or ipa take na medicines kahit hinde masabi if may Tb daughter namin, ang worry lang po namin baka may bad effects if negative naman salamat po. God bless.

[leletmd]

^ Repeating the chest x-ray is one option if the first chest x-ray done is equivocal or doesn't give much information.
If no TB and treatment was given, possible problems include resistance to meds (hindi na tatalab like what happens in patients na palaging binibigyan ng antibiotics kahit hindi kailangan) and development of allergy later on when meds are re-introduced or there is a need to re-introduce the meds.

[luveeduvs]

Thank you so much doc lelet more power!

[Princess_Chill]

doc lelet,

just want to ask when will we need to panic regarding PC? and nakakasira ba talaga ng atay ng bata ang gamot for pc?

my daugther has lymph nodes sa neck and sa batok...she's diagnosed with PC daw pero di naman siya inuubo or wala naman weight loss pina take namin siya ng tb drugs iyong 3 pero 1st day plang lumpaypay siya not her normal na masiyahin na laru ng laru kaya tinigil muna namin....

when should i be alarmed?

[snowyice]

@leletmd ask ko lang kapag Pneumonitis ang bata tapos nagpositive sa skin test around 20mm after 48hours does it mean sure na sure may PC? Wala naman lymph nodes balik balik ang ubo

[leletmd]

doc lelet,

just want to ask when will we need to panic regarding PC? and nakakasira ba talaga ng atay ng bata ang gamot for pc?

my daugther has lymph nodes sa neck and sa batok...she's diagnosed with PC daw pero di naman siya inuubo or wala naman weight loss pina take namin siya ng tb drugs iyong 3 pero 1st day plang lumpaypay siya not her normal na masiyahin na laru ng laru kaya tinigil muna namin....

when should i be alarmed?

PC meds are metabolized by the liver, but not necessarily nakakasira ng atay ng bata. Meds are computed based on a specific dose/kg na proven by studies na hindi nakaka-affect ng liver. For high risk cases, we sometimes request for liver enzymes panel before starting PC para may baseline levels in case magkaroon ng side effects...
Pasensya na pero bagong diagnosis ba ito ng PC sa daughter mo or related pa rin sa question mo 2 pages back in this thread na your daughter was diagnosed with PC about a year ago, but you didn't continue with the meds anymore? If hindi ito bagong diagnosis, then I suggest that you have a repeat chest x-ray done just to clear your doubts regarding whether or not your daughter still has PC despite your decision not to continue treatment...
Alarming signs: failure to gain weight, open wounds with yellowish cheesy discharge sa chest area, hemoptysis (pagsuka ng blood), other organ involvement like the bones, meninges and liver.

@snowyice:
Pneumonitis pertains to inflammation of the lungs due to viral infection and not TB. This is commonly seen sa mga patients with asthma like symptoms. Hindi siya specific for TB.
PPD skin test size of 20 mm shows that the child was exposed to a person with TB so dapat mag-gamot for exposure.
Judgement call ng doctor if she will opt to treat or not based on the findings you posted...

[snowyice]

doc letlet,

   I just want to ask about what you stated na it's the doctors opt to treat or not to treat?  Pwede bang hindi itreat? The child was given 1 week antibiotic and parang 6 months nga na medicine anti-tubercolosis.  Diba kapag hindi sure na PC hindi pwedeng uminum ng medicine and kapag naman may PC diba hindi naman pwedeng hindi gamutin? Sorry ha medyo limited lang kasi ang alam ko dito.  Thanks so much for the help.

[Princess_Chill]

Hi Doc,

No new diagnosis...i'll go back to her pedia to have chest xray. may nakapa kasi ako na kulani sa neck niya e...lakas parin naman niya kumain etc normal kid...

thanks doc

[leletmd]

@snowyice:
Doctors take into consideration clinical findings (history and physical examination findings) and correlate it with chest x-ray and ppd findings so lets say for example, inconclusive ang x-ray findings pero history and pe point to possible PC tapos positive ang PPD and meron actual source of exposure then 3 out of 5 criteria for PC positive na kaagad and kailangan na talaga mag-treat for PC.
Try to back read so you can check the criteria for diagnosing PC.

@Princess_Chill:
In my opinion, having a chest x-ray done may clear up your doubts.

[snowyice]

a ok. thanks!

[iamjessi]

Hi po.. Ask ko sana if there's a chance na false positive ang ppd test? medyo makulit kasi si baby and nung ppd test nya malaki [textspeak!] naging bump nya during skin test. tapos after we went home, umimpis naman pero during our pedia visit sabi 10mm daw sya. Which is for me, ganun na rin ang size nya before although nagflatten unlike before. Does it mean na positive na po sya or pwede iparepeat? Worried po kasi ako na bigyan sya ng meds tapos baka false positive naman pala. thanks po

[leletmd]

@iamjessi:
Causes of false positive ppd:
a. Infection with nontuberculous mycobacteria (kamag-anak ng TB pero hindi TB)
b. Previous BCG vaccination (kaya kapag vaccinated with BCG, > or = to 10 mm ang considered na positive PPD reading compared to non - BCG vaccinated persons na sa 5 mm, positive na)
c. Incorrect method of administration
d. Incorrect interpretation of result
e. Incorrect bottle of antigen used
f. Booster phenomenon (repeating the test within 3 years from the previous PPD may result in a booster phenomenon or enhanced PPD test - lalong malaki ang reaction if previously positive)

Since there is such a thing as booster phenomenon, I do not suggest repeating the PPD test. I also cannot comment on whether or not the technique was correct since it will be unfair to your pedia since I was not there when the PPD test was done. What I do suggest is that you talk things over with your pedia regarding your apprehensions with regards to the PPD results. Do not be afraid to voice out your concerns since it will give your pedia a chance also to clarify/explain to you her side.
Also, PPD just shows exposure to a person with TB. What were the reasons as to why the test was done? What are the chest x-ray results?

[iamjessi]

We just had the xray result and sabi po primary ptb. Gumuho po yung mundo ko.. Ask ko po if nakakahawa ba po siya, like sakin kasi minsan nagkikiss siya sa lips.. Ayaw ko naman po iwasan ang baby ko kaya lang if magkaroon ako hindi ko na sya lalo maaalagaan kasi baka magrotate lang saming dalawa yung sakit. Also how do I know po if may allergies siya sa gamot na binigay? Thanks po

[leletmd]

@iamjessi:
Hindi nakakahawa ang bata na may PC because they have very little mycobacterial load that is not enough for transmission and their mycobacteria is usually hidden in the lymph nodes.
Children get TB from exposure to adults with TB so I suggest that you have all the household contacts of your kid, including you, undergo a chest x-ray to find out kung sino ang nanghawa sa kanya.
Again, you do not have to isolate your child kasi hindi siya nakakahawa pero you have to identify kung sino ang nakahawa sa kanya kasi it is important that the source get treatment, too.
If it is her first time to take anti - TB meds, the allergic reaction will not manifest on the 1st take. It would usually take 1 to 2 weeks before the rashes to appear. And you would know if it's allergic if the rashes and itch appear within minutes to 4 hours from intake of the meds and would re-appear each time she takes the meds.

[iamjessi]

thanks for the answers po. My baby's appetite decreased after taking the kidz kit medication, is that normal po? Nung dinala sya sa pedia, she asked for cbc tapos sa cbc nya ang taas ng wbc, 17. Is that normal for 1 year-olds with PC? or does it mean may iba syang sakit?