Primary Complex Thread 2

[babyxian]

hi doc lelet this is my first time to join this thread...unfortunately, my 9-month old son was diagnosed with a primary complex..he has a positive chest xray but a negative ppd test..which is more accurate po kaya?..what are the factors which might give a false negative result?..what are the possiblities na magkamali yung xray?..you know i was hoping and praying that there are errors in the tests...we had our second opinion sa pedia pulmo na talaga..pinagawa siya ng xray apicolordotic view..we dont have yet the results..but regardless of my doubts and hopes na baka mali yung first xray ng baby ko..we started the treatment prescribed ng original pedia ko..Kidzkit3..

[leletmd]

@iamjessi:
You won't usually see high WBC with PC. Usually normal wbc with high lymphocytes ang finding so it is possible that your child has a superimposed bacterial infection which may also be the reason for her loss of appetite.

@babyxian:
PPD will just show you exposure. It will not show you if the patient has an actual disease already. To show actual pulmonary TB, you need to have a chest x-ray done. You need to fulfill 3 out of 5 criteria to determine if the patient has actual TB.

Causes of false negative PPD  include:
a. wrong technique
b. malnutrition
c. immune deficiency causing anergy (hindi madetect ng immune system)
d. very young age (less than 6 months of age)
e. viral infections like measles and chickenpox (wait 3 months before having a ppd done)
f. recent immunization with measles or MMR (wait 3 months)
g. recent TB exposure ( if around 8 to 10 weeks pa lang since na-expose, pwede pang negative kasi hindi pa nakabuild ng enough antibodies ang immune system to produce a positive PPD response)

The apicolordotic view will help distinguish if there are really PC infiltrates. 

[snowyice]

@leletmd ask ko lang usually when are repeat ng sgpt , sgot exam kapag tumaas due to medicines?  Thanks!

[leletmd]

@snowyice:
It's lelet, not letlet 
Depends on how high the levels are and whether or not dose adjustment was done, we can repeat within days to within 2 to 4 weeks from dose adjustment.
If lets say, 3x elevated and levels, and we do dose adjustment, we can repeat the levels the next day na. if high normal, pwede within a week or within 2 to 4 weeks. It would depend on the risk kasi for drug induced hepatitis.
I suggest you clarify with your pedia also since she is the one who is most knowledgeable about your child's condition.

[snowyice]

^ay sorry po hindi sinasadya.

[leletmd]

^ No problem 

[cheezecake]

hi doc leletmd  I just to ask my son was diagnose to have PC and was asked to take medicines but after 2 weeks the doctor noticed a sign of jaundice and he was asked to stop his medicines.  Due to colds he was asked to take Zinnat for 5 days and yesterday we went to a lab to have his blood test but lalong tumaas yung results nya.


                 dec 19        jan 3
sgpt           14.8           33.4
sgot            27             40
alkaline       478           467

Is it because of Zinnat kaya tumaas yung blood best niya?  My husband read the info about zinnat and sabi niya may nakalagay daw dun na can have temporary raise in liver enzymes.  But his last dose of  Zinnat was January 1  morning and the blood test was taken january 3 around 2pm.     

[leletmd]

@cheezecake:
 Same pedia ba ang nagprescribe ng Zinnat? If hindi same pedia, was the pedia aware of the previous episode of jaundice? Nawala na ba ang jaundice ng anak mo?
I suggest that you go back to your pedia (the one who saw the jaundice) para ma-interpret ng maayos ang lab results. All lab results should be correlated clinically. We just don't look at the lab results, we look at the patient also through history and PE so that we can weigh in all factors that may have contributed to the lab results.

[leletmd]

@erl:
Pasensya na but this is the primary complex thread. Your question is out of topic. Baka mapagalitan tayo ng moderators.
Medications, once opened, should not be used for a long time. There are antibiotics like clarithromycin that should not be stored in the ref and should be discarded after 7 days once opened. This is one of the reasons why most meds come in 60 ml or 120 ml format lang. Madaling masira ang medications kapag mali ang pagkastore and if directly exposed to light (which is why nasa dark bottles sila). I suggest you read the product insert of the medications that your child uses since storage precautions are included there.

[ZionZisel]

hi Doc Lelet, I'm a newbie here, My 2 year old son was diagnosed with PC two months ago, after two weeks of taking meds (kidz kit 3) nawala na po yung cough and colds niya., Mag three months na po siya on february 08 under meds, Worried lang ako doc kung normal lang po na magkaroon siya ng colds, now po kasi may sipon po siya, does it mean na he is not responding well on his meds? and  ilan po ba normal weight gain ng 2 years old per month? .. I also have 6 months old baby, done na po ng PPD and Xray two months ago, both negative po ang result pero the doctor advised that she should take isoniazid for 3 moths, pero natakot husband ko na painumin siya ng isoniazid since 3 months pa lang po si baby during that time, ask ko lang po Doc Lelet is my 6 months old baby really need to take isoniazid since both PPD and Xray came out negative? pero na exposed po siya to someone who has PTB. Thanks in advance doc 

[mayap01]

hi po doc lelet

doc lelet ask  lang po ako yung pamangkin ko me sa xray nya me primary knoch's sya pero negative sa skin test.,... tas indi naman sya binigyan ng pedya nya ng med. na inumin nya.. ok lang po keya  yun ?

 se po sa  unang test na dec. 22 sa ibang doc. dahil na sa vic. po yung talagang pedia nya ... pina xray ko  po sya nun at iyun nga po yung result me primary knoch's sya at binig yan nya po agad kami ng reseta na dapat inumin  ng bata for 6months. pero hindi ko po binili at pina inum yung gamot ng ni reseta nya hinintay ko po yung talaga pedia nya ..  and dun ko pe sya pina skin test at xray uli ... pero hindi ko po sinabi sa pedia namin na pina xray ko po sya dun sa i bang doc .... ang sinabi ko lang po pina check up ko sya sa iba kasi me ubo at lagnat sya... at ayun nga po  pina sray at skin test at sa skin test negative po pero sa xray eh hindi.... ipabalik po kami ng pedia namin after 2 weeks mula nun.. at pag balik ko nga po kasama sya..... sabi naman nya ok naman daw kasi magana kumain mataba ubuhin lang pag inum ng inum at kain ng kain ng malalamig..   

ok lang po ba yun ? hindi po ba dilikado yun kung hindi sya agad mag take ng med.?
thank you sana po masagot nyu po ko thank you po ng madami

[leletmd]

@ZionZisel:
Even while taking PC meds, he can still have cough and colds caused by other infectious organisms (virus and bacteria). It is not a sign na hindi siya nag-rerespond sa meds niya.
Kids 1 year and above gain about 2 kgs/year. Mas mabagal na ang weight gain compared to infancy na you expect 600 grams/month weight gain during the 1st 6 months and 500 grams/month weight gain from 6 months to 12 months.
Were you able to find the source of your son's PC? If there is an adult source who has been around you when you were pregnant with your baby, then there is a need to give INH prophylaxis to your baby.

@mayap01:
What was the time interval between the 2 x-rays? Did you have it done at the same lab?
I think, first and foremost, is that you should be honest with your niece's pedia.
Aside from a properly conducted physical examination, doctors depend on the patient for proper history/information. Eto ang basis ng diagnosis and plan for the patient.

[ZionZisel]

@leletMD
thanks po sa reply doc Lelet :)doc opo yung father ko po yung source, nagkaroon po siya ng COPD and PTB, pero nasa third month na po siya under meds and lumipat na din po kami ng bahay kasi suspected with PTB na din po yung mom ko since siya po yung nagalaga sa papa ko. naexposed po si baby sa kanila ng 3 months po, after birth  dun kami sa bahay ng parents ko nakatira kasi di ko po alam na meron na po pala TB virus dun and nung nalaman ko po eh pina PPD and Xray ko po yung 2 kong anak, yung panganay ko po na 2 years old, positve PPD and sa xray po nakalagay pneumonitis pero sabi po ng pedia niya considered PC na daw yun and 6 months baby ko naman po parehong negative pero since naexposed daw po siya sa virus after birth  isoniazid daw po ang iinumin niya for 3 months. nagpa  xray na din po kami ng husband ko both clear naman doc.

[leletmd]

@ZionZisel:
In my opinion, your baby should receive Isoniazid prophylaxis since he was exposed to an adult with an active source of infection. Technically, he is already category 1 (exposure to active source). The Isoniazid prophylaxis is given so that he may have protection against contracting the mycobacterial infection. Actually, dapat lahat ng household contacts ng father mo na negative sa chest x-ray should receive INH prophylaxis.

[cheezecake]

my sons sgpt, sgot and al po4 has finally became normal  Thank God.  His pedia gave him Isoniazid 200mg  3.5ml and Pyrazinanide 250mg 5ml.  I hope hindi na siya magjaundice.  Butas na butas na ang bulsa ko.

[mama_ni_andrei]

Hi Doc Leletmd,

Pls enlighten me because Im a bit worried about my son. He is 1 year and 4 months na. Last January 19 first day nag start yung fever ng baby ko at d ko napatingin sa pedia nya because it was sinulog here in Cebu. dinala ko siya on the 21st na and may cough and colds na yung baby ko at that time. Pedia prescribed us cefaclor and asmalin, eto yung palagi nyang ni resita sa amin if may cough and colds si baby. on the 23rd dinala ko na talaga siya sa hospital kasi ayaw kumain at mag milk natakot na akong ma dehydrate kasi yung diaper niya walang laman the whole night. So far naging ok si baby dun kaya lang nung nakita ko xray results nang baby ko at nakasulat dun is Pneumonia, Left paracardiac region. What i remembered is pina skin test cya and it was negative naman. eversince talaga doc yung baby ko payatot na baby. never siya nagkaroon ng fats. i was a bit disappointed nga eh. akala namin ang culprit eh mga milk. halos lahat ng milk nasubukan na namin pero hindi talaga siya tumaba.. tapos ang slow ng weight gain nya. pihikan din at d mahilig sa milk. Milk nya ngayon is pediasure. Pina try na namin si baby ng Heraclene pero hindi parin. Doc weight ng baby ko is only 8.1 kg today. chineck ng pedia nya yung leeg nya tapos may mga kulani nga. hanggang she prescribed us Curazid forte (Izonaizid) and Natricin forte (Rifampicin) for 6 months daw yun doc.  When I told my cousin who is a public health nurse about the meds that the pedia gave us, sabi niya its for TB daw yun. Aware ako sa PC doc kasi nag reresearch naman ako if may mga kids ba na same nang situation as with my son. Kaya lang Pneumonia naman yung diagnosis doc, nagtataka lang ako bakit po pa iinumin young baby ko nun? Actually parang na relief din ako kasi super gumana yung appetite nang baby ko.. halos kada oras humihingi ng pagkain. Although he's into solids talaga at pihikan parin sa milk. Kak ka tart lang namin sa mga meds doc nung January 28 pa until today, stop kami on July pa. Natakot ako bigla ng nabasa ko na makasasama daw yun sa liver ng kids. Ok lang po ba doc na kahit pneumonia lang yung findings eh binigyan kami nun? paminsan minsan kasi my sip-on at ubo yung baby ko. main concern ko lang tlaga nun is slow weight gain at pihikan sa pagkain. At isa pa doc, yung mother in law ko sinabi nya yung husband ko daw ganyang-ganyan daw before.. naka 6 months medication din kasi super payat din at maraming kulani sa leeg. Akala ko nga hereditary. Kasi d naman ako payat nung baby ako eh. Yung husband ko nakita ko sa pics super payat. tapos doc, D rin kami nag pa xray kasi sa totoo lang doc hinintay ku muna yung sasabihin ng pedia ko if dapat ba mag xray kami. pero since its pneumonia, we assume na wala lang talaga.

[leletmd]

@mama_ni_andrei:
Isoniazid and rifampicin lang ba ang binigay? No pyrazinamide? May active source of PC or TB ba kayo sa household? What are the exact chest x-ray findings aside from the assessment na Pneumonia at the left paracardiac region?
I suggest you clarify it with your pedia as to why your son was prescribed PC meds. He is the best person to answer your question kasi siya ang nag-prescribe ng meds. Baka kasi may ibang information na for him satisfies the criteria for TB or baka for him, different category... Ask him or her na lang to clarify things for you.

[mama_ni_andrei]

Hi doc. Yes yung dalawang meds lang yung sinabi. wala na yung pangatlo. Batsta ang alam ko doc, xray nang hubby ko is clear. Hindi ko rin masabi na walang source kasi d pa kami nag papa xray. Last xray ko pa is 2010 pa. pero sa hubby ko, last month lang. Yung exact nakasulat sa xray ng bb ko doc is : Trachea is midline. Reticular densities are noted in the left paracardiac area. Cardiac shadow is not enlarged. Diaphragm and costophrenic sulci are intact. Soft tissue bony thorax are unremarkable. Yung conclusion is Pneumoina, left paracardiac area. Yun lang yung nilagay. Actually doc nung last check up namin is January 30, sabi ng pedia wala na syang marinig sa lungs nang bb ko. maybe because wala na syang ubo ngaun at sip-on. Na mention ko yung TB sa kanya doc, pero wala siyang sinagot na about TB or PC.

[luveeduvs]

hi doc lelet, Pinag start na po kami ng HRZ pedia kit forte, mag 3 pa lang po yung daughter ko this week and her weight is 14.5 kilos, ok lang po ba na 5ml lahat ang bigay ng pedia nya for the 3 meds? nabasa ko po kasi sa iba na hinde pareparehas ang dosage sa 3 medicines, just wondering lang bakit sa anak ko 5ml sa lahat ( pyrazinamide, isoniazide and rifampicin) thanks!

[leletmd]

@ luveeduvs:
Try to ask your pedia if the meds were computed based on weight and not by age. Dapat kasi by weight ang computation to lessen the risks of liver related problems.

@mama_ni_andrei:
I suggest you ask your pedia why the 2 meds were prescribed kasi if it was for PTB treatment, dapat 3 meds. If kung PTB prophylaxis or prevention, we usually prescribe 1 to 2 meds (if there is risk of resistance) when there is an actual source of TB infection and there is a possibility that the child or household contact will get infected from the constant exposure.