Primary Complex Thread 2

[pumngold]

Hi po Doc, totoo po ba na isang sign na may Primary complex ang bata kapag pawisin especially malamig ang pawis niya? ang baby ko kasi kapag tulog pawisin and sometimes malamig nga pawis niya.

[merie]

corect. by weight talaga computation ng dosage ng gamot

[artemis26]

same question as sis pumngold. My 3 yo kid, sobrang pawisan talaga. Sa gabi, kahit aircon kami, papawisan muna sya mga 1-2hrs after settling into bed, kaya di muna ako natutulog kasi inaantay ko ma'regulate' ang body temp nya with respct to the aircon. Weird nga na ako nilalamig na, sya pinapawisan pa. May I ask na din pala sis kung sinong may sabi nyan? Nadiagnose din kasi with PC yung anak ko when she was more than a year old, pero isoniazid lang ang naprescribe kasi negatvie xray, pero postivie skin test. One symptom was very slow weight gain though. Last chest xray nya, negative pa din naman. Although on and off ang sipon nya, pero more of allergy ang diagnosis ng pedia. (baka ma-OT na ako kasi about AR na).

Yun lang. I have been also wondering kung bakit kahit aircon eh nagpapawis pa din, especially when sleeping. Is there a 'usual' room temp to be considered at normal levels for a kid?

[pumngold]

Hi sis artemis26, sabi lang ng friend ko ito kasi nagka primary complex anak niya. Minsan kasi napapaisip ako na may PC anak ko kasi nga payat siya, she is 2yo now at 11kg.

before low weight gain din siya kaya pina request na ipa xray. pero negative naman sa xray. Pero di pa namen napa skin test for PC kasi di naman siya sakitin. Once pa lang siya inubo with fever nakuha naman sa antibiotics (she was 1 yo then) . Kung magka sipon man gumagaling naman siya sa vitamin C agad.
Yun nga lang bumabalik ang doubts ko she might have PC kasi payat pa rin siya and mahina magsolids.

[princessrio]

my 11-month-old son was diagnosed with PC just this monday. we didn't do xray or skin test na. we thi k it was triggered by the measles vaccine. yung pagiging masakitin nya started 2-3 weeks after the measle vaccine. he was hospitalized because of high fever and vomiting, and i was so afraid of dehydration noon. 2 weeks after, here comes ubo and sipon. after a week, gumaling sya pero nagdiarrhea naman. 2 weeks after, here comes sipon and ubo again. tapos nung umayos na yung sipon and ubo, fever naman.

pedia thought na followup na lang kami nung monday pero kaya ko sya pinacheckup eh dahil nilalagnat sya sa gabi. pedia said na madami kulani si baby and said na gagamutin na namin sya for PC. she asked kung gusto ko paxray and skin test si baby, but eitherway, negative or positive, same medication pa rin ibibigay nya. so i decided na wag na lang ipagawa. she prescribed comprilex for 3 months.

here were the signs na nakita ni pedia:
-almost no weight gain since december. we were stuck at 9.4 kg.
-sobrang naging masasakitin
-kulani

[puglover]

hay mukang magiging tambay ako ng thread na ito. just got the results of my son's (14month old) chest xray. yet to backread pero here are the findings:

streaky infiltrates over both lung fields with enlarged hilar lymph nodes
heart not enlarged
impression: pulomonary koch's infection

gano kalala ito? yet to see pedia tomorrow.
ang iniisip ko ngayon san ako nagkulang may times kasi na iniiwan ko sa maid dahil i have to work, eh mukhang yung isang maid dito lagi inuubo malamang dun nahawa. may isang bata din dito na anak ng maid na may primary complex although nung naglalapit siya sa anak ko, in the process of taking medicines na siya.. hindi naman niya lagi dinidikitan son ko pero there are times na pag naguusap syempre nalalapit. ganun ba kadali mahawa? and i was wondering kung may kinalaman ba yung not so normal bcg vaccine ng baby ko dati.. ang tagal kasi naka bukol more than a month, remembered posting about the bcg vaccine sa vaccination thread..

when he was around 11 months, may ubo siya na sobrang tagal mawala, the pedia said pa xray daw, clear naman, i don't know kung nagkamali kasi ang likot nung baby ko nun pinaxray ko siya nun..and dun sa lab/diagnostic center sa east ave, di ko alam quality ng lab tests nila dun.

now, wala pa ngang 6 months pina xray ulit kasi nga hindi magana kumain and pabalik balik ubo.. ayun, nakitaan na nga..

[leletmd]

@pumngold:
Night sweats, low grade afternoon fever, loss of appetite, failure to gain weight, enlarged lymph nodes, prolonged cough, difficulty in getting rid of infections etc are some of the signs and symptoms of TB.
TB is a disease with protean manifestations, which means that it has a wide variety of symptoms that may also be found in other diseases and situations.
Just because your child has night sweats doesn't necessarily mean he has PC or TB. That is why it is important to get a good history and physical examination so that we will be able to tie up all the signs and symptoms and request for the necessary lab tests (if there is a need for it) and make an accurate diagnosis of TB.
On the part of the patient or parents/caregivers of the patient, it is important that you give us accurate information and not withhold information.
You mentioned that she has fair appetite for solids. How about for milk? How much is her milk intake/day? Kasi if she is consuming a lot of milk pa rin, then the tendency is she will have lesser appetite for solids.

@artemis26:
A child with a fast metabolism will also sweat a lot.
When she tested positive sa PPD skin test, did you try to find the source of her exposure?
Skin test positive, chest x-ray negative means she doesn't have the disease yet but she has already been exposed kaya she only needs to take 1 to 2 meds. The meds are given to help prevent the dormant TB in her body to start manifesting as disease.

@princessrio:
Why daw only 1 medication for 3 months?

@puglover:
As I said in my earlier posts, hindi nakakahawa ang bata sa bata since they have very little mycobacterial load and it is usually hidden inside their lymph nodes. What I would suggest, though, is to have the maid undergo a chest x-ray kasi there is a good chance na siya ang nanghawa sa anak niya na kalaro ng anak mo.
As to the bcg vaccine undergoing scarring at more than 1 month, that has nothing to do with your son having PC. BCG protects mostly for extrapulmonary TB and has very little protection for pulmonary TB. Mas delikado if the BCG had pus formation and scarring within 7 days from injection. We call that BCG acceleration and that means the child was already exposed in the womb and needs to be worked up for TB.
I suggest you bring your son for follow up with his pedia so that your pedia can see the x-ray plates and correlate the results with the history and physical examination of your son.

[artemis26]

@ doc leletmd
that time she got a positive sa skin test, we sought the opinion of a pedia pulmo, and usually daw tmag-positive sa skin test, especially if may BCG vaccine. None of us naman was a possible source of exposure. Kaya isoniazid lang nirecommend ng pulmo, when her pedia that time suggested 3 meds.

If a child with fast metabolism sweats a lot, it would also mean she won't gain weight fast right?especially if she doesn't eat ng madami talaga. Yung kid kasi namin uber hyper rin. hayy. At 3 years and 5 mos, she's at 15.3kgs.

[leletmd]

^ Do you still remember the size of the PPD? Kasi we have a different size interpretation for those who had BCG vaccination (positive PPD is > 10mm)  compared to those who did not receive the BCG vaccine ( > 5 mm).
If the positive ppd of your child is due to her having received the BCG vaccine, then why was there a need to treat with Isoniazid?
Nagpa-chest xray ba lahat ng household contacts?
A person with fast metabolism would be getting hungry a lot but not gaining weight much kasi mabilis maubos energy stores niya.
Normal weight for a 3 year old would be 14 to 16 kgs so within the normal weight range naman ang anak mo. Best to ask your pedia for the ideal weight for height kasi better to correlate the weight with the height status rather than use the age of the child as reference. 
Children 1 year old and above gain only about 2 kilos/year unlike during the first year of life na malakas talaga ang weight gain.

[princessrio]

doc lelet, i'm not sure kung bakit 1 lang. pedia said na she usually gives yung triple meds but depending on the age of the kid. since baby is only 11 months old, she decided to just give 1 med.

[leletmd]

^ With all due respect to your pedia, age has nothing to do with what meds to give to a patient with PC or TB. It depends on the TB category of the child. Kahit 4 month old na bata at napatunayan na may TB disease, 3 meds pa rin ang ibibigay. I suggest that you clarify it na lang since if there really is infection, 1 medication is not enough.

[princessrio]

^will do. thanks!

[puglover]

Hi doc lelet nandito ka rin pala sa thread na to. You're a big help really, second opinion ka na without actually paying for check up hehe thanks!

anyway, we went to the doctor na yesterday. Skin test ginawa sa kanya, wala daw muna meds. we'll go back naman monday for the result and meds. If negative daw ppd 3months lang meds kung positive 6months? 3meds to be given.

Doc, yung results ba na nakalagay sa xray ng baby ko malala na yun since 2 lungs na? Ano po yun streaky infiltrates? Sayang kasi sana when he was just 11months nagamot na nun nagumpisa palang siya maging sakitin, kaso wala pa kasi lumabas sa xray nuon. And pedia did not suggest skin test naman. Dont know kung wala talaga nuon o nagkamali yun lab. Nakakatakot lang kasi baka anong mangyari sa baby ko. Now napawisan at nahanginan lang ng konti inuubo ubo nanaman tapos may sinat -dont know kung dahil sa pcv vaccine which was also done yesterday or dahil sa primary complex nanaman niya.

[puglover]

Tsaka doc, yung brother ko kasi na bunso has symptoms of tb din. Pero pina xray namin siya clear naman siya, pabalik balik din ubo. Do wee also need to have him take a skin test?

[leletmd]

@puglover:
If it is proven that your son has PC, then I suggest that you look for the source of the infection by having at least a chest x-ray done for all house hold contacts. If your younger brother is also showing signs but with negative chest x-ray, I suggest you have a PPD done to determine exposure.
Streaky infiltrates means that there's some phlegm scattered in the lung area. Hindi pa naman ito malala. Usual finding lang ito for someone who has cough with a bit of phlegm.
If chest x-ray positive, regardless of skin test results ( and the patient was able to fulfill 3 out of the 5 criteria for TB diagnosis), then there is a need to treat with 3 meds for at least 6 months.

[puglover]

thanks again doc.. last question, kahit walang symptoms yung mga tao sa bahay do we need to have them x-rayed? kagaya ko, hindi naman ako ubuhin or sakitin, pero last xray ko more than a year na.. negative pala sa ppd si baby ko. pero binigyan na kami ng kids kit 3. will take for 6 months daw.

[puglover]

simpleng kausap lang ba sa baby mahahawa na agad? paano pala kung magamot na siya, pero after, maexpose nanaman, say sa mall may nakausap. edi mahahawa nanaman po?!

[Kermy]

Doc Lelet, question lang po. My 22 month old kid had a mild pneumonia last December 2012. Result ng xray is bilateral 'something' consider pneumonia. Wala naman sinabi sa results about primary complex.

My concern is hanggang ngayon meron pa rin syang mga kulani. Weight nya at 22 months is 10.5 KG. Malakas naman sya sa milk pero when it comes to solid there are times na magana minsan hindi. My kids pedia is advising to give 2-3 months to observe if the lymph nodes will subside. If not, have my kid take a PPD test.

I learned about the criteria's you posted for a kid to be considered with PC but can you suspect if my kid really has PC with the following scenarios?

1. Only I, my baby and my wife are living in one roof.
2. Every time I take my company's Annual Physical Exam, my x-ray always shows a pulmonary scar. Since year 2000 pa po laging ganyan but I do not remember having TB or Pneumonia in the past. Last year, the xray result was clear but this year it showed the pulmonary scar again. 
3. My wife's xray is clear

I am just a bit worried. Doc Lelet, thank you for continuing to educate parents in this board. There are only few doctors who takes time to read and answer patient concerns online because of hectic schedules. You are indeed a one of a kind doctor. We truly appreciate what you are doing in this forum.

[leletmd]

@puglover:
Kahit walang nararamdaman, dapat magpa-xray if one member of the household has been found to be positive for TB kasi merong mga adults na walang symptoms, pero pagka-xray, meron pala.
It takes prolonged repeated exposure to a person with TB bago mahawa kaya please don't blame people in the mall, the streets, neighbors, relatives you visit once in a while for your kids' infections. Pasenya na, hindi ko sinasabing ganito ang situation sa inyo but this is the common scenario we get at the clinic kasi na ayaw magpa-work up ng mga parents and other household contacts and would rather blame random strangers. Malaking tulong sa anak niyo if mahanap niyo ang source and mapagamot ang source ng infection para hindi na ito bumalik.

@kermy:
It takes a while for the lymph nodes/kulanis to decrease in size. Hindi sila mawawala since they are a vital part of our immune system. They are found all over our body. It is usually not palpable, unless they are producing antibodies to fight off infection such as bacteria (like the pneumonia), virus, TB, or allergies or wounds or tumors.
Was your son given antibiotics for the pneumonia? If yes, did he get well after the antibiotics were given?
Were you ever referred to a pulmo for the scar in your chest xray? Was your sputum ever examined to see if you still had viable mycobacteria? If the scar keeps showing up in your x-rays, then it is possible you had an infection before. There are rare situations wherein the immune system takes care of the infection without the need for treatment or maybe you had treatment before but you were too young to remember.

[puglover]

oo nga doc, kaya sabi ko gusto ko din magpaxray pero sabi ng mommy ko wala naman daw ako ubo bakit pa magpapa xray.. and parang imposible nga rin na makita mo lang sa mall mahawaan ka na, edi sana lahat ng babies may TB na..

i've been reading forums din kasi at nababasa ko na bineblame nga nila yung visitors na pumupunta sa bahay nahawaan na agad yun anak.