Primary Complex Thread 2

[ankyneMD]

thank you po dra. Lelet. Totoo nga na sumasagot kayo. :-) ganito po kasi yan: october2012 inuubo po siya, pina x-ray siya ng pedia (1st pedia) at eto po ang result
Chest pal:
Reticulonodular densities are noted in both hilar areas.
Heart is not enlarged.
Diaphragm and sinuses are intact.
Impression:
PRIMARY KOCH'S INFECTION
so the pedia prescribed her kids kit3 rifampicin and isoniazid 5ml each before breakfast, pyrazinamide 5ml after breakfast and 5ml again after dinner.  One week na siya nakakain0m ng kids kid3 nang ma c0nfine naman siya sa hospital because of dengue. Sinabi ko sa mga d0ctor dun na nag tetake siya ng primary c0mplex medicine so they c0nduct ppd skin test to her and negative ang result, pinakita ko din yung x-ray nya na positive. Pero ang sabi nila, hindi daw reliable ang xray lalo na kung inexray nang may ubo ang bata. Kaya ipinahinto nila yung kids kit 3. so ang akala ko ok na, nawalan na din ako ng tiwala sa 1st pedia. December 2012 inubo nanaman ang anak ko, so dinala ko siya sa ibang pedia (her pedia until n0w) at ikinuwento ang bu0ng history ng anak ko. At ang sabi niya, p0sitive nga sa pc ang anak ko kasi positive ang xray though negative ang ppd kasi pwde naman din daw mag false negative ang skin test dahil may virus siya sa katawan which is the dengue nga. Kaya nirestart ng pedia ngay0n yung kids kit3 5ml. Pero ngay0n naka kids kit 2 na lang siya 7ml each dahil nasa 4th m0nth na siya ng medication. Ok lang po ba yung dosage sa timbang ng anak ko na 25kg for 5years old? Ok lang po ba doc na natigil at nirestart yung pc meds ng bata? 1year ago po pala may naging kapitbahay kami na may tb.
Yung pagpapawis nya po, sinaBi ko din sa pedia nya ngay0n at sinabi din na mabilis lang ang metabolism nya dahil mataba siya. Pero s0bra naman po kasi pati sa gabi at kahit tulog pinapawisan pa din especially sa likod.. N0rmal pa din po ba yun?

[leletmd]

@ankyneMD:
Dapat sana di natigil ang treatment because there is a chance for resistance and allergies to develop but since your child is already on her 4th month of treatment, then wala ng risk for allergies by now.
Tama yung 2nd pedia that we do not really rely on PPD for TB diagnosis. Marami kasing cases of false negative results. Also, it will only show exposure and not disease. Sa chest xray pa rin kami tumitingin kung may active disease na ang patient. Try to backread for the criteria needed to fulfill to diagnose TB or PC.
Aside from your neighbor na may TB, nagpaxray ba kayong mga household contacts niya?
I would have to agree with your pedia that the sweating may not at all be related to PC. It may be due to your child's fast metabolism and also the fact that she is a bit big for her age.

[ankyneMD]

hello po doctora lelet, ngayon lang nakapagpost ulet medyo busy kasi  thank you po ulet.. Another question po, bakit po hanggang ngayon may mga times pa din na umuubo ang daughter ko pag natutulog siya? ( nap time at sa pagtulog niya sa gabi) part pa din po ba yun ng primary c0mplex niya? Everytime na tinatanong ko po kasi si pedia tungkol diyan, lagi niya sinasabi na allergy lang daw. Is it true po ba? Thank you po ulet.

[leletmd]

@ankyneMD:
Cough occurring while sleeping may be due to allergy and not due to primary complex. If it is persistent, then maybe you can ask your pedia to refer you to an allergologist for management.

[chofontanilla]

Sorry doc di na ako nakapagback read, may tatanong lang ako, cousin kasi ng baby ko na kasin age niya may nakapa na kulani sa gilid ng 2 tenga niya so sabi ng doctor ipaxray para malaman kung may PC. Si SIL di naniniwala n may PC baby niya kasi daw mataba naman and malakas kumain, tama po ba yun? And sabi niya din normal lang daw magkaPC ang mga baby. Saka possible po ba na magkaPC baby ko kasi nasa iisang bahay po kami. Thanks doc.

[leletmd]

^ Aside from the kulani at the back of the ears, wala bang ibang symptoms ang pamangkin mo like ubo or sipon? Hindi kasi usual site for enlarged lymph nodes of PC ang back of the ears. Mas common pa ang enlarged lymph nodes sa neck and clavicle areas.
If back of the ears malaki ang lymph nodes, that is usually due to sipon or ear infection...
Baka naman may nakapa pa ng ibang areas with lymph nodes ang pedia ng pamangkin mo kaya nag-request ng chest x-ray to rule out PC. Kung ako kasi, I would follow the advice of the pedia...
Also, hindi normal na magkakaroon ng PC ang mga bata. It is a common infection pero it is not normal...
If indeed may PC ang pamangkin mo and you live in the same household, then, yes your child has increased risk in developing PC, not because of your pamangkin, but because most likely they have the same adult source. Remind ko lang, hindi nakakahawa ang bata sa bata sa PC. Ang nakakahawa ay adult to child.

[chofontanilla]

Thanks doc, will keep that on mind. Bale kaya po nagpacheck up yung bata kasi may sipon, wala naman po ako dun nung nagpacheck up sila kaya di ko narinig explanation. Sana pala sumama ako para nakapagtanong ako. Anyway, thank you po ulit doc.

[leletmd]

^ If the lymph nodes do not return to their normal size within 2 to 4 weeks from the time na gumaling siya from the sipon, then I suggest you to tell your SIL to follow up with her pedia.

[chofontanilla]

Thanks doc. Will do that.

[ankyneMD]

naku ang alam ko po mahal ang consultation fee ng isang allergo.. Hindi naman po kami mayaman driver lang ang mister ko. Sana naman wag na maging sakitin ang baby. Hindi po namin afford ang magpa chek up sa mga mahal na doctor. Salamat nga po ako at libre ang c0nsultation sa inyo. Thank you doc

[joycee_1923]

hi doc lelet! very informative po talaga mga post nyo dito...thanks a lot!
Pwede po bang humingi ng advice regarding sa situation ng anak ko? March 2012 nagstart ng Kidz Kit3 2nd son ko na 1 yr and 1 mo. old by that time, dahil nagpositive result ang cxr nya pero negative s ppd. madami kulani sa noo, ulo, batok at clavicle area. since march 2012 monthly regular check-up na sa pedia, then after 6 mos. nagrequest ulit cxr pedia nya, the result was minimal clearing daw kya continued medications until 9 mos. then after 9 mos. ndi pa kuntento c pedia dhil konti pa lang na-gain weight ng baby ko. kya extend ulit gamutan na  inabot ng 1 yr 'eto lang last march. the other day, inistop ko na po HR pediakit nya bale 1 day ago na. since tingin ko naman ay ok na baby ko, later of 2012 magana na po xang kumain at malaki na tinaas ng timbang nya from 1 yr and 1 mo./10 kilos, ngaun po estimate ko 13-15 kls na siguro. mukhang malaki na rin improvement ng immune system nya, ndi na po gaanong nagkakasakit. meron ngaun on and off ubo, ndi ko alam kung dry cough [textspeak!] pong phlegm at ndi nman wheezing. nung time pla na nag-gagamot, lagi xang nagkakasakit ng lagnat ,ubo, sipon, at madalas may tonsilitis kya pabalik-balik kmi sa pedia at lagi nireresetahan ng antibiotic, halos every month last yr nag-aantibiotic. sa sobrang dami ng iniinom nyang gamot plus vitamins kya minsan ndi ko nasusunod right compliance sa pagpapainom ng pc meds lalo na po during hospitalization, ang hirap sundin at sobrang hirap painumin ng gamot ng baby ko. minsan nga 3 days ndi ko napapainom. 'yung anak ko po pala doc ay kinukumbulsyon pag mataas ang lagnat. last year 3 times na-confine sa ospital, tinatakbo ko po agad pag may high grade fever at mostly nga po reason ng hospitalization ay tonsilitis and fever. ngaun po doc, ndi pa kmi nakabalik sa pedia since january 2013. 
ang question ko po doc, tama lang po ba na itigil ko na pc meds nya o magpa-cxr muna ulit. acc. sa mga nabasa ko sa post nyo maaaring magkaroon ng "radiologic lag". naaawa na po ako sa anak ko kakainom ng gamot. 
possible source po pala ng ptb ng anak ko ay sa kapitbahay. so far po, c baby pa lang at kuya nya na 4 yrs old ang may cxr. kami ng papa nila wala pa, pregnant po ako eh. papa nila malakas manigarilyo pro every other day lang nauwi dhil sa work. pls give me some advice po doc. it is highly appreciated!

[jhenbreak]

Hi Doc Lelet,
Yung son ko po, he was diagnosed of PC June 2012, no symptoms at all, no cough, okay yung weight, etc, even his pedia was doubtful kaso nga po positive yung xray and ppd. Everyone in the household was clear of TB din. Pero nagtreat pa rin po kami, ngayong March nag-end yung medication niya, pina-xray ko po siya agad after eh, positive pa rin po, pero no symptoms pa rin po talaga.
Nabasa ko po sa post nyo, pag na-i-skip yung meds, nagkakaron ng chance for resistance and allergies to develop. May mga times po kasi na nai-skip yung pagtake ng meds ng baby ko eh, yun po kaya ang possible cause kun gbakit after 6 months of treatment, positive pa rin siya sa PC? Thanks po.

[leletmd]

@joycee_1923:
Pasensya na but I do not agree with you stopping the meds without your pedia's consent. Your pedia should be the one to decide if treatment is enough, with or without a chest x-ray.
I suggest you follow up with your pedia ASAP.
Also, how often does your son interact with your neighbor with TB compared to how much he interacts with his dad? Dapat kasi mapa-xray ang husband mo kahit na every other day lang siya umuuwi para na rin for the sake of your unborn baby.

@jhenbreak:
Yes, poor compliance to medications may lead to poor/delayed clearance of infection. Dapat nabibigay ng maayos ang meds niya para gumaling siya ng maayos.

@ankyneMD:
Sa PGH - OPD, meron Section of Allergy where you can bring your child for free consult. Tiyaga lang sa pila.

[dredlav]

@letletmd
good morning dra. first time ko po itong mag post... my son was diagnosed with pc when he was 7. Chest xray showed perihilar nodular modes ata po ang nakalagay den sa impression po ay Primary koch's infection is possible.. his pedia did not order skin test na po. 6 months po sha nag medications. super amazed po kasi talagang he gained weight and hindi na sha nag uubo unlike before na halos every 2 months may ubo.. after 6 months nag repeat xray po sha and meron po dun nakalagay na natatandaan ko is regression of densities ..... den sa impression nakalagay is Resolved/Resolving primary koch's infection...   the pedia told me to stop the medications and okay na daw po ang pc ng anak ko..
ang main concern ko dra letlet i,s ang bata po ba nagkakaroon ng scar once nagkaroon ng pc? naawa po kasi ako kung sakaling ganun nga yun... o mawawala naman po un sa paglaki nila? is there a need for me to have my child undergo xray again para ma check ko lang po kung may scar ba or something.. nag iisang anak ko lang po kasi kaya medyo ganun po ang concern ko... Salamat dra letlet, sna po mabasa po ninto ito.. thanks again po...

[leletmd]

@dredlav:
Development of scar tissue depends on how the immune system responded to the infection. There may or may not be a scar seen on chest xray.
If there is a scar seen naman on chest xray, it just means that the immune system was able to wall off the infection and there is nothing to worry.

[ankyneMD]

hello sisses at hello po doctora. Napaka informative po talaga ng mga post ninyo. Magtatanong po ulit ako since libre naman dito sa gt    hanggang ilang taon po ba ang bata para masabing pc or tb na ang sakit nya? Kung 12 years old na po ang bata, pc pa rin po ba or tb na? And totoo po ba na isa sa mga nagpapahina ng baga ng bata ay yung pagligo niya sa gabi? Or twice a day siya maligo? At kung pawisin ang bata, masama ba talaga matuyuan ng pawis dahil yun ang nagiging dahilan ng ubo? Sorry po dami tanong  thank you po doctora.

[leletmd]

@teri_28:
Primary complex is TB.
When a person gets infected for the first time, the mycobacteria enter the lungs and after 1 to 2 months, they form a "focus" in the lungs, then spreads to the adjacent lymph nodes, thus leading to primary complex.
During the first time that your twins developed the infection at 4 years old, were you able to find the source of their infection? The reason I ask this is because if you were able to find the source of infection in your household and you had the source treated, then there would be lesser chances of them getting re-infected.
Please have everyone in your household get at least a chest x-ray so you can find the source of your children's infection.
Also, PPD just denotes a positive exposure to a person with TB. It will not show infection or disease so regardless of whether or not, it is positive or not, dapat may Chest x-ray pa rin to determine disease. If negative PPD and positive chest xray, kailangan pa rin mag-treat.
Please back read for the criteria to diagnose TB.

@ankyneMD:
PC is TB.
Taking a bath at night will not weaken your lungs or your kids' lungs. In fact, we recommend having everyone take a bath or shower prior to going to bed to at least remove allergens, dirt, microbes, etc.
Hindi rin totoo na magkakaubo or sipon kapag napawisan, natuyuan ng pawis, naulanan, etc. You get cough or colds from either infection or allergies.

[dredlav]

good evening po dra letlet... i would like to ask you po again sana... someone told me that "densities" means scar daw po.. is that true dra.. kasi part po doon sa 2nd xray ng son ko after his 6 months medication is regression of densities... kaya bothered lang po ako.. maraming salamat po dra letlet....

[dredlav]

good evening again dra letlet.. i hope you could read this post.. i am needing enlightenment and actually 2nd opinion.. my son's 2nd xray resut after 6 months of medication was this : chest xray result when compared to previous result shows regression of densities. heart is not enlarged. Impression: Resolved/Resolving Primary Koch's infection. Pedia ordered me to stop medications. sign and symptoms imrpoved very much like weight gain, improved appetite.. my most concern dra etlet is reagrding the word resolving. i asked the pedia why it had a wrod resolving, is it literally resolved, or not yet because of the word reslving. the pedia told me, ang tinignan nia dun ay ang words na regression of densities and it is already resolved.. ang sa akin po dra ang basa po da dun ng mga dr ay Resolved/at ang niresolve (resolving) ay ang primary koch's infection.. i am now worried since someone told me that whenever there are words like densities daw in an xray result that already means scar.... i hope3 you could enlighten me.. i am hoping that i could get an opinion from you... thank you very much dra letlet..

[myjoy]

good morning mommies! my baby was diagnosed with pc. naggagamot na sya pero gusto ko lang itanong kung talaga bang kailangan ipainom yung gamot nya ng walang laman ang tyan, pagkagising na pagkagising sa umaga? nagwo-worry kasi kami na baka sobrang lakas at sumakit ang tyan, kawawa naman. tia!