Primary Complex Thread 2

[rhylie10]

morning dra.lelet, pinacheck up ko po sya sa ibang dr kahapon, ask nya nga din po yung plates, nung una ayaw po ibigay, pero kahapon po nakuwa ko na din po, babalik po kami sa isang pedia nya bukas babasahin nya po yung plates para malaman daw po kung need pa ng ppd test, yung sa pedia nya po sa cgh ppd test daw po sa june 14.. di ko po alam if babalik pa po ako dun, sabi po ng pedia nya kahapon yung guy po payat daw po yung anak ko sa edad nya..will post po ulit and will ask po ulit sa inyo if ano po sasabihin nung new pedia nya po..thanks po ulit dra. god bless po

[Jeshua]

hi dra lelet., may 2 months old baby has colds for more than a week na though hindi sya running nose but more on congested, we had him check and gave him antibiotic for seven days. last saturday his monthly check up his pedia said wala na syang halak and clear na daw but yesterday my mom noticed na merong mucus on his left ear with blood tinge. is it an ear infection? what do we need to do po kaya? thanks in advance.

[leletmd]

@ankyneMD:

Hindi na siya nakakahawa even after the 1st 2 weeks of treatment. Nawawala ang pagiging contagious as long as nakapag-treat for at least 2 weeks na, pero, of course, there is a need to complete at least 6 months of treatment.
Also, hindi naman talaga dapat na-separate ang mga gamit niya (utensils, plates, cups, etc) since hindi naman natratransmit ang TB infection via fomites or inanimate objects.

@cheezecake:
Medyo OT ang question. Baka mapagalitan tayo ng mods. This is a PC thread.
Anyway, to answer your question, there are other liver function tests to check for liver inflammation like SGOT and SGPT. Also, ultrasound of the hepatobiliary tree may be needed to assess if there really is liver inflammation. Hepatitis profile may also be done to rule out a possible hepatitis infection as the cause of liver inflammation.
Bottomline, there are many other causes of liver inflammation: infections, congenital diseases. Hindi lang medications.

@Tobeyrich:
Pwede ka mag-switch ng brands, as long as pareho ng formulation so if 200 mg/5 ml ang Isoniazid, dapat 200 mg/5 ml pa rin ang kapalit na brand since dosages are computed based on weight of the kid as well as formulation of the medication.

@rhylie10:
Better to have the chest xray plates evaluated first to decide if a PPD test is indeed needed.

@Jeshua:
Pasensya na, but your question is also out of topic since this is the PC thread. Baka magalit ang mods.
Anyway, best thing to do is to have your child checked up by the pedia since bloody ear discharge is one of the signs of an ear infection. Please do not clean your baby's ears using a cotton bud or an ear pick and make sure that water doesn't get into his ears when he is bathing to lessen the risks of further aggravating the ear infection if there is any.

[cheezecake]

^sorry for the misunderstanding my son po has PC and his TB,db,IB,SGPT,SGOT is okay naman kaya lang yung doctor e pabalik ng pabalik for consultation and honestly I'm kinda short right now due to the enrollment.  Ayoko muna sanang magpacheck up dahil ang mahal ng fee niya. The reason why I ask is nagka jaundice kasi yung anak ko dati due to Rifampicin gusto ko lang malaman kung safe ba siya as long as normal ang BLOOD TEST.  Balak ko kasi next month ko na lang ipacheck up

[leletmd]

^ Actually, I remember the case of your son which you posted early this year. I was wondering if your question was related to other causes of liver inflammation since it's been about 4 months since that time. If the liver is still inflamed until now, then, maybe, there is a need to look for other causes.
Anyway, I think your doctor is just being cautious which is why there are frequent follow ups. How often ba ang follow up and naka-ilang determinations na ba na normal ang liver function tests? Pang ilang month na ng PC meds?
By the way, it is recommended that patients who are taking meds follow up at least monthly with their doctors to assess response and adverse reactions.

[ankyneMD]

thank you po doctora. Sometimes kasi when we hear him coughing, parang medyo lumalayo na kami specially baby ko inilalayo ko. Natatakot na kasi ako e, hindi ko rin pa siya pinapahalikan sa baby ko. Sabi ko nga sa kanya k0nting tiis na lang. Wala naman kasi siya symptoms of tb before kaya nagulat kami sa result ng xray niya na positive for ptb nga daw.. Wala na ibang test na ginawa sakanya aside fr0m xray.. So the d0ctor prescribed him 4 tablets of myrin-p forte for the first two m0nths and plain myrin p for the remaining m0nths before breakfast.. Ok lang po ba yang dosage na yan for him? Magandang brand po ba yang myrin-p na tb meds? kasi po kung kelan naggagam0t na siya, parang ngay0n po lumalabas yung symptoms ng tb nya. Parang makati daw po yung throat niya, naging sobrang pawisin din daw siya. When i ask him kung pinapawisan siya sa gabi, hindi naman daw. Pero during the day grabe daw siya pawisan na dati hindi naman daw siya pawisin. I d0nt kn0w kung dahil lang ba summer ngay0n. And may nakakapa din daw siya kulani sa leeg niya na dating wala. Nung kinapa ko leeg niya parang mer0n nga s0mething swollen. Kaya nagwoworry tuloy ako baka hindi magandang brand yung myrin p at hindi siya gumaling dun. Tapos baka maging MDR-TB pa yung sakit niya. Mas mahirap yun diba. Pasensiya na po doctora ha. Ayoko lang po kasi mahawa pa ng pc ulet ang baby ko. Thank you po

[cheezecake]

^up to August 20 yung meds niya.  Normal naman yung blood test niya minsan elevated but ang laging sabi ng doctor e normal pa din daw yun dahil mga diagnostic lab ginagamit reference values ng mga adults.  Minsan every week yung check up namin e, most of the time 2x a week.
umol/L
tb 20.31
db 4.01
ib 16.3

u/l
sgpt 32.2
sgot 14.8

hindi rin naman naninilaw mata niya and no sign of jaundice

[leletmd]

^ Within normal levels ang range ng liver function tests niya. Perhaps what you can do is that next time you follow up, you can ask for the reason for the close monitoring. Meron pa bang jaundice ang anak mo until now?

@ankynemd:
Is your dad being seen by a pulmonologist? Why was the chest x-ray repeated after just 2 months of treatment? It is not routine kasi to order a repeat chest xray after just 2 months of treatment. Pwede pa after 6 months...
Did he have TB na ba before? Was his sputum checked for AFB smear and culture?
Talaga naman kasing binabawasan ang meds after 2 months of treatment, from 3 to 4 meds to just 2 meds. I will not comment on the brand of meds being taken by your dad since it will be unethical for me to do so.

[cheezecake]

^wala na po doc sasabihin ko nga pagbalik namin na hindi na ako makakapagpacheck up every 2 weeks dahil sobrang busy na sa school.  Thank you so much doc

[leletmd]

^ If no more jaundice and liver function tests are within normal levels, then try to ask na lang the pedia if pwede monthly follow up.

[cheezecake]

yupyup.  Thanks doc

[rhylie10]

goodeve po dra. lelet, kagagaling lang po namin sa pedia-pulmo kanina, and binasa niya po yung x-ray ng anak ko yung pinost ko po almost 2 weeks na po yata yun, kung sya daw tatanungin sa x-ray palang daw po masasabi nya ng may primary complex anak ko, and kung titignan naman daw po yung katawan  payat nga po siya, and madami pong kulani sa may leeg, kasi po diba nakalagay impression is bilateral pneumonia, so sabi po niya di na need ng skin or ppd test, diretso na daw po treatment, pero na sa akin na daw po yun kung gusto ko pa daw po ipa skin test since sa x-ray palang daw po mewron na talaga, ano po sa tingin niyo? need ko pa po ba ipaskin test? reseta po niya is HRZ PEDIA KIT, yung comprilex and Rimaped po is empty stomach and need to wait 1 hour before eat si baby for 6 months po yun, then yung Zinaplex po yata yun ask ko lang po empty stomach din po ba yun? just to make sure lang po, ingay kasi ni baby kanina kaya di ko masyadong nagets po, yung comprilex and rimaped po pwede daw po pagsabayin before breakfast, so ask lang po yung zimaplex po pwede kahit hindi empty stomach and pwede kahit anong oras basta once a day and for 2 months po siya? thanks po.. need ko pa po bang ipa-skin test kung sa x-ray palang po nasabi nya ng may pc po anak ko? thanks..worried lang po..godbless po

[rhylie10]

PS po, di po kami nirequesan ng xray para sa mga kasama namin sa bahay.

[rhylie10]

PS po ulit..napapaisip po talaga kung need ko pa po ba siyang ipaSKIN TEST, since sabi ng pedia pulmo kanina may pc nga daw po sya base sa nakita sa x-ray niya,

[rhylie10]

goodam po dra. lelet, kagagaling lang po namin sa pedia-pulmo kanina, and binasa niya po yung x-ray ng anak ko yung pinost ko po almost 2 weeks na po yata yun, kung sya daw tatanungin sa x-ray palang daw po masasabi nya ng may primary complex anak ko, and kung titignan naman daw po yung katawan  payat nga po siya, and madami pong kulani sa may leeg, kasi po diba nakalagay impression is bilateral pneumonia, so sabi po niya di na need ng skin or ppd test, diretso na daw po treatment, pero na sa akin na daw po yun kung gusto ko pa daw po ipa skin test since sa x-ray palang daw po mewron na talaga, ano po sa tingin niyo? need ko pa po ba ipaskin test? reseta po niya is HRZ PEDIA KIT, yung comprilex and Rimaped po is empty stomach and need to wait 1 hour before eat si baby for 6 months po yun, then yung Zinaplex po yata yun ask ko lang po empty stomach din po ba yun? just to make sure lang po, ingay kasi ni baby kanina kaya di ko masyadong nagets po, yung comprilex and rimaped po pwede daw po pagsabayin before breakfast, so ask lang po yung zimaplex po pwede kahit hindi empty stomach and pwede kahit anong oras basta once a day and for 2 months po siya? thanks po.. need ko pa po bang ipa-skin test kung sa x-ray palang po nasabi nya ng may pc po anak ko? thanks..worried lang po..godbless po , sa mga nabasa ko po, ano po bang connect ng BCG sa primary or TB? curious lang po..pasenya na po daming tanong huh..sorry po

[rhylie10]

ask lang po ulit. halos lahat ng nabasa ko po sa thread ang nireseta sa kanila is KIDZ KIT 3, samin po kasi nireseta sa anak ko is HRZ PEDIA KIT, ano po ba difference nun? mas effective po ba yung KIDZ KIT 3? hehe..senya na po, almost same price lang naman, ang alam ko yung KIDZ KIT 3 is 475, yung HRZ is 481, generic lang po ba yung HRZ pedia kit? kasi kung generic ano po ba mas magandang gamut?thanks

[Tobeyrich]

Thank you dra lelet...

[leletmd]

@rhylie10:
PPD test will only show you if there is exposure, not if there is actual disease na. Chest xray pa rin ang main basis for determining if there is actual disease na and as I said earlier, dapat mareview talaga yung xray plates and not just rely on readings.
Isoniazid and Rifampicin should both be given first thing in the morning, at least 30 minutes to 1 hour before breakfast, because this is the time that the tummy is most empty. Mas mabilis ang absorption ng 2 meds na ito pag empty ang tummy.
Pyrazinamide may be given after a meal.
There is not much difference between HRZ kit and Kidz kit packs. Same formulation, different manufacturers.
Kahit hindi kayo sinabihan, dapat pa rin na hanapin niyo kung sino ang nakahawa sa anak mo by having everyone undergo chest xray at least...
As I said in an earlier post, BCG protects mainly for extrapulmonary TB (TB infection occurring outside the lungs such as Potts disease, TB meningitis, etc. ). Please try to back read so you can read also on the criteria to diagnose TB.

@ankyneMD:
How has your child responded to the medications in the past few months? Was there improvement of symptoms, such as weight gain, improvement of appetite and well being, decrease in size of lymph nodes, etc. ?

[rhylie10]

thanks po, yung pyrazinamide anytime po pwede basta after meal? yung sabi nyo po na dapat malaman or atleast pa xray kami, pwede po ba kami pa xray kahit walang request? di po kasi kami nirequesan or sinabihan.. yun nga po yung sa pedia pulmo pinakita ko po sa kanya yung plates ng chest xray ng anak ko kasipo diba nakalagay sa impression is bilateral pneumonia yung pinost ko po ditto nung una, then nung nakita niya po yung plates sabi niya no need na daw for skin test kasi nga po sa xray palang meron na at dami nga daw po kulani kaya niresetahan na po siya ng HR2 PEDIA KIT, and then kahapon po nagpunta po kami sa talagang pedia niya (hindi po yung pedia-pulmo), sinabi ko po sa kaniya yung sinabi ng pedia-pulmo, sabi niya po samin  mas suggestive daw po ang skin test kesa sa x-ray, pang support lang daw po ang x-ray which is naguguluhan po ako kung start ko na po ba yung gamot na nireseta ng pedia pulmo na pedia kit or pa skin test pa siya dahil po sabi niyo din di rin aman dapat rely sa skin test and sa mga nabasa ko nga po is dami false negative/positive sa result, ang sabi pa po kahapon nung pedia nya na kapag negative daw po sa skin test pero sa x-ray niya meron (nakita nya na po yung plates ng xray pero gusto nya pa po skin test), sabi po pag negative sa skin test and positive sa xray 3 months lang daw po ang medication, which is iba sa sinabi ng pedia-pulmo dahil nga po niresetahan na ng pdia kit for 6 months and no need na daw po sa skin test, san po ba ko dpat? sa pedia niya talaga or sa pedia-pulmo?? thanks po..wait for your answer again dra lelet.sensya na po.god bless

[rhylie10]

4. x-ray findings suggestive of PC/TB like hilar infiltrates, hilar lymphadenopathy, etc. yan po yung nakalagay sa criteria na post nyo po diba, kung sa x-ray po ng anak ko nung may 1 bilateral pneumonia w/ lymphadenopathy, di parin po ba consider na may pc sya? nung sabi ng pedia-pulmo tinignan yung plates kung siya daw po tatanungin may pc daw anak ko and dahil dami kulani sa leeg, pina-skin test ko po siya kahapon, will know the result tomorrow ([textspeak!] sa pedia nya po talaga) kung negative po sa ppd test pero sa pedia-pulmo eh positive sa x-ray at sa physical examination niya sa anak ko 6 months parin po ba ang gamutan yung hr2 pedia kit? and yung about po sa source, pwede po ba kami pa x-ray ng walang request? kasi di po kami sinabihan or nirequesan ehh..thanks po