Primary Complex Thread 3

[ysuran]

Hi Doc Lelet.

Sobrang appreciated ko po ang very informative and enlightening explanation mo po regarding sa case ng baby ko..

I really need to find another pedia for 2nd opinion.. And sabi din ng mga previous pedia sakin nagtataka sila kung bakit hindi tumataba yun baby ko kahit di naman malnourished.

Masigla sya, very playful, magana kumain..

Anyway isa rin sa mga worries ko yung pag nag giggle sya or humahalakhak.. may sound na parang hinahabol nya yung hininga nya..

Anyway, thank you ulit doc Lelet

[smile22]

thank you doc lelet, i feel relieved. my daughter is 1 week into her meds and shes doing fine. parang nung first day ko lang nakita na nag red orange yung wiwi nya dahil sa rifampicin. although pumapasok din ako sa ofc kaya d ko napapansin kung nag oorange wiwi nya.

thank you again doc

[leletmd]

@sky_butterfly17:
PPD testing only determines exposure and not disease so lahat ng findings, dapat ma-correlate clinically. It's your pedia who is the best person to make the final diagnosis.

@ysuran:
Halak coming from laughing may be a sign of an asthma predisposition. Strong emotions kasi like crying and laughing are non - allergic triggers of asthma. I think you should mention this to the pedia when you bring your daughter for check up para ma-evaluate ng maayos.

@smile22:
Were you able to find the source of infection already?

[smile22]

@doc lelet, me,hubby and the lola are all negative for TB. the current maid has possibility of pneumoniasis.. pero sabi nila malayo naman daw ito sa TB.

so i guess sa mga previous maids/yayas nya nakuha? madami na din kasi dumaan samin parang yearly iba iba ng yaya.

[jayredz]

Hi Doc Lelet,

Galing po kami ng pedia kanina and was advised na ipa ppd test ang son ko (1 yr and 10 months) even if normal iyong xray result nya.

Sabi sa akin kapag 5mm naging result ng test, dalawang type of gamot iyong papainom pero pag umabot ng 10mm tatlong type na ng gamot.

Hingin ko lang po sana opinion niyo about this. Worried lang ako na maover-prescribe (if positive iyong result) given that there could be some possible side-effects.

Thanks po in advance.

[leletmd]

^ We do not rely on the PPD size to determine how many meds to give. The PPD test will only show if the child is positive for exposure but not actual disease. You still need a chest xray or a sputum test for that.
If positive PPD and negative ang chest xray then that means the child just has exposure and no actual disease yet, so only 1 to 2 meds are needed.
If ppd positive, chest xray findings point to TB, and there is one other criteria present (signs and symptoms that point to TB, a positive exposure to an adult patient with TB and positive sputum test) then there is actual disease and there is a need to give 3 meds. Kailangan kasi maka-fulfill ng 3 out of 5 sa criteria in order to diagnose TB or PC.
This is the CDC fact sheet on Tuberculin or PPD testing:

http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm

[jayredz]

Thanks po for the info doc lelet.

[smile22]

hi doc!

ask ko lang if hindi ba maooverdose sa mga gamot yung baby ko kasi nag kikidz kit 3 sya. exactly 1 month na sya nagmmedication. tapos pinrescribe din sya ng 3 vitamins na tag 5ml each. appebon, ceelin at growee. ang worry ko baka ma over sya sa mga gamot.

[leletmd]

^ Did you ask why there is a need to give 2 multivitamins (appebon and growee)? Malaki ba ang weight na kailangan niyang habulin?
Appebon is composed of Vitamin B complex plus Iron plus lysine while Growee is composed of Vitamin B complex, vitamins A, D and E plus taurine, lysine, choline and CGF so halos magkapareho lang ang components ng 2 vitamins. Kindly clarify na lang with your pedia why your child needs 2 multivitamins kasi baka may special reason sya for this.

[lian_06]

hi doc,

please enlighten me.

my son got positive primary koch infection in xray but negative in ppd test.
hindi pa siya pinag take ng gamot until nag ka ubo at sipon siya ng pinacheck up nmin siya binigyan cya ng antibiotics plus gamot sa ubo at pinagstart na kami sa kidkits
my son is gaining weight kaso mga .2 kilos lang in 1 month time.

nag second opinion ako from anothre pedia.
sabi nya wag daw muna magstart kasi nakita naman nya walang kulani anak ko, masigla, negative ang ppd, nag gain ng weight ang sinabi lang nya antibiotics lang muna dahil may ubo at sipon lang.

nalilito tuloy ako. hay.

nagpa xray kami normal naman result nung sa amin mag asawa. Yung nag aalaga sa anak ko ang result eh  residual fibrosis upper lobe. Sa pagkakabasa ko po sa internet ang sabi main complication of completely recovered from Lung tuberculosis. Possible bang dito nakuha ng anak ko anak ko yung primary nya?

TIA!

[leletmd]

^ Why was the chest xray and ppd done? What were the symptoms prior? What was written in the chest xray result aside from positive primary koch's infection?
Also, just to clarify, did he take kids kit already before you had the 2nd opinion? Or it was never given?
Did any of the 2 pedias ask for a repeat chest xray? When I am in doubt with the chest xray findings, I usually have a repeat chest xray done 2 to 4 weeks after antibiotic intake.
Re:fibrosis, most common cause is latent tb or healed tb infection and patients with latent TB infection are usually not infectious. If you want to be sure, you can have the care giver do a sputum AFB test x 3 days. Best to bring her to a pulmo or an internal medicine to determine if the sputum test is needed.
I suggest you also bring your child to a pedia pulmo if you have not done so.

[lian_06]

hi doc,

last july nagkafever yung anak ko tapos ayaw magmilk nor water.
so my pedia decided iconfine to fine out why 39 ang fever niya at di bumababa.
so nagcvc, urinalysis and xray to find out kung bakit nilalagnat wala naman siyang ubo o sipon that time.

sa xray po lumabas pneumonia tapos primary koch infection.
after magpositive sa primary nagskin test po kami and it turned out to be negative naman.

hindi pa kami binigyan ng kidkits. pinaobserbahan lang anak ko kung maggain ng weight at masigla.


tapos last week inubo at sipon anak ko so pinacheck up ko kay pedia binigyan kami antibiotics plus pinagstart na kami ng kids kit.

hindi ko muna pinainom kasi naawa ako ang daming iinumin gamot may antibiotic, gamot sa ubo at sipon pa.

at gusto ko ng second opinion.

i consulted another pedia tapos repeat xray result ulet pneumonia at primary koch infection.
ang binigay lang ni second pedia eh antibiotic lang tapos observe lang ulet kagaya ng una pag daw hindi nag gain ng weight at walang ganang magmilk ibalik ko daw at mag skin test ulet.

so right now tinatapos lang namin yun antibiotic. nastress lang ako sa primary koch na yan.

sige po hanap kami ng pedia pulmo

[leletmd]

^ Nacompare ba ang 2 chest xrays? Also, what was written in the chest xray result other than the diagnosis of pneumonia and primary koch's infection? Meron kasi dapat description ng findings before the diagnosis like infiltrates, lymphadenopathy, heart is not enlarged, etc.
The ppd test kasi will only show exposure and at times, it may even be falsely negative if the child's immune system is down, malnourished, etc. Your child should fulfill 3 out of the 5 criteria (please back read for the criteria) in order to diagnose PC or TB.
Please try to consult a pedia pulmo and bring the 2 chest xray plates/results, other tests and prescriptions given so that the pedia pulmo can review them and correlate it with the history and physical findings of your child.

[glyzza026]

Thanks God at natapos na din ang 6 months na gamutan ng baby ko. last week his pedia requested him to take a repeat xray. We are so happy when we got the results that he is already healed and now cleared from PC

[dyen]

hi,
ask ko lang po kc [textspeak!] baby has fever for almost 12 days na pag madaling araw.. so our pedia advised us for a skin test.. so parang positive sya base dun sa bump.. ang worry kc hirap painumin ng medz ang baby ko. nag pupumiglas sya or if ma pwersa nmin i needle dropper, nasusuka sya, mahina ata sikmura sa lasa ng medz parang ako.. ask ko lang if may alam kyo na trick sa pag papainom ng gamot nya.. [textspeak!] ibibigay ba na dalawang magkasabay na gamot na dapat taken with an empty stomach, pwede ba haluan ng dutchmill, kc ganun namin napapainom ng antibiotics.. or may alam kyong paraan na hindi ko pa nasubukan..tnx

[lez101]

Good day doc lelet, ask ko lang po kasi yung son ko nagkaron ng mga kulani sa likod ng tenga at sa gilid ng batok, so pinacheck ko sa pedia, that time kasi my sipon pero hindi naman ganun kalala at nawala naman agad ang sipon then after a week hindi padin nawala ang sipon, inobserbahan ko muna ng another week pa, hindi padin nawala, so last monday dinala ko na ulit sa pedia nya at pina xray namin, kahapon po nakuha namin ang result eto po

Streaky infiltrates in the inner fields with some perhilar fullness
Heart is normal in size and configuration
Diaphragm, sulci and bony thorax are intact

Impression/Conclusion:

Interstitial pneumonitis and or primary PTB
Follow-up study is suggested

so ang ginawa po after nag skin test po sya, sa saturday po malalaman yung result, sa ngayon my nakita na akong red spot dun sa arm nya kung san siya tinurukan.

Question ko po,

1. Base po dun sa Impression AND OR kasi ang nakalagay so possibleng isa dun sa dalawa or yung dalawa, Ano po yun dok? bakit po dalawa?

2. Hindi pa po namin alam kung kanino sya nahawa, kaming maggiina lang po sa bahay me, daughter  7yrs.old my son 11months at yaya..ang suspect ko yung naunang yaya na 1month lang at umalis din agad, or etong current yaya ko ngayon..ngayon dok if ever magpositive si baby, magpapaxray nadin kaming lahat, at worried ako baka kaming lahat nahawa, pauwi panaman si husband from barko bawal sya mahawa, ano po ang dapat kung gawin if ever magpositive din ako? Mahahawa po ba si hubby ko?  napapraning na ako di ko alam kung anong gagawin ko, wag naman sana..

[leletmd]

@dyen:
Was a chest xray done? We do not base diagnosis of PC solely on PPD test alone since PPD testing will just determine if your child was exposed to TB or not.  The patient must fulfill 3 out of 5 criteria in order to diagnose PC or TB.
You cannot mix Rifampicin and Isoniazid with dutchmill or milk since food interferes with the absorption of the meds. If you give it via dropper, I suggest you give it in increments rather than 1 full dose and aim towards the cheek and not the throat to lessen the chances of your child spitting out or vomiting the meds.

@lez101:
The and/or impression in the chest xray means that the findings can either point to pneumonitis alone or PC with pneumonitis which is why the radiologist suggested a follow up xray. Eto yung mga readings na ideally ay pinapa-repeat chest xray ang bata or patient after 2 to 4 weeks to determine if the infiltrates seen was really due to PC or pneumonitis lang pala.
Pneumonitis may present with on and off colds and cough din kasi and since it is a viral infection, it can lead to enlargement of nearby lymph nodes. There are cases of TB or PC na may super-imposed or kasabay na infection katulad ng pneumonia or pneumonitis.
If pinaulit ang chest xray and mawala ang infiltrates, then most likely, it was really just pneumonitis but if present pa rin ang perihilar infiltrates, then most likely it is PC or TB.
Yes, if your child was found to have PC or TB, it is essential to find out who infected him. All household contacts should have a chest xray and a consult with an IM pulmo for treatment if ever may makitang findings sa chest xray. As to your hubby getting infected while he is here, as long as naka 2 weeks na tuloy tuloy na gamutan ang source, hindi na considered contagious so if more than 2 weeks pa naman bago umuwi si hubby, then pa-xray na kayo para maka 2 weeks na ng meds before he arrives.

[lez101]

Good day again mommies and dok lelet, update po. Last saturday oct.4 bumalik kami sa pedia para tignan yung ppd ni baby, sad but positive sya 10mm yung  sukat ng red spot niya, so binigyan sya ng kids kit 3 for 6months, 2days na siyang umiinom. Right after namin sa pedia tumakbo agad kami ng hospital kung san makakakuha kami ng same day result ng xray, nag xray kaming lahat kasama ang yaya..clear ang yaya at ang eldest daughter ko, ako my nakita sa akin so nag xray ulit ako sa balikat, then kahapon ko lang nakuha result, oct 5, ang impression sa xray merong PTB, i was so shocked! san ko nakuha yun? meron akong annual physical exam at ok lahat yun, at this year hindi ako nilagnat at inubo man lang..I was like, oh god sige ok lang since curable naman sya, tinatangap ko na po..Then pagpasok ko sa room ng dr para basahin yung result ng xray ko, tinignan nya yung xray ko then sabi ng dr. wala naman, even dun sa unang xray ko wala at sa pangalawang xray ko wala din, then sabi ko, eh doc bakit my nkita? sabi nya,  expose kasi tayo so malamang scar lang yung nakita sayo. pero kung gusto mo makasigurado mag phlegm test daw ako ( nakalimutan ko kung ano tawag dun sa test na yun sorry) so magsasubmit ako ng phlegm sa lab for 3days. Now the big problem is, wala naman akong ubo, wala akong plema pano ako magbibigay? up to now Im trying to produce sana lang para matapos na tong nightmare na to. magpapadouble check pa ako sa pulmo dr. para mapanatag na loob ko. At kung meron talaga, well hindi ko aatrasan ang gamutan na yan. My only fear is, sana lang si hubby ko hindi mahawa..working sya abroad, at pauwi na sya next month at umaalis sya every two to three months.

[mariefranchesca_soberano@]

Good day!

Hello, Dra

ask ko lang po, normal ba na frequent maglabas ng dumi si baby pag nagtatake ng kids kit 3?
yan ang reseta sa kanya,

he is 10.6kls
11month old.

start palang kami ng gamutan pero concern ko yung pooping nya, in the morning, yun yung normal na dami ng pupu nya, then after magfeed, parang mapapa-fart lang sya tapos may nalabas na dumi and super rashes kaya iyak talaga sya. what should I do? thank you

mga mommies, ganyan din ba baby effect ng meds sa baby nyo?

[purplepink888]

Hi Dr Lelet, I would like to ask lang may son's pedia said hindi nag gain ng weight yung son ko from our last visit. Last August pinainom yung son ko ng propan and growee alternate. Ang dami na niyang vitamins aside from the first i have mentioned. Taurex, ferli, ceelin and 1 multivatamins plus the 2 nga. The propan and growee for gain weight daw kasi na stuck na ang weight ng son ko sa 10.5 kgs since nag 1 year old siya. Upon checking naman (google) normal weight naman un according sa age niya now 13.5 months. Pag hindi pa rin nag weight gain ang ipapa TB test daw.

As for symptoms wala naman siya kahit ano twice lang siya nag ka ubo since birth pero hindi ko naman pinainom ng gamot more on fruits kame when he had cough. The pedia said she just want to make sure daw na walang PC si baby. I know also na asymptomatic ang PC.

Ang concern ko lang ayoko kasi sana mag iinom ng gamot ang son ko eh. Kasi from the start (thank God) yung Ubo niya lang ang naging sakit niya and after 3 days wala na after no medication.