Primary Complex Thread 3

[leletmd]

@guiding star:
Even if treatment with PC is ongoing, your child can still develop cough and colds since there are numerous other causes of cough and colds. If he has allergic rhinitis, symptoms can be on and off, depending on the trigger. It would be best to have him evaluated by the pedia or an allergologist if persistent ang symptoms niya.
With regards to your pedia not treating the pneumonia cited in the xray results, it would be best to go back to your pedia because he is the only one who can explain the reasons behind his management. He might have had reasons as to why he decided to treat the xray results as PC instead of Pneumonia. Hindi lang kasi ang xray results ang kinoconsider when treating a patient. Dapat kung ano man ang lumabas sa lab results, it should be correlated with the history and physical findings of the patient.

[miminibebe]

Hay, waiting kami now sa results ng xray ng eldest ko and yung sa blood chem niya.  Nagkaron kasi siya ng ear infection at nagkakulani, pero almost 3 weeks na siya nagaantibiotics, hindi pa din nawawala yung kulani niya sa left side ng neck, though lumiit na naman na and yung sa right side nawala.  Kaya lang since di pa nga nawawala, pina-xray and blood chem siya ni pedia last Saturday to check for PC.  Last september naXray na din sila ng 1 year old ko kasi parehong di nawawalan ng sipon at ubo.  Ang duda namin because our previous yaya eh nagsmoke without our knowledge ayun ang naging cause.  Pinalayas na namin yung yaya na yun a month lang after ko makuha kasi nga nalaman ko na naninigarilyo.  Kaya lang si eldest ko eh palagi pa din me sipon at inuubo ubo.  Worry ko baka may dalang TB din yung matandang yun, though di naman siya inuubo at di din naman payat.  Nakaka-aning lang magintay ng results.  Sana naman dahil lang sa nagka ear infection siya kaya me kulani..

[guiding star]

@ Doc leletmd

Ouy of the country ang pedia ni baby, so last monday we went to a pedia pulmo kasi may fever, cough and cold. She prescribed ventolin and alnix for a week and montelukast for 3 months. Naaawa na ko sa son ko ang daming iniinom na gamot. Added stress pa kasi the doctor gave us a referral to a pedia  cardio because she heard a murmurs daw :-(

[miminibebe]

@Doc leletmd - favor naman po.  Patulong paginterpret ng results ng daughter ko.
May 1 week convention si pedia kaya next week ko pa mababalik sa kanya results ng anak ko.
Xray result - Normal chest
PBS Results:
RBC - Normocytic, Normochromic
Platelets - Adequate and Morphologically Normal
Toxic Granules - None
Abnormal Cells - No blast cells seen
Differential Count:
Eosinophils 4.8
Segmenters 48.8
Lymphocytes 41.6
Monocytes 4.8
             -----------
             100 %

Sa CBC naman niya eto ang results
Hemoglobin 146
Hematocrit 0.43
WBC 9.0
RBC 4.8

Segmenters .22 (L).55 ang lowest
Lymphocytes .78 (H) .35 ang highest
Platelet count 380

Up to now me kulani pa din siya.  Thanks in advance Doc leletmd!

[betsyness]

may 2 y.o. daughter had it nung 1 y.o. sya. it was treated naman, though mahina pa din sya kumain ngayon. picky eater lang siguro talaga. sadly, sa yaya nakuha, kasi lahat kami nagundergo ng xray and si yaya yung mejo may tama. kaya standard rpocedure na ngayon an if kukuha ng new yaya, check-up na muna kasi kawawa pag si baby ang nagkakaskit.

[leletmd]

@miminibebe:
Hindi naman talaga mawawala ang kulani. Liliit lang siya. People with an intact immune system have kulani all over our body. We need them because they are the ones producing antibodies to fight infection and disease. Ang mga taong immunodeficient or mahina ang immune system from birth ay usually walang lymph nodes na nagproproduce ng antibodies kaya mas madaling kapitan ng sakit.
The ear infection in itself can cause enlargement of the lymph nodes near the ear. How long has he had the ear infection?  Based on the cbc kasi, he has an old infection since the lymphocytes are on the high side.
Please have all the lab results interpreted by your pedia since it needs clinical correlation. Bring the chest xray plates or cd as well since it would be better to look at the images itself rather than relying on the radiologist results.

@guiding star:
You can ask your pedia why she opted to treat for PC rather than Pneumonia once she comes back from abroad. She is the best person kasi to explain her decision.
What was the pedia pulmo's diagnosis for the cough and colds? New finding lang ba ang murmur?

[frostbite]

hi doc let  my daughter has been admitted for 5 days because of pneumonia and have take hom meds for 9 more days . still coughing , dr.  gave her  Pred , and combivent  for 5 days then montelukast for 14 days we are now on the 7th day of montelukast still  though not very often coughing sometimes w/ sticky pleghm   she was diagnosed w/ primary before and we were able to finished all 6 mos med is it possible na magkaroon ulit sya   since her cough is already more than amonth na kala ko mawawa na after hospitalization ..... latest xray result  pneumonic consolidation , right middle lobe in partial regression... what doe it mean?
blood test  rbc 4.18 (ref 4.5-5.1) ;WBC 4.2 (ref4.4-11) ; Platelet 237 (ref150-450); Neutrophils
.44( .50-.70) ; Lymphocytes .56 ( ref .20-.40),
pls advise   may primary po kya ulit sya? na PPD sya sa hospital pero negative naman daw po// dapat po kya i repeat? pls help thanks doc.

[guiding star]

@doc leletmd

I will ask her pedia once she comes back. The pulmo said its viral, and she prescribed montelukast (for 3 months) & ventolin for his cough. After 5 days we came back kasi parang hindi nagiging okay ang ubo. The pulmo changed ventolin to dilatair, now he is okay na. The murmur thing is new, pulmo even asked if my son's pedia mentioned it before but no, this is just the first time.

[leletmd]

@frostbite:
Does you child have asthma or allergic rhinitis? The meds that you mentioned that were given to your daughter are anti-asthma/anti-allergy meds. Was she given antibiotics during her hospital stay?
If the pneumonic consolidation in the chest xray is already regressing then that means it is getting better. There are times, though, wherein, it takes a long time for the cough to go away because the lungs become hyperactive, especially if the asthma gets triggered by the infection. Please follow your pedia's instructions and bring her for follow up so that the pedia can assess response to the meds given.

@guiding star:
How old is your son? If it is a new onset murmur, best to have the cardio to look at him to assess cause.
Montelukast and ventolin are both anti-asthma meds. Viral infections can trigger asthma attacks so it is possible that his current cough is not due to PC.

[m_lim]

bakit ganon 3months na nagttake ng HRZ kit ang anak ko pero hindi parin nag ggain ng weight??

sabi ng pulmo pedia (Dr. Alex Koa Lee), pag nag gain ng weight tsaka lang masasabi na "nagamot" na ang PC.

hindi rin naman daw kasi pwede X-Ray or PPD test kahit matapos ang 6month treatment.

so paano yun hindi tumataba edi hindi gumagaling??

pang apat na lipat ko na ito ng pedia. yung mga unang pedia, meron hindi sigurado sa gamot, meron nag susuggest ba ibang test wag daw PPD, etc etc. in short, ang gugulo nila mag explain ng diagnosis and treatment. :-(

[mikaela325]

Pagka nagka bacterial pneumonia prone ba magka primary?

[miminibebe]

Thanks for your reply doc leletmd!

Babalik ko siya sa pedia this Saturday para maread na yung mga results.
Up to now swollen pa din kulani niya.

[guiding star]

@doc leletmd

My son is four years old. Last monday we had him check by a pedia cardio, the doctor said its an innocent murmur and nothing to worry about. We are asked to come back after 6 months just to be sure na hindi lumalakas ang murmur.

[leletmd]

@guiding star:
It is good that he was seen by a cardio already. Most new onset murmurs at his age are due to innocent murmurs but it would still be best to have him seen by a specialist to make sure there isn't anything that needs immediate intervention.

@miminibee:
It takes a while for the "kulani" to decrease in size. Best to bring him for follow up until he is fully recovered.

@mikaela325:
No, getting pneumonia doesn't make one prone to getting TB or primary infection. However, if you have a weak immune system, you get more prone to getting infections and it takes a while for your immune system to recover, making you more susceptible to getting secondary infections (one infection on top of another) such as having pneumonia and TB at the same time.

@m_lim:
How is her appetite? Activity? Does she still get sick easily compared to before she started treatment? Mas reliable kasi talaga ang clinical improvement compared to repeating the chest xray and PPD kasi there is a risk of radiologic lag and false positive/negative PPD.
No problems in giving meds daily? Are the meds given at the appropriate time and dose? Napa-sputum test na ba ang mga source ng infection niya?

[m_lim]

^Hi doc, even before pa na diagnose ng Primary Complex ang baby ko, hindi siya sakitin. as in walang symptoms talaga hanggang ngayon. kaya nga ang hirap ma determine kung gumagaling ba o hindi?

yes, very strict ako sa gamot niya. never naka miss sa time and dosage. 3rd month na niya ngayon and nag gain ng 2lbs. hindi ko masabi kung dahil pinalitan rin yung milk niya from Progress Gold to Pediasure. sa food naman, same appetite lang. mahirap pakainin ever since pati milk.

nagpa sputum 2 drivers and 1 yaya.. lahat negative. si yaya pinauwi ko na. yung 2drivers hindi ko mapaalis kasi office drivers sila at more than 20yrs na samin...pero stay in sila eh. ok lang ba yon doc? kasama parin namin sa house but no direct contact naman sa baby ko unlike yaya na halos maghapon kasama... and provided ang gamot nila for 6months pati check up. regular rin pag remind ko sa kanila not to forget their meds...

[m_lim]

by the way doc, kahit naka todo ang aircon namin, pinapawisan ng sobra si baby sa gabi. sign po ba yun ng Primary Complex?

kahit nung maliit pa siya, ganon na siya... 2.3yrs siya now.

i hope ok lang na hindi paalisin yung 2drivers kung nag gagamot naman... importante kasi ginagawa nila sa office namin kaya hindi pwede paalisin nalang.

nahihirapan nga ako ngayon kasi yung Yaya na may TB, more than 10years na sa amin yun. ang hirap humanap ng pagkakatiwalaan ngayon :-(

actually, advice ng pulmo doc ng yaya, ok lang daw pa stay...kaso ayoko maman mag take risk lalo na may diabetes rin si Yaya.. ang pagka intindi ko, pag may diabetes at napabayaab ang sugar, may chance bumalik ang TB kahit gumaling na. tama po ba yon??

[rogue0214]

Doc lelet, ano po ba meaning ng mild right hilar vascular prominence, no cardiomegaly? Nagpa xray kasi husband ko to rule out TB. Yan po result ng xray ng nya. Sabi ng doctor observe daw muna ng 6 months My daughter was suspected to have primary complex kasi lagi nilalagnat pero walang ubo or sipon. So nag order po yung pedia ng urinalysis, complete blood test, blood culture and xray. Normal naman po lahat ng results except dun sa xray. Bronchitis po yung findings kaya hindi na sya pina skin test ng pedia. Kailangan ko pa po kaya ipa skin test yung daughter ko?Thank you.

[miminibebe]

Went to see my daughter's pedia last Saturday, normal naman daw result ng xray and lab tests nya.   Pero since suspected nga niya is Primary complex, nag tuberculin skin test na kami.  Chineck ang result last Monday, and negative din.  So sabi ni pedia i-observe muna si daughter, pag lagi nagkakasakit, magstart pa din kami ng kit for Primary complex.  Nilagnat si daughter tuesday ng madaling araw, possible pa din ba na primary complex pa din to kahit na negative lahat ng test?

[leletmd]

@m_lim:
Usually kasi we base improvement on whether or not nawala na ang old symptoms, like before mahina ang appetite pero ngayon malakas na. With the case of your child na walang symptoms, negative din ang chest xray pero positive ang PPD, judgement call kasi ang nangyari since she was exposed to more than 1 person in your house with TB kaya nag opt to treat ang pedia pulmo kahit na she doesn't strictly fulfill the criteria. In cases like that, it will be up to your pedia pulmo to determine whether treated na siya or not.
If negative naman ang sputum test ng 2 drivers and 1 yaya, then it is possible that they are responding well to the meds. I said "possible" kasi wala silang baseline AFB smear (prior to treatment) na masasabing nag-convert sila from positive to negative. Ok lang naman for them to stay in your household as long as they are religiously taking their anti - TB meds.
With regards to your yaya, technically, ok lang din for her to stay on kaya lang there really is a risk of recurrence since both Diabetes and TB are considered secondary immunodeficiencies (mahina ang resistensya niya dahil sa diabetes and TB). Mas madali siyang magka-TB ulit if her blood sugar is uncontrolled and she gets exposed to someone with TB again.
Night sweats is one of the many symptoms of TB, but a lot of kids normally experience night sweats due to their fast metabolism. In general, mas pawisin talaga sila compared to adults kaya kahit tayo nakabalot na ng blanket, ang mga kids, ayaw pa magblanket. Kung baby pa siya till now ganoon na, baka talagang mabilis lang metabolism niya or madali talagang uminit ang body niya.
Bukod sa yaya and 2 drivers, lahat ba ng household contacts (family and staff) ng daughter mo nagpa-test for TB? Baka kasi meron pa palang source na hindi pa nagagamot till now.

@rogue0214:
"mild right hilar vascular prominence, no cardiomegaly" means na merong ugat sa hilar area na medyo malaki than usual pero the heart is not enlarged naman so baka: 1. due to how your husband was positioned during the taking of the chest xray kaya nag-appear na medyo malaki ang isang ugat or 2. anatomic variation or sadyang malaki lang talaga yung isang ugat na yon. It has nothing to do with TB or PC, though. Pwede niyong ipaulit ang chest xray ng husband mo to see if meron talagang hilar vascular prominence.

@miminibebe:
Wala na ba talagang ibang mahanap na cause sa frequent na pagkasakit ng anak mo like allergies? Ang ear infection kasi can be caused by frequent na pagbabara ng nose na hindi natreat ng maayos. Baka naman kasi hindi talaga PC ang problem.

[sophiegrayy]

hi, i am so confused now. we went to 3 pedia pulmo. one said he has primary complex, no doubt. this is based on the chest xray pa lateral.  we went to another pedia pulmo, she said that he doesn't have primary complex by just touching the area under his nape. she confidently said that he doesn't have pc, no doubt.  and no need to have chest x ray and or ppd (this is the first pulmo pedia we went to so we still haven't done the xray) the third pedia pulmo saw the xray, she said that she doesn't think he has primary compkex.

my son is 9 yrs old. he has recurring cough n colds, he also seems to have night sweats.

in the past, when he was 3 yrs old, he got a positive in his ppd but negative in xray, so he just took one med for 6 months.  when he was 5 yrs old, he got positives in both pod and xray. so he took 3 kinds of medicine for 6 months. after finishing the meds, he had xray and his doctor said okay na.  late last yr up to this year, he gets sick quite often.

@letletmd and other doctors out there, pls advice what we should do next. thank u.