Primary Complex Thread 3

[rhylie10]

Good morning dra. leletmd possible po pa bumalik ang primary complex? yung anak ko po nagkaprimary complex nung 2013, 6 months medication, then sabi ng pedia niya stop na, sabi niya nun lumiit na daw mga kulani, dun po siya nagbase na ok na. then last month pacheck up kami dumami or lumaki nanaman daw mga kulani niya, di naman siya nagrequest any laboratory test. kasi po ang concern ko nun is pag dumudumi anak ko may dugo naman, madalas sumakit tummy niya, blood test lang po ginawa at stool exam, sa stool exam negative, sa cbc po mababa yung dugo niya, maputla at payat po yung anak ko, malikot siya pero sabi ng iba hindi porke malikot eh mukhang healthy na, maputla daw kasi siya, ang gusto ko sana mapacheck siya ng mabuti or maayos po, para macheck kung anong infection, or sakit ng anak ko, ang sabi po kasi pag may lagnat nilalabanan ang infection, ang tagal ng hindi nilagnat ang anak ko, di ko na nga po maalala kailan yung last ehh.. so kung lumaki yung kulani does it mean something wrong po? any advice naman po. tia. paranoid lang po kasi minsan oa naman.

[leletmd]

@sophiegrayy:
What were the description of the findings in the recent chest xray?
When he tested positive for exposure and disease when he was 5 years old, were you able to find the source of his infection? Did the source get treatment, too?
What were the assessment/diagnosis of the 2 pedia pulmo?
Aside from PC or TB kasi, there are other causes of recurrent cough and colds like allergies (asthma and Allergic rhinitis), gastric reflux, other types of infection like bronchiolitis or bronchitis, flu (symptoms may last several weeks to resolve) as well as continuous exposure to pollutants such as smoking and even fumes from gas stoves, etc.

@angie malvar:
Yes, it is possible for PC to come back if the patient did not receive adequate treatment (hindi natapos ang 6 months, hindi naibibigay ang gamot araw araw or sa tamang oras, etc.) and if there is continuous exposure to the source of infection. PC or TB usually comes back at a time when the child's immune system is down.
But, I would have to agree with the doctors who assessed your baby there. The symptoms of your baby point more to an allergic cause like Asthma than an infectious cause. Why? cough is episodic (pasumpong sumpong), triggered by activity/emotions, preceded by colds, etc. Baka your child needs to be on maintenance medications for Asthma or hindi adequately treated ang asthma niya kaya hindi ito gumagaling.

@rhylie10:
Please refer to my answer above regarding risk of PC or TB recurrence.
Maraming possible na cause ng paglaki ng kulani sa neck and nape area like infection sa ears, nose and throat, sirang ngipin or dental caries, sugat, rashes, allergies, etc. Pag lumaki ang kulani, it means that it is making antibodies to help the body fight whatever it needs to fight.
What is the current diagnosis of the pedia? May anemia ba raw siya? Nahanap at nagamot niyo ba ang source of TB infection niya last 2013?

[bimbo9711]

Hi dra. My son (2yo7mo) was diagnosed yesterday of primary complex because the results of his chest xray showed "consider primary konch's infection" although his PPD test was negative and he doesn't seem to show any symptoms (yet) of PC (i.e., prolonged coughing, lymph nodes, etc.) I had him tested because my twin nieces (4yo), who are staying with us for the summer, were diagnosed with PC a couple of weeks back. My xray result and the results of all the yayas in our household showed that we are clear of TB. I'm running out of people in our household to test in order to determine the source of the TB.

Is it possible that the kids got it outside our home? But they don't really go outside for prolonged periods of time to interact with other adults. Does the adult source have to be in close contact with the kids to infect them (i.e., kasama talaga sa bahay)? If the source is outside of our household, how come all three of the kids were infected? Should I widen my "search" and have those people who just visit our home tested too? Or pwede bang naubuhan lang silang tatlo saglit ng kung sinuman na nakasalubong nila sa labas kaya sila na-infect?

Thanks so much!

[leletmd]

bimbo9711:
Since all 3 kids got infected, the source is most likely someone they all associate with regularly. You don't get infected with just 1 encounter with a TB patient kasi. It takes prolonged exposure and a weakened immune system in order for infection to occur. Your son also did not get it from your nieces. It is most likely from an adult that they all associate with regularly.
You mentioned that your nieces are just visiting for the summer. Have their parents and yayas been tested, too? How about grandparents or other relatives they regularly come into contact with?
Did you have all the chest xrays done at a reputable clinic or hospital? Did the adults undergo PPD testing or sputum test, too?

[bimbo9711]

hi doc lelet. thanks so much for taking the time to answer our questions. i'm having even those outside of our household checked already to find out the possible source. the adults in our household had x-rays only, no PPD and sputum test. would you still advise us to take them?

I have another question because I noticed that magkaiba yung dosage ng meds ng anak ko from my nieces. They have different pediatricians.

my son (12 kg)
refampicin (200 mg/5 ml) - 4 ml
isoniazid (200 mg/5 ml) - 4 ml
pyrazinamide (500 mg/5 ml) - 3 ml

my nieces (15 kg both)
3.75 ml for three anti-TB meds

When I asked my son's pedia with regard to the difference in the dosages, his pedia said that my son's dosage is already based on his weight and the minimum therapeutic dose of the meds. di ba supposedly, mas mababa ang dosage ng anak ko dahil mas magaan sha? i'm just concerned na baka ma-overdose ang anak ko at magkaron ng side effects na tulad nung mga mentioned nyo from previous threads. I wanted to have my nieces' dosages rechecked too pero ayaw na nung nanay, so wala ako magagawa.

It would really help me a lot (for my peace of mind) if you can give me clarity on this. Baka mag-alangan akong painumin ang anak ko hanggang di naso-solve ang misteryo ng pagkakaiba ng dosage nila. Thanks!

[leletmd]

@bimbo9711:
I would suggest at least PPD testing for your household to check for exposure.
With regards to the difference in dosage, the medications should have been computed based on weight and minimum therapeutic dose needed as well as the preparations of medications to be used. Was your son's 12 kg weight the one used in computing his dosages for the 3 meds? Did your pedia instruct you to give the meds daily or on a 3x a week schedule? The dosage would be dependent on the protocol used kasi.
With regards to the dosages of your nieces, it seems to be in accordance with the usual recommended minimum therapeutic dose for the 3 meds.

[bimbo9711]

@leletmd... hi, doktora. I just checked my son's medication, and these 3 meds (refampicin, isoniazid, and pyrazinamide) with 4ml-4ml-3ml dosages, respectively, are prescribed once a day. They are  already based on his weight and on the minimum therapeutic dose of the meds, as reported by my pedia... My son's and nieces' medicines are identical. Should I be concerned about the dosage of my son's medication? I've been giving him those dosages for more than a week now. But so far, I don't see any negative side effects.

[abyquitz]

hi dra. leletmd, mag ask lang po about sa way nag papagpapainom ng 3 meds.. magkaiba po kasi ang advise ng gen. pedia and pedia pulmo (nagpa 2nd opinion po ako dito)..

gen. pedia, advise us to take po with empty stomach every morning ang 2 medicines (isoniazid and rifampicin).. pero may 30 mins interval sa pag papainom.. hindi dpat mag kasunod.. after breasfast naman po si pyrazinamide...

while advise namang ng pedia pulmo is, pwede i take ang 3 medicines, mag kakasunod na then wait 30 mins bago mag breakfast.

naguguluhan po ako... since working mom po ako at need ko umalis ng early sa bahay, mas practical ang advise ni pedia pulmo.. pero sa pag bback read ko po wala ako nakitang ganitong way nag pagpapainom.

[leletmd]

@abyquitz:
Pwedeng magkasunod ang Isoniazid and Rifampicin. Both medications should be given at least 30 minutes to 1 hour before breakfast.
Pyranizamide is ideally given after a meal.
Example:
6:30 am - given Isoniazid and Rifampicin
7:00 am - breakfast
After breakfast - Pyrazinamide

@bimbo9711:
As long as your pedia computed the dosages based on his weight and the therapeutic dose of the meds, then, best to follow the prescribed dosages given by your pedia. I computed it based on the information you gave me and all 3 meds do not exceed the range for the therapeutic dose. 

[abyquitz]

thank you po dra. lelet sa response..

[vuzhia]

Bumalik kami kay Pedia kase may matagal na akong napapansin na medyo malaki na kulani sa bandang batok ng 15 mos baby boy ko. Wala Pedia ni Q nung visit naming kaya yung reliever Pedia (medyo bata pa) gumawa lang ng referral na X-Ray & PPD. Nag pa x-ray si LO & humanap kami ng Pedia na nag PPD.

After 3 days balik kami kay Pedia & dala lahat ng X-Ray result tapos nakita nya agad na negative skin test ni LO kase walang redness & hindi naman namintog. Sa X-Ray negative din si LO, tapos lahat kaming nakapaligid kay LO negative din sa X-ray. May reseta lang na antibiotic kay LO for 10 days para sa kulani then skin test daw ulit after 3 mos. Sana naman magtuloy tuloy na yung negative nya & mawala ng kulani kase last ubo & sipon pa ni LO ay February pa bago sya mag 1st bday & No. 1 symptoms daw ng PC ay mahina kumain & bumababa timbang na kabaligtaran naman lahat kay LO dahil magana sya kumain & never pa bumaba timbang nya lagi pataas.

[abyquitz]

@dra. leletmd
hi dra, mag ask po ako ulit.. now ko lang kasi napansin na magkaiba pala ang dosage na naibigay ng gen. pedia at pedia pulmo ko.. 5 days na siyang umiinom ng gamot..

ippacheck ko lang po kung ok lang po ba ang dosage, baka po kasi mali or sobra ang dosage.

7.5kg po ang baby ko nung nadiagnose.

gen. pedia:
isoniazid - 2ml
rifampicin - 2ml
pyrazinamide - 1.5ml

pedia pulmo
isoniazid - 1.8ml
rifampicin - 2.5ml
pyrazinamide - 3.5ml

thank you po.

[leletmd]

@abyquitz:
Check the prescription of the 2 pedias and compare the preparations prescribed for pyranizamide. There are 2 preparations available for pyranizamide: 250 mg/5 ml and 500 mg/5ml. It is possible that the 2 pedias prescribed different preparations.
For the Isoniazid and Rifampicin, there are 2 preparations available: 100 mg/5ml (most commonly prescribed or given at local health centers) and 200 mg/5ml.
Also, did they base the computation on the same weight na 7.5kgs?

@vuzhia
If the kulani that was enlarged is found on the nape area or batok, check for ear infection, colds, scalp rashes or infection. From the location kasi ng enlarged na kulani, malalaman ang possible na source ng paglaki nito.
For PC, ang usually malalaking kulani is nasa neck area and yung mismong nasa lungs na makikita sa chest xray.

[vuzhia]

^thanks po Dc leletmd, balik po kami sa original Pedia ni baby sa Saturday for Vaccine pa check ko po mabuti lahat

mukha naman pong walang ear infection kase hindi naman sya fussy, wala rin po colds, minsan po medyo may napapansin ako butlig butlig sa anit malapit sa batok parang bungang araw tapos malimit po nya kamutin pag antok sya pakita ko po kay Pedia, thanks so much sa info =)

[abyquitz]

Hi dra. lelet..

upon checking po sa prescription ng 2 pedia, magkaiba nga po..

gen. pedia:
weight: 7.5kg
refampicin (200 mg/5 ml) - 2 ml
isoniazid (200 mg/5 ml) - 2 ml
pyrazinamide (500 mg/5 ml) - 1.5 ml


pedia pulmo:
weight: 7.3kg
refampicin (200 mg/5 ml) - 2.5 ml
isoniazid (200 mg/5 ml) - 1.8 ml
pyrazinamide (250 mg/5 ml) - 3.5 ml

aside po sa tb meds, ang vitamins po ng baby ko ay Restor big drops and pedzinc.

natatakot lang po kasi ako baka kulang or sobra ang dosage para sa weight ng baby ko.. ayoko naman po ma extend pa ang gamutan namin.

nakaka cause po ba ng constipation ang tb meds? constipated po kasi now ang baby ko..

thanks po dra.

[leletmd]

@vuzhia:
Yung butlig butlig sa scalp area can also cause the antibodies to enlarge so good for you to show it to your pedia on the next visit.

@abyquitz:
Both prescriptions are within the range of the therapeutic dose for anti- TB meds. Magkaiba lang sa dose because of weight and the mg/kg dose used. The pedia pulmo may have computed for the upper range for rifampicin while the pedia used the minimum therapeutic dose.
For the pyranizamide, check what preparation you have and follow the dose for the preparation you have.
Anti - TB meds can cause tummy symptoms such as abdominal pain, soft stools and bloating. I suggest you mention all this to your pedia when you follow up.

[ysuran]

Hi Doc leletmd!

nakita ko yung post ko last year pa pala.. hehe.. anyway, nagpalit na po kami ng pedia sa pcmc na kami pumunta to a general pedia muna, yung small lump sa ulo nya di pa rin nawawala hanggang ngayon (23 months na sya).. bukol man yun or kulani. pinaglaboratory sya for:

urinalysis - urine gravity is somewhat low base sa sabi ni doc (other fields are normal naman)
kaya pinagawa nya ako ng table/chart to monitor yung volume ng intake at output ng liquids ni baby

cbc - normal
x-ray - normal
and ppd - 8mm

1. So, binigyan kami ni doc ng isonazid anti-tuberculosis 200mg/5ml na med, yung sample may kasamang rifampicin sa box, pero di na binigay samin, can you enlighten me doc bakit yung isang medicine lang binigay nya kahit naka package yung box na dalawang meds yun?

2 Yung chart for intake/outflow ng liquid, pinauulit sakin kasi ang gulo nun ginawa ko.. hehe.. dapat daw halos magkalapit lang yung result ng intake at outflow.  Tama po ba doc? Chart to be shown to her the result sa next appointment 2 weeks from now. at pinapa urinalysis ulit for specific urine gravity for the 2nd time (dito lang sa medical clinic malapit sa area namin). At sinasabi nya na sakin na just incase na may problema nga sa urine gravity, just in case its too low, she might refer us to an endocrinologist. Any inputs po for this doc?


3. Gusto po ng husband ko na magpa 2nd opinion kasi dun lang naman daw sa ppd positive kasi medyo skeptic sya. Do we need to go for another pedia specialist, a pedia-pulmo? or a general pedia na lang ulit will do?

Maraming salamat po sa inputs in advance Doc. Godbless you!

[leletmd]

@ysuran:
Was your child exposed to anyone with TB recently? Did she receive BCG vaccination in infancy? Does she have a BCG scar?
For patients kasi with previous BCG vaccination, PPD induration size greater than 10 mm is considered positive unless there is recent close contact with a TB patient wherein pwede na ang PPD induration size na 5 to 10 mm.
Treatment of PPD positive or TB exposed patients consists of giving either Isoniazid alone or a combination of Isoniazid and Rifampicin if there is a chance of resistance.
Medications may be bought individually or in a kit of 2 or 3 meds. The sample box may be a kit of 2 meds and since your pedia only prescribed Isoniazid, she did not need to give you the other medication in the sample box.
Causes of low specific gravity may be hormonal in nature and may be due to diabetes insipidus which is probably the reason for the Endocrinology referral. It may also be seen in patients with kidney problems. Best to follow your pedia's advice regarding this.
Before going for a 2nd opinion, I suggest you discuss your concerns with your pedia first so she can explain further her decision to treat. Baka kasi may reason siya as to why she decided to treat. If you feel the need to go for a 2nd opinion, I suggest you go to a Pedia infectious disease specialist or a pedia pulmo.

[fionnah325]

^ Doctora leletmd may tam=nong lang po ako my 15 months old baby pinacheck up ko last saturday pabakunahan ko sana ng hepa a kaso nagkasinat siya bigla last week nilagnat siya for 2 day nalito ako kung bakit siya nilagnat eh nong june 1 nabakunahan siya ng anti flu vaccine...taz sabi ng pedia niya nong saturday baka daw may primary complex siya kaya pina skin test muna siya at kahapon pina xray namin..ngayon babalik ako kami sa pedia niya at tngnan yong skin test niya if namaga pag namgaa daw positive....Doc gusto ko sana ipa xray kapatid ko at magpa xray din ako kasi baka sa amin nakuha at sana naman hindi positive si baby..My problem is hindi ako pwede magpapaxray kasi baka buntis ako eh...isa ba din sa symptoms ng pc yong hindi tumataba yong bata?may sipon siya pero wala naman siyang ubo...

[leletmd]

@jell-00:
It takes antibiotics 2 to 3 days to take effect. If there is no improvement till now, then it would be best to bring the baby back to the pedia for re-assessment.

@fionnah325:
The flu vaccine is given to protect against Influenza infection (which is just one type of virus among many others) so your child can still get fever, cough and colds despite being given the flu vaccine. There are lots of other types of virus and bacteria that may cause those symptoms kasi.
Common signs and symptoms of PC in kids: enlarged lymph nodes or kulani at the neck area, frequent cough and colds na hindi madaling gumaling, failure to gain weight, lack of appetite, low grade afternoon fever, night sweats and madalas matamlay.
Confirm first the diagnosis before having your household members undergo chest xrays. Confirm also if you are pregnant or not before having a chest xray.
What were the results of the chest xray and the PPD?