Primary Complex Thread 3

[dropdeaad]

@dra lelet almost 3 months na po kami naggagamot sa PC niya bale nakita sa skin test at xray noon kasi hindi pa po kami nakakabalik sa pedia para macheck yung kulani. So far wala naman po siyang ibang nararamdaman na at nung nagstart na po gamutan hindi na po siya nagkakasakit. Thanks po kasi sa umaga nagmimilk po kasi siya pagkagising eh.

[leletmd]

^ Observe mo na lang if the lymph nodes or kulani will decrease in size.
Ideally, monthly ang check up sa pedia habang nag-gagamot for PC to monitor response so baka dapat na magfollow up kayo.

[hun_nie08]

2mos na ang baby ko naggagamot so pinastop nasamin si Pyrazinamide.

[MommyNice]

Good day mommies! ask ko Lang po, ilang months bago makita ang improvement sa Bata? Mag3 months na naggagamot ang 8year old son ko sa PC nya Pero payat pa rin sya. Pero malakas sya kumain at Hindi naman nanghihina. 2hrs after lunch time sched ng paginom Nya. Hindi nya Kasi kaya ng paggising sa  umaga kasi sinusuka nya. Umeepekto kaya yung gamot? Thanks po sa mga magrereply..

[leletmd]

^ Depends on the state of the immune system of the child. Meron mabilis magrecover, meron naman mabagal. What is important is that the meds are given consistently, as in, walang missed dose. The source of infection should also be identified and receive treatment. Better also if there is regular follow up with your pedia during treatment para mamonitor ang response ng bata sa gamot. Don't stop the meds until you get your pedia's go signal.

[Aya_isabelle]

Hello dra lelet! Newbie lang po ako dito, sobrang stress na po kasi ako kay baby ko, mag 15 months old na po sya this jan18. And 3months na po sya nagtatake ng meds nya for PC, her pedia and a lung specialist gave her the HRZ kit po... Ang problema ko po is hnd ko po napapainom religiously kay baby un gamot po 😢 kasi hindi ko po sya napapainom nang gamot kapag gising po sya, palagi po sya nasusuka kahit sa vitamins po. Kaya tuwing tulog po sya saka ko lang po napapainom ng gamot at vitamins, kaya lang madalas po ako maka skip kasi lalo na po kapag ayaw nya magsleep sa morning and afternoon 😔 pero nun tinanong ko naman po sa pedia nya kung ayos lang po maka skip eh sabi nya po ayos lang basta wag lang dw po lalampas ng 2weeks. Pero napansin ko po though nag gain naman po sya ng weight sobrang hina padin po nya kumain ng solid foods, minsan nakakatatlong subo pa lang po ayaw nya na, mahina din po mag milk sa 24 hrs po nakaka 18-24oz lang po sya ng milk. I can say na halos milk lang po ang sumusuporta saknya. I dont know what to do po please help

[leletmd]

@Aya_isabelle:
Try to establish a routine with your baby regarding intake of meds. If hindi consistent ang pagbigay ng meds, there is a danger of failure of treatment as well as risk of resistance and developing allergies.
Since he is 15 months of age, hindi na dapat milk ang main source of nutrition niya. His milk intake should be limited to 12 to 24 oz per day. Solid food na talaga ang dapat main source of nutrition niya. He should be eating what you eat. No mashed or soft food na. Kanin and ulam na talaga. If konti lang siya kumain, try to increase the frequency of feeding per day (small, frequent feeding). You can try feeding him 5 to 6 x a day. If hindi pa rin nagbabago, ask your pedia to refer you to a feeding specialist or nutritionist para maturuan ka.

[kyandren]

@leletmd
doc leletmd i hope ur still there, i have a problem na diagnose poh ang anak ko primary last dec 4, 2015 dahil lumaki lympnodes nya, x ray negative,mantoux test positive..after 1 week of kidskit 3 treatment nabuhay poh ang dematographism nya...pinatigil kami sa treatment ni doc#1 para ang allergy na muna ang ei treat.  ang problem doc its almost 1 month na hanggang ngayon hindi pa rin nawawala ang allergy, allerkid was given but still andyan pa rin, sabi ni doc#1 kung hindi pa rin mawala skin test na kami..kawawa naman anak ko he's 5 yrs old..nag patingin kami kay doc#2 allergologist last jan 13, 2016, ang sabi 2 weeks allerkid plus mag start na kami muna sa isoniazid for 1 week kung walang reaction add pyrazinamide after 1 week if no reaction rifamizide problem ko doctor#2 will proceed to medication kahit hindi pa nawala allergy, since at the same time he's taking allerkid panu malalaman reaction ng gamot..im confused tuloy doc, doc#1 wants allergy to be  cured before proceeding but doc#2 cannot risk na patagalin pa treatment ng primary..pls help doc 

[sweetarwen07]

Hi Doc Letlet (leletmd)

Reliable po ba ang skin test for primary complex?
Positive daw po kasi si baby.

May elderly po kasi kami sa house na di namin alam na may TB pala.
Maari po ba syang mahawa in a matter of 1 week?

Dec16 xray po kasi ni baby, clear pa naman.  Within a week ng makahalubilo nya si elderly, nilagnat, ubo sipon na po sya at mabilis ang breathing, tumataas ang tyan sa paghinga.

Sabi ni Pedia, tonsilitis lang.  After almost 2weeks, nilagnat ulit.  At after ng skin test, Primary Complex na nga daw.

1 month treatment lang po ang sinabi samin.  Will name the meds later when I get home.
15 months pa lang po si baby.

[leletmd]

@kyandren:
Did pedia number 2 explain to you the possible cause of your child's rash? Is drug allergy the number 1 consideration or not likely? If more than 1 month na nastop ang meds pero meron pa rin kasi ang rashes, then most likely, the meds may not have caused the rash. My suggestion is follow up with your pedia allergologist and talk to her about your concerns so she can fully explain to you the reason behind her suggested management. She is the best person kasi to explain to you the reason behind her management.

@sweetarwen07:
lelet po, not letlet
Skin test to TB or PPD test or mantoux test only denotes exposure to TB. It will not tell you if the child is infected with TB. It is just one of the 5 criteria needed to diagnose TB.
The chest xray is the one that will tell you if there is disease or not.
Pwede kasi na-expose pa lang and there is no disease yet (clear chest xray) since the immune system is mounting a response to contain the exposure. So you can still take prophylactic meds to prevent infection.
One week lang ba talaga sila magkasama ng possible source (elderly) niyo or matagal niya na kasama pero lately lang nadiagnose ng TB? It takes several months of consistent exposure to develop a positive PPD test as well as to develop infection kasi. Hindi niya ito makukuha sa 1 week exposure lang.
Ano ang meds na binigay? One month lang ba daw talaga ang treatment or pinababalik kayo after 1 month? For positive PPD test, with positive source, no findings on chest xray, usually either 3 months, 6 months or 9 months ang treatment.

[sweetarwen07]

^ doc lelet, thanks po sa feedback.

Nag conclude sya agad na primary complex dahil sa skin test at nag based sya sa dec16 clear xray.

Tama po, more than a week lang ang exposure nya simula nung malaman namin na may TB si elderly at naging pirming nasa taas na lagi si baby, away from the elderly.

Kidz kit 3 forte
1. Isoliazid (purazid forte) 2.5ml before breakfast

2. Rifampicin (natricin forte) 2.5ml before breakfast

3. Pyracinamide ( z-cure suspension) 2.5ml before or after lunch or supper

[kyandren]

@doc lelet

 doc actually nong 2 yrs old [textspeak!] meron na poh  dermatographism, pero na treat poh yun dati almost 3 months din, after ilang years wala hindi na poh bumalik may few allergy problem lang but nawawala naman agad.  Bumalik lang poh talaga doc after 1 week of taking kidskit 3. Sabi kasi ni pedia#2 marami naman kasing factors ang dermatographism hindi naman poh sa food alone kaya he can eat anything daw, pinagbawal poh kasi ni pedia#1 lahat ng high allergenic foods.Pedia#2 told me isa isahin muna namin ang gamot starting from ang may pinaka least na effect, first isoniazide 1 week if no reaction pyrodoxine 1 week then last rifampicin. iba c pedia#1 unahin ang rifampicin,then isoniazide then pyrodoxine. naguluhan tuloy poh ako doc. isa pa pala doc nagtaka poh ako bakit c pedia#2 nag resita ng ethambutol tablet nabasa ko poh kasi for 7 years above lang.doc if drug reaction kahit nag tatake sya ng allerkid lalabas pa rin ang rash doc?

[leletmd]

@sweetarwen07:
Pwede kasing matagal ng meron na PTB si elderly pero recently diagnosed lang so kung matagal na silang magkasama, kahit pa recently diagnosed lang si elderly pwede pa rin counted as exposure yun.
I suggest you clarify with your pedia kasi baka may isa pa siyang criteria na nakita sa baby mo for her to conclude that your baby has PC. You need 3 out of 5 criteria to diagnose TB or PC. Also baka follow up ang sinasabi na 1 month at hindi lang yun ang duration of treatment for the 3 meds. Best thing to do would be to come back for follow up and bring up your concerns to the pedia para ma-explain sa iyo ang reason for treatment.

@kyandren:
Dermographism kasi is just due to increased or heightened sensitivity to pressure or friction on the skin. It is a form of pressure urticaria. Hindi ito dahil sa food or meds. Unless na it is dermographism with another form of urticaria. Urticaria kasi has many causes. Sa totoo lang, food is not a common cause. Madalas lang ito pagbintangan ng patients. Mas common pa na cause ang infection so technically, the present infection can trigger his urticaria.
With regards to the rechallenge, pasensya na, hindi ko pwede sabihin dito sa forum on how to do a proper rechallenge since there is a danger that parents might do it at home without medical supervision. Dapat kasi properly supervised ang rechallenge since adverse reactions may occur.
Did you ask Pedia # 2 why ethambutol was prescribed? She is the best person to explain to you her reason for prescribing ethambutol.
Do not be afraid to ask questions during consultations. Better to bring up concerns during the consultations para at least ma-explain sa inyo ng pedia as to the basis for their management.

@Mamaofkainten
To answer your questions:
1. If infection (galing sa virus and bacteria) ang cause ng cough and colds, then yes, ito ay nakakahawa.
Kung allergy, no.
Kung due to irritants like smoke or strong vapors, no.
If due to PC, no, since hindi nakakahawa ang bata sa bata. Ang PC ay nakukuha ng bata sa isang matanda na matagal na niyang kasama.
To be on the safe side, when one has cough and colds, wag na pag tabihin or pagsamahin ang magkapatid at strict hand washing palagi.

2. Depends on the size of the child and the severity of the infection

3. Laboratories including chest xrays should always be clinically correlated. Dapat chinecheck pa rin ang history ng bata or patient and kinocompare ito sa nakuhang laboratory. Hindi kasi dapat magtreat based on xray results lang or lab results lang kung wala talagang clinical basis for it.

4. Wala bang asthma or allergic rhinitis ang anak mo?
For now, I suggest you follow your pedia's suggestions since siya ang naka-examine sa anak mo.

[cutiecam]

Hi po would like to ask lang po kasi my little one is 2 years old 9 days sya nlagnat and naconfine 3 specialists(hema,cardio,forgot the other one) medyo naguguluhan ako,dinischarge kami without any final diagnosis,the hema told us na he looking at primary complex....nag abdominal ultrasound sya and may mga nodes daw na nakita ,nangyayari ba talaga sa primary complex yun.apart sa nodes sa neck niya.PPD  according sa pedia is positive,we are waiting for the gastric culture pa

[Ms.Mafi]

HI mommies and doc lelet,

Ang meds po na na rifampicin, Isonaizid at Pyrazinamide at dapat same time every day?

Yung baby ko po kasi ay 2ml in the morning before breakfast and rifampicin at isoniazid then yung pyrazinamide di po same time everyday.

Pero lately lagi ng mga 12-1pm ang inom nya. okay lang po ba yun?

she's taking for 2 weeks palang.

Her symptoms are:

Cough last Dec 31-Jan 4 (1st time nya ubuhin at magkasakit ng ganun sa loob ng isang taon) She's breastfeed baby kaya parang malakas din kasi loob ko na di sya sakitin. kaya nung inubo sya inexpect ko na mawawala din agad.

Fever din kasabay nung cough nya at sipon

Then lymphadenopathy mula nung dec 17 akala ko mawawala sya kasi lumiit then nung nag ka ubo sya nung dec 31 lumaki ulit got infected kaya need pa i FNAB para maalis yung abcess

1st time nya mawalan ng gana sa pagkain nung dec 31 nakabawi nalang ysa nung nag start na sya mag gamot 2 weeks ago.

+ PPD test im not sur eif 8mm yata yung sukat nya.

+ primary koch's infection sa sa Chest xray nya

[leletmd]

@ReanloveYael:
How many times elevated ang liver enzymes niya? In some cases kasi, kailangan lang magrest from meds for some time then balik ulit ang meds kapag bumaba na or magnormal na ang enzymes. There are also times na hindi tinatanggal ang meds. Binababaan lang ng dose. Depende sa taas ng liver enzymes kung magstop ng meds or bababaan lang ang dose.
Hindi naman sayang ang 4 months kasi sa 4 months na yun, meron na naman kahit papaano effect sa pagtreat ng TB.
I suggest you discuss your concerns with your pedia on your follow up. Ask the pedia what the long term plan is for your son and the possible scenarios. Do not be afraid to discuss your concerns with the pedia since she is the best person to answer your questions.
Were you able to find the source of your son's infection? Nagtreat din ba ang source?

@cutiecam:
TB is one of the primary considerations for prolonged fever without any specified cause. TB can affect other organs, not just the lungs. Pwede rin bones, liver, meninges. Meron bang Infectious disease specialist handling your child's case?
Did they do a gastric smear as well or culture lang? Medyo matagal ang results ng culture pero ang smear sandali lang. What is the result of the gastric AFB smear?

@Ms.Mafi:
Ideally same time everyday binibigay ang meds.
What is the result of the FNAB? Makikita rin kasi doon kung may TB or hindi.
If hindi niyo pa nagagawa, I suggest you try to look for the adult source. Dapat lahat ng adults sa bahay magpa-xray kahit walang nararamdaman.

[cutiecam]

Meron pong ginawang smear negative pero sabi ng hematologist dapat 3 times daw ginagawa yun.yes infectious disease doctor yung nagpagawa ng culture 7 days after daw po kuhain sa fmab.. ppd is positive yug xray pneumonitis daw according sa pedia,pero may nakita si hematologist na nagcoconsider syang primary..he cleared us sa blood na dn.pero pina MGH po kami without any final diagnosis...kanina we got his cbc

Wbc 8.6
Rbc 4.16
Hgb 119
Platelet 770
Esr 34(it went down before 108)
Lymphocyted 52
Segmenterd 37

Tapos po nagwowonder kami bakit nagpaafb sila 7 days pa kukuhain...nacoconfuse na po kami kasi yung isang pedia isnt leaning towards PC the other one naman might be daw.

Then just today sabi like daw ipabiopsy ng pedia and infectious disease tung lymph nodes sa neck ng anak ko if di lumiit,kasi negative ang afb and while waiting for the 8 weeks culture😢

[Ms.Mafi]

HI Doc Lelet! Wala pa po ang result ng FNAB eh 2 weeks daw kasi. Pero so far yung husband ko palang ang nagpapa xray ako this weekend kasi wala pasok. I'll ask my mom and dad na mag pa-xray na din.

So far same day nadin naman sya every day ang te-take ng meds.

Thank you!

[a_y_e_n]

my son have pc din. he was diagnosed in april via tuberculin test. after 6 months nagtuberculin test ulit siya and pinaextend ng pedia niya yung gamot until December. nagkaubo son ko kaya pumunta kase sa isang pedia (clinic based siya, not his regular pedia) sabi dapat daw di na inextend ny p[edia niya yung gamot for pc kase magaling na daw dapat yung bata after 6 months. di rin daw dapat ginamit ng pedia yung tuberculin test on the 6th month kase di naman daw agad mawawala yung trace ng pc  sa bata.

di naming sinunod yung pedia na yun and continue lang klase sa gamot ng anak ko until 1st week of January, inubos lang naming yung gamot. question ko lang is pano malalaman kung magaling na yung bata sa pc? I mean ano test magdedetermine nun? di pa kase ako nakakapunta sa totoong pedia ng anak ko eh.

[Ms.Mafi]

Hi Doc Lelet Normal naman po lahat ng labs nya.

Negative din sa AFB.
No growth sa gs/cs nya
negative din sa histopath no malignancy daw.