Primary Complex Thread 3

[raineherrera]

Doc @leletmd
Na-diagnose ng PTB recently ang husband ko, my daughter is 10 mos old. We brought her to her current pedia, at ang gusto ni pedia is mag-undergo ng prophylactic treatment ang daughter ko. No xray or skin test, iinom siya ng 2 meds for 3 mos and after 3 mos dun palang ixray. If negative ang xray, stop na ang treatment, pero kung meron makita, continue untill six months. Medyo duda ako kaya we sought for 2nd opinion. Pedia#2 naman advice us na magpa xray at skin test. Magdedepende daw dun kung anong treatment ang appropriate kay baby. Pero if magnegative both tests, no need for treatment daw at observe lang si baby.

Sino po ang mas reliable doc?
Thanks!

[erza0916]

Hello po.. My 10 month old just got diagnosed with PC yesterday Jan28,16.. Dec 2015 nagstart sya magkaron ng ubo every other week na tumatagal ng 1 week.. Nag pa xray kami and nakita nga mga kulani sa baga nya..nung kailan lang kami nag pa PPD test and sadly positive sya sa PC.. Today nag start na kami ng treatment with KidzKit3..  2 in the morning before breakfast and 1 in the evening..

Doc Lelet, Tanong ko lang po

1)  yung dosage nung gamot.. Isoniazid 2ml while Rifampicin 3ml.. Baby is 8.7kgs..  May nakita akong post dito na tig 2.5ml yung dalawang gamot.. Pano po ba cncompute ang dosage ng TB meds nya? Hindi po kasi na explain..

2) diba po dapat empty stomach? Iba iba po kasi feeding ng baby ko (breastfed)..minsan dirediretso ang tulog ng walang feedings at night..minsan naman 1-2 times dumedede ng tulog kami..bubuksan lang nya boobs ko tapos dedede na sya..we plan on giving her meds consistently every 8am cause that's the time she usually wakes up.. Pano po pag nag feed sya ng 6am? Pwede parin po ba ng 8am meds? Gano po ba katagal bago maging empty ulit ang stomach nya from breastmilk?

3) 100% sure na pong may PC si baby diba? Dahil sa xray and ppd test? Nagsabi po kasi mom ko na mag seek ng 2nd opinion.. Nagdadalawang isip po kasi sya iundergo si baby sa ganung kahabang gamutan.. May iba pa po bang options? Pwede ba idelay yung pag gamot until she's atleast 1 year old? Thanks so much doc.. Im so glad na active parin po kayo until now.

[leletmd]

@cutiecam:
What were the other considerations other than PC? What was his initial platelet count? Were they able to rule out kawasaki disease?
Ideally, 3 consecutive days ang gastric or sputum smear to check if there are positive bacilli. Ang culture, matagal talaga kapag AFB. It takes 2 months for TB to grow in a culture kasi.
Ano ang treatment nila before sending your son home?

@Ms.Mafi:
Follow lang the pedia's instructions regarding the meds and try to find the source of the infection.

@a_y_e_n:
PPD or tuberculin test does not determine if may TB or not ang bata or patient. If it is positive, it only means that the patient was exposed to someone with TB. Chest xray and AFB smear ang magpapakita kung meron nang active TB or PC.
Tama rin si Pedia #2. Hindi inuulit ang PPD test after 6 months. It takes about 2 to 3 years for the PPD test to convert to negative. Repeating the PPD test may even result in an exaggerated response kasi nastimulate ang antibodies.
Clinical findings ang ginagamit para malaman kung gumaling na ba ang patient or hindi, which means, wala na bang initial symptoms? Nag gain na ba ng weight? Gumana na bang kumain? Lumiit na ba ang lymph nodes? Hindi rin kailangan ulitin ang chest xray.

@raineherrera:
Since there is actually positive na source na (your husband) and sure na exposed ang daughter mo kasi kahit now pa lang nadiagnose ang husband mo, hindi rin naman alam how long he's had TB (matagal bago lumabas ang symptoms ng TB), then, there is really no need for skin test or PPD anymore since whether negative or positive ito, meron na talagang exposure ang anak mo and dapat mag-treat for exposure.
If you want to be sure that exposure lang ang meron siya and wala pang active disease, pwede magpa-chest xray ang bata. If walang symptoms sa chest xray, then you only need to treat her for exposure or preventive treatment/prophylaxis which would consist of 1 to 2 meds only.

@erza0916:
If you are not convinced with the findings, you can go for 2nd opinion but you have to be honest with the 2nd doctor na you are going for 2nd opinion and you have to tell/show the doctors the tests done.
If it was proven that your 10 month old child really has PC, you cannot delay treatment (unless you want to wait for further symptoms to come out or bumaba pa ang timbang niya) and you have to look for the person in your household who infected your child.
Dosage is based on the weight of the child and preparation of the medication used. It is not based on age.
It takes 2 hours for the stomach to get empty so kung last feeding was 6 am, earliest time to give the meds will be at 8 am. Try to give it at the same time each day para masanay din si baby.

[cutiecam]

The cardiologist cleared us na po wala kasu sya other s/s other than prolonged fever,and kulani,negative sa palms and rashes,negative sa redness ng eyes and strawberry tongue.prior to admission ang cbc nia

Wbc 25.2
Plt is 593

No given diagnosis nung mgh ang gamot na bngay samin is cefixime kasi they are focusing on infection na hindi nila alam nasan nagmumula.

He is feeling better than last week,but disturbed pa dn ako kasi ano yug nakita sa abdominal utz na multiple nodes the doctors never brought it up when they sent us home na.

But the hematologist cleared us sa leukemia and lymphoma na nung nag blood smear h told us that it might be PC nakalagay po sa x ray niya nung naadmit siya is

Streaky infiltrates in the R Lower lUNG
Calcified tracheobronchial lymphnodes are noted
Diaphragm are costophrenic

IMPRESSION
Pneumonitis right lower lung.

[a_y_e_n]

^^yes, gumana na siya kumain, he gained weight and tumangkad na din. pero since di pa naming nababalikan yung pedia niya, di pa naming alam kung lumiit na yung lymph nodes. thank you for answering my questions! atleast may 3rd opinion na kame. will check his pedia soon.

[raineherrera]

Thanks Doc @leletmd
Ibig sabihin po ba nito mas reliable ang sinabi ni Pedia#1? Pero bakit po ang sabi niya 3 mos treatment then after nun, ixray, kapag negative ang xray, stop treatment, pero if meron nakita continue until six mos. ? Ang concern ko pa doc is yung xray. Kasi when my daughter was 4-5 mos old, she underwent skull xrAy kasi nahulog siya sa kama. Sa pagkakaalm ko po kasi masama ang too much exposure ng radiation sa mga infants.. Any thoughts Doc? Thanks

[sweetarwen07]

@leletmd thank you po doc

Talaga pong 1 week exposure lang sya kasi umalis na din po agad yung elderly.

Feb19 po ang schedule ng balik namin sa pedia. 1 month po yun after taking the meds. Tignan po namin kung patutuloy nya pa ylit ang meds.

At eto pa po. Before sya madiagnose nitong PC, halos nawala na po ubo at sipon nya. Akalain nyong after 2 weeks of taking the meds, dun pa sya sinipon at inubo ng matindi ngayon. Mabilis po ang paghinga nya nakikita ko po sa tyan nya. At may tunog ang paghinga. Ganito po ang kondisyon nya nung sinabi ni pedia na may tonsilitis sya before ma diagnose ng PC.

Worry ko tuloy baka wala naman sya PC talaga. Lalo na st skin test lang ang positive.

Thanks po @leletmd doc.

[leletmd]

@sweetarwen07:
I suggest you clarify with your pedia regarding the basis for diagnosis and duration of treatment. Baka may iba siyang reason for treating your child as PC.
Even if your child is already taking PC meds, pwede pa rin talaga magka ubo at sipon since maraming ibang causes ng ubo at sipon like viral infections, allergies, reflux, etc.

@raineherrera:
Regular bang nakakapagcheck up and xray ang husband mo? When was his last xray prior to the diagnosis of TB?
If kasi clear ang last chest xray niya and the last chest xray was done within the last 6 months, pwedeng recent lang talaga ang pagkakaroon ng TB niya so pwedeng exposure lang talaga meron ang anak mo and not yet enough time to mount an infection so magiging clear pa ang chest xray. Baka eto ang basis ni pedia number 1 as to why she wants the chest xray in 3 months pa. The best thing to do is to clarify it with pedia number 1 as to why the xray will be done in 3 months pa.
If your husband's last chest xray was last year pa and medyo matagal tagal na ang symptoms niya, pwedeng na-infect na talaga si baby at may makikita na sa chest xray.
It depends kasi on the full medical history of your husband and child.
Ideally talaga, if one member of the household was found to be positive for TB, dapat macheck din ang household contacts so kasama ka rin sa dapat ma-xray. If no findings on chest xray, then treatment will be geared towards prophylaxis lang or exposure lang.

@cutiecam:
Pneumonitis is due to a viral infection. That could explain the streaky infiltrates seen. However, meron kasi calcified nodes that may have been due to an old infection. Yun pwede basis for PC.
Yung abdominal lymph nodes, hindi lang TB ang possible cause. Pwedeng due to an abdominal infection.
Anyway, better to go for follow ups para ma-establish ang diagnosis.

[leletmd]

@Aileen19:
Skin test to TB or PC or PPD will only tell you if there is exposure to someone with TB. This is more useful if you are not sure if your child has been exposed to TB or not.
Since meron na talagang exposure (your brother), regardless of the PPD result, dapat pa rin magtreat for exposure and that is giving the child either Isoniazid or Isoniazid and Rifampicin for 3 to 9 months. This is to protect your child from progressing from just exposure to developing symptoms or getting TB.

[cutiecam]

Dra lelet yung 2 years old kong baby still waiting for the gastric culture,pero ginagamot na sya for primary,ask lang po i just saw na yung ethambutol is contraindicated sa 6 years of age below,nahihirapan ako painumin kasi tablet.Also yung gastric culture ba is sure to detect Primary complex ? Thanks

[Aya_isabelle]

Doc lelet goodmorning po... Malapit na po kasi matapos sa pc treatment si baby ko this april, pero wala parin po pinagbago yun appetite nya sa food mga dry foods lang po kinakain nya like cereal without milk, biscuit, toasted bread minsan, wafer. Pero kahit po kumakain sya ng mga yan eh konti lang din po kinakain nya. I've tried na po lahat ng payo sakin tulad ng gugutumin sya, hahayaan kumain mag isa, bigyan ng mga finger foods, mashed foods, idistract habang kumakain, panoorin ng gadgets etc Masigla naman po baby ko kasi mahilig po maglaro. Her weight now is 10kgs at 16mos.

[Aileen19]

Doc Lelet
Hindi po ako makapag-reply sa message nyo pero thanks po sa response.  Medyo naguguluhan rin po kase ako sa case ng kapatid ko, sa health center lang po kasi sya nagpa-check. yung xray nya po may findings tapos negative naman daw po pala yung sputum nya nung nagpa-test sya, wala rin naman po kasi syang sign na may TB sya pero niresetahan parin po sya ng gamot. iniisip ko po baka wala naman talagang tb yung kapatid ko, baka error lang yung xray nya.
Yung sa case naman po ng anak ko wala na po syang ubo at sipon ngayon. Feeling ko po rhinitis ang meron sya at hindi tb kasi po meron din yung husband ko, baka namana nya po.
Doc nalalaman nio po ba sa stethoscope kung may possible na PC ang bata? kung hindi ko pa po kasi nabanggit sa pedia-pulmo nya na naggagamot for tb yung kapatid ko di nya po maiisip na baka my pc yung anak ko. sabi nya po kasi my asthma daw kase my wheezing sa bandang likod pero clear naman po yung dibdib. Di ko pa po inumpisahan yung Isoniazid, gusto ko po kase talagang mapa-second opinion muna. baka po kase ma-expose sa maling gamot yung anak ko.

[leletmd]

@cutiecam:
Culture is the gold standard for diagnosing TB, but even if it is negative, it does not mean the child does not have TB. The diagnosis of TB can still be made based on clinical findings. Pwede kasing walang proper specimen na nacollect or walang sputum or mucus sa gastric specimen. Usually kasi, gastric culture is performed in kids to be able to get swallowed sputum.
As to ethambutol, it is used with caution in kids below 13 years of age. Please voice out your concerns with your pedia para ma-explain niya sa yo why ethambutol is needed. Baka kasi meron silang reason as to why they added ethambutol sa drug regimen.

@Aya_isabelle:
From what your wrote, it seems that your child's feeding problem is a preference issue rather than due to PC. Baka you can ask your pedia to refer you to a nutritionist para maguide ka on proper feeding. Children go through sensorial issues kasi as part of development. Kasama diyan ang feeding. Meron kids na preferred ang dry texture, meron naman certain colors lang ang kinakain. Better to seek consult with a nutritionist.

@Aileen19:
Hindi nadidiagnose ang PC by using a stethoscope. Hindi ito katulad ng pneumonia or asthma na may specific chest sounds to aid in diagnosis. Also, pwedeng walang symptoms ang isang tao na may TB at sa chest xray lang makikita na may findings. Matagal bago magdevelop ang symptoms ng isang tao na may TB.
Also, even if negative ang AFB smear, hindi ibig sabihin na wala siyang TB. It just means na it is possible na hindi siya nakakahawa dahil konti lang ang TB load niya. Pwede rin false negative kasi marami ang maling specimen ang sinusubmit. Instead na sputum or phlegm, laway lang pala so talagang magiging negative ang AFB smear.
Maari naman na wala pang TB ang anak mo pero the mere fact na exposed na siya sa brother mo, warranted na talaga na magtreat for exposure. This is to protect your child from developing infection.
Kahit kayong mga adults na kasama ng brother niyo, ideally dapat nagpawork up din for TB since exposed kayo sa brother mo. If negative ang work up, ideally dapat pa rin magtreat for prevention para sa protection niyo.

[cutiecam]

Dra ngayon daw po kasi quad meds na talaga daw binibigay,sabi samin.dati 3 lang daw pero as per doh daw po 4 na which is ethambutol

[erza0916]

Strict rule po ba yung dapat painumin ng Rifampicin and Isoniazid on an empty stomach? Kailangan po ba walang walang laman ang tyan? Baby ko po kasi 11 months pa lang.. Sa morning po nagigising sya na umiiyak gusto ng dede kaya pinapadede ko tapos natutulog ulit.. Usually 8am gising nya pero mga 7am iiyak sya gusto dumede..Breastfeeding naman kami kaya madali lang sya padedehin kaso kung 7am nagfeed sya 9am ko pa sya pwede painumin tapos 10am pa sya makakakain ng breakfast..parang nalilipasan na sya ng gutom nun kasi wala nang gana tapos atrasado din po lunch nya..pano po ba dapat gawin? Pwede po ba na kung 7am sya nagfeed 8am painumin na ng gamot? May difference po ba yung dami ng feed nya? Parang konti lang naman po dinedede nya pag sa morning. Thank you so much

[Aileen19]

Thank you po Doc Lelet. maghahanap na po ako ng bagong pedia kasi nahihiya na ko bumalik sa dati kasi di ko pa na-start yung gamot.
Doc, tama po ba yung sinabi ng pedia na after 3 months magpapa-skin test ulet yung anak ko?

[cutiecam]

Doc lelet sorry if OT ito po kaso nakuha ng husband ko sa x ray

Suspicious densities are noted in both upper lobes
Bronchiovascular markings are accentuated
Streaky infiltrates are seen in left lower lung

Suggest for Apico lordotic view in follow up

Possible ba na Tb?

May ubo siya ulit 4 days na and masakit din daw sa dibdib on and off cough niya for the past months na, we thought change of weather lang and allergic rhinitis,minsan maririnig mo siya na malalim talaga ubo niya.

Yung anak ko kasi 2 years old and 3 months still to consider pa din ng primary were waiting for the gastric culture pa din infectious doctor ana ong lim,were looking for adult specialist naman ngayon.

[leletmd]

@cutiecam:
Your husband's chest xray is suspicious for TB which is why an apicolordotic view is needed to confirm if he has TB or not. It would be better to have the apicolordotic view done to confirm the diagnosis. Mas kita kasi sa apicolordotic view kung may infiltrates or densities talaga.
If maconfirm na talagang may TB ang husband mo, then it is possible na the symptoms of your child are due to PC.
You are in good hands with Dr. Anna Ong - Lim. Magaling na, mabait pa. Just follow her instructions.

@Aileen19:
Yes, the PPD skin test may be repeated after 3 months.
Pwede ka naman bumalik sa dating pedia. I think it would be better nga that you bring up your apprehensions to the pedia para ma-explain sa yo ng mabuti ang rationale niya for treating your child.
Your pedia is the best person to explain the reason behind her management kasi.

@erza0916:
For better absorption of meds (para magwork ng maayos ang gamot), it is recommended that both Isoniazid and Rifampicin are given on an empty stomach or at least 2 hours after a meal. If you cannot give it in the morning, how about in the afternoon, like 2 hours after lunch? Delay mo lang ang merienda ng 1 hour after giving the meds.

[hun_nie08]

Finally graduate na kami after 6mos pinapaubos na lang yung natira nya until weeked ends... After a year pa daw siya pwede i xray

[cutiecam]

Dra possible ba na pwedeng nag negative sa ppd yung eldest ko,if may tb yung husband ko?. Wala kasi reaction sa ppd niya