Primary Complex Thread 3

[leletmd]

@cutiecam:
Yes, still possible since there are cases of false negative PPD results.
Causes of false negative PPD results are:
a. weakened immune system - this can cause negative PPD result even with exposure since if the immune system is weak, it won't be able to mount a response

b. recent TB exposure (within 8 to 10 weeks pa lang) - which is why pwedeng ipaulit ang negative PPD result after 3 months kasi pwedeng negative ito kasi kaka-expose pa lang

c. very old TB infection (several years ago)

d. very young age (less than 6 months of age) - wala pa itong masyadong immune response kasi

e. recent live vaccination like measles - this can weaken the immune response

f. overwhelming TB infection - TB in itself can weaken the immune system

g. viral illness like measles and chickenpox can cause false negative PPD

h. Incorrect PPD administration - mali ang pag-inject so pwedeng maging negative

i. Incorrect PPD interpretation  - mali ang paginterpret so possible na positive pala pero it was interpreted as negative

There are also cases of false positive PPD:
a. infection with non-tuberculous mycobacteria - hindi TB ang cause pero a different kind of mycobacterium

b. Previous BCG vaccination - kaya iba ang positive na size sa BCG vaccinated patients compared to those not vaccinated with BCG

c. Incorrect method

d. Incorrect interpretation

e. Incorrect antigen used

If your son's PPD was done during the time his immune system was at a weak point, then pwede talagang negative ang PPD.
Kung proven na may TB ang husband mo, definitely there is still a need to treat for exposure, regardless of your son's PPD result. Bakit? Meron ka ng identified source so definitely may exposure na naganap.
Nakapag-apicolordotic view na ba ang husband mo? Sputum smear?

[sofiameredith]

If yung isang baby sa bahay is under medication due to PC, nakakahawa pa rin ba 'to? Yung pamangkin ko kasi is may PC daw 11 mos old kaya alam ko nag-u-undergo ng medication, ang worry ko kasi yung baby kong 1 year old is baka mahawahan...I mean, hindi naman sa nagseselan o ano, pero ano yung preventive measures para di magkaron yung anak ko, kasi iisang bahay lang kami pero different rooms naman, kaso siyempre di ba naglalaro sila together hindi  ko naman pwede ipaglayo baka ma offend ko yung parents nung pamangkin ko.

[leletmd]

@sofiameredith:
Hindi nakakahawa ang bata na may PC kasi konti lang ang maycobacterial load nila at madalas ito ay nakatago sa kulani. Ang transmission ng TB ay from adult to child, hindi child to adult or child to child.
Sino ang nakahawa sa pamangkin mo na may PC? Dapat lahat ng household members ay magpawork up for TB kasi definitely meron isang adult sa inyo ang may TB at dito possible mahawa ang anak mo.

[sofiameredith]

^thanks po, di ako sure kung pano na-acquire nung baby yung sakit. yung tatay niya kasi alam ko may hika pero malakas pa din mag yosi. if may adult na nagkahistory ng TB pero cured naman na, may chances pa ba na makahawa pa din siya?

[leletmd]

^ If nagtreat na ang adult, hindi na nakakahawa unless na-reactivate ang TB.
Pero yun na nga, sino ang nakahawa sa pamangkin mo? That same adult who infected your nephew or niece can infect your child kasi since you live in the same household.

[sofiameredith]

^That I would have to know pa. Pano po malalaman if na-reactivate ang TB dun sa dating meron pero gumaling na?

[leletmd]

^ Pwedeng may symptoms such as madaling magkasakit, matagal gumaling ang ubo, pwedeng wala. Best to do a repeat chest xray and sputum AFB smear and culture. Sa sputum AFB smear makikita if there is live TB bacilli.

[sofiameredith]

^Noted. Thanks po.

[raineherrera]

hi Doc leletmd,

My husband was diagnosed of PTB. We found out na last July2015 pa pala siya may TB nung halungkatin namin yung medical results niya kasi Dec2015 nagpositive din yung chest xray niya. Negative ang sputum test niya.

Nung nalaman ko ang condition ng husband ko, we visited the Pedia for confirmatory tests. My daughter underwent XRAY (negative) and PPD (result was 8mm) but the Pedia#2 considered it as negative. So wala kami tinetake na gamot.. Ngayon repeat chest xray after 3 months kami.. Tama po ba na 8mm considered as negative for PPD? Worried din ako for too much xray and radiation exposure, doc. Okay lang ba na-irepeat ang chest xray after 3 months? BTW, my daughter already had her skull xray kasi when she was 5 months old (nahulog sa kama), kaya worried ako for too much radiation. Please advice.
Thanks!

P.S Nagbago ang appetite ng 12 month old daughter ko, kumonti ang solid intake niya, although, sabi naman ng pedia niya na normal lang yun sa age niya. At naggain din siya ng weight from 10 or 10.2 kilos, ngayon 10.5 kilos na siya..

Any thoughts, doc?

[leletmd]

@raineherrera:
If your husband's sputum test is negative, it is possible his mycobacterial load is low which means hindi siya nakakahawa masyado. Another possibility is wrong specimen sent (saliva instead of sputum). Baka yung negative sputum test ang basis ng pedia as to why hindi kayo pinagtreat for prophylaxis. It would be best to ask your pedia her reasons for not treating.
PPD of 8 mm is still considered negative. Maliit lang ang radiation from xrays. Still, we only order xrays when it is really needed so best to follow your pedia's recommendations.
How is her milk intake? Pareho bang nagdecrease ang solid and milk intake? Pwede kasing mahina sa solids kasi malakas pala sa milk. Try to list down your child's food and milk intake and show it to your pedia para ma-assess kung may kulang pa. Agree with your pedia, though, your child's weight is still within the norm based on her age. Once a child turns one year old kasi, 2 kgs/year na lang ang expected weight gain.

[sassysazha]

May question lang po ako kung pano malalaman kung ok na after 6months ng gamutan? Both of my daughters were detected na may primary complex and this month ang ika 6th month nila. Upon repeat chest x-ray ang nakalagay no changes from previous ones. Nung pinax-ray ko sila one week prior nagkaubo at sipon sila. Then their pedia requested ESR blood test. One result is 18 and the other one is 7. Then sabi ng pedia ok na daw yun stop na ang medication.

I've read before na hindi nagheheal agad ang scar so kapag ganun po ba kahit magpaxray meron pa din makikita? Gano po katagal mawala ang scar? Never sila nagsputum test and naggain naman po sila both ng weight.

BTW, negative kami lahat dito sa bahay sa xray pero di din po kami nagsputum tests. Yung dating nakatira dito sa house ang meron pala TB and hindi po samen sinabi late na namin nalaman.

[leletmd]

^ We rely more on clinical improvement rather than the chest xray when making a decision to stop treatment at 6 months. Pwede kasing magkaroon ng radiologic lag which hindi nawawala ang findings sa xray pero clinically, maayos na ang patient. Even in pneumonia, pwede magkaroon ng radiologic lag kaya ang basis pa rin is whether or not, may improvement ba sa initial symptoms ng patient?

[glayse]

Hi Doc Leletmd,
I am an OFW and nung 14 weeks pregnant ako I had PPD test, yung nag-interpret, she said 14mm, kaso I have doubts doon sa interpretation niya, kasi yung sinukat niya ay yung buong redness, kinakamot ko kasi yun, hindi nila ako sinabihan na hndi pala pwede kamutin so hours after injected nakakamot ko na ito. Then, they told me to go to CDC dahil positive daw, but then flight ko na pabalik sa pinas, so hindi na ako nakaproceed dahil flight ko na. sobrang stressed ako that time kasi I was diagnosed to have open cervix and need to undergo Cerclage. I was also scared to mention doon sa new OB in Manila about my ppd test result. Then after a few months, I went back to my province dahil doon ako manganganak, and then sinabi ko about dun sa positive ppd results, yung OB sabi nya, ganun daw talaga magiging resulta dahil sa BCG nung bata pa ako and it is a false positive. Doc, ask ko po sana what is the chance na maging positive din ang ppd ng baby ko. She is now 1yr and 10 months. Alos, my husband and I we have clear chest xrays.  Thank you doc.

[leletmd]

@glayse:
Your daughter's ppd may turn out positive if she is exposed to someone with TB. Since clear ang xrays niyo ng husband mo, possible na wala siyang exposure unless may iba pa kayong adult na kasama sa bahay.
A positive PPD only means that a patient has been exposed to someone with TB. It doesn't indicate active disease. Sa chest xray and sputum test along with signs and symptoms mo lang malalaman if there is active disease.
What was the reason why they did a PPD on you before? May symptoms ka ba or routine ppd testing lang ito sa inyo?
Is your daughter doing well? Doesn't get sick often? Gains weight as expected for age? Did you bring up your medical history with your daughter's pedia?

[glayse]

Hi doc,

thank you very much for your reply, yes it is a routine here to all pregnant women to undergo ppd testing. Slow ang weight growth ni baby pero nasa normal range naman daw. She is 26 pounds at 1 year and 10 months, she was 5.5 when I gave birth to her at hindi rin po siya sakitin. Hindi pa nakunan ng ppd si baby, maybe when she turns 2 years old dalhin ko ulit sa public health, more on public health workers lang dito, wala masyado pedia, since we are in a small island country. What happen doc if her ppd turns positive? i-xray ba nila sya? and kami din po ba ulit ipa-xray or repeat ppd? I have heard din po na there is a difference sa accuracy when she reach 2 years old? thank you po ulit.

[leletmd]

^ Was she given the BCG vaccine at birth? If so, there's a different positive size for BCG vaccinated patients compared to non - BCG vaccinated patients. As for the xray, it will depend on the TB protocol of the island (I'm assuming this is not in the Philippines). Iba iba kasi ang protocol for TB ng different countries. If ever she has positive PPD and chest xray, I suggest that you and your husband undergo work up for TB so you can find the source of her infection.

[graciemie]

Hi Doc,

What are the possible side effects of PC sa kids? My son was diagnosed with PC last april 17, and ginagamot na siya ngaun ng HRZ pedia kit, pero napansin ko kasi parang nangingitim siya masyado? hindi naman kami nags swim at nag papa araw. And also slow ang weight gain niya, pero he's active naman. And also, 2-3 times siya magpoops sa isang araw. Is it normal? worried kasi ako parang natutuyo ang anak ko sa gamot. TIA sa sagot po.

[leletmd]

@graciemie:
How old is your son? Wala siyang ibang known illness or disease like G6PD or kidney disease?
Nakapag-follow up na ba siya sa pedia and nabring up mo na ba ang concern mo regarding change in his skin color or the increase in number of bowel movement?
Maraming side effects ang anti- PC meds. Common side effects would be abdominal pain, softening of stools, change in color of secretions (orange urine, sweat and tears), joint pains (PZA can increase uric acid), jaundice or paninilaw, seizures (INH may deplete Vit B6 and cause seizures which is why there is added Vit B6 in INH preparations).

Here are the other side effects:

http://www.tbalert.org/about-tb/global-tb-challenges/side-effects/

It would be better to bring your son to the pedia for follow up so as to address your concerns. When a child is on PC meds, ideally, dapat monthly ang check up to assess response and to check for adverse effects of the medications. Sometimes, dose adjustment is all that is needed to stop side effects from occurring kaya best to follow up.

[hushush]

Good afternoon po Doc Lelet.
Ilang araw po ako nagbasa ng PC thread 2 at ngayon lang po ako nagkaron ng chance na magpost para po magtanong sa inyo..

Yun anak ko po kasi na 3.10yo ay dinala ko pa sa pedia nya last week at nakapa na may kulani sya sa leeg at malaki ang weight loss..prior to that dahil naging maulan po ang panahon ay nagkaron po sya ng lagnat for 3days.then nawala yun lagnat nya.then from July 9-11 3days syang nagkaubo.pero nun 4th day ay gumaling na yun ubo nya sa Solmux. Though may occasional cough pa sya on 4th day. then nagpaxray po sya at ang report ng radiologist ay ganito:

FINDINGS:
1. Both lungs are clear
2. Heart is not enlarged
3. Note of prominent nodular densities in the hilar and retrocardiac region
4. Visualized osseus structure are intact

Impression:
Consider:
1. Healed previous pulmonary infection
2. Primary infection suggest clinical correlation

Nag-underwent na po sya ng PPD test at ang result po ay negative. Then pinagtake po sya ng Isozianid for 3mos at 3rd day po nya ngayon though hindi po sinabi sa akin kung PC ba ang sakit ng anak ko.pero nirequest nya kaming mga kasama nya sa bahay magpa-xray.ginawa po namin yun at sa friday ko pa po makukuha ng resulta..lagi ko po kinakapa ang kulani nya eversince.pero today po ay hindi ko na ito makapa.posible po ba ito na nadissolve na yung kulani?ibig sabihin po ba ay wala na syang infection?bukod po duon ay naggain sya ng weight na 700g bago pa sya magmedicate dahil pinapainom ko po sya ng appetite stimulant (pediafortan) once a day na hindi nya nireseta.though epektib naman po kasi bumalik ang gana nya sa food.

Ano po pala ang ibig sabihin ng "Healed previous pulmonary infection"? Hindi po kasi ito ipinaliwanag sa akin. Tinanong lang ako kung nagkaron na sya dati ng PC.hindi naman po sya nagkaron.pero ang natatandan ko ay nitong january ay nagkaron sya ng ubo for almost 2wks at nilagnat sya on 3rd wk.kaya dinala ko po sa pedia at pinagtake sya ng Ceclor.then after nyang gumaling sa ceclor after 5days  hininto ko po yun antibiotic which is dapat 7days (my fault) then nagkalagnat na naman sya kaya nirestart ko ulit ang ceclor for 7days at tuluyan na syang gumaling.pero nung time po na iyon ay hindi po ako aware na dapat pala tapusin ang antibiotic as preacribed at about sa kulani wala din po ako alam dahil yun old pedia po nya hindi naman po sya kinakapa ang leeg for kulani. Ngayon lang po ako naging aware sa importance ng kulani nung nagpalit kami ng pedia...

Salamat po at sana ay masagot po ninyo ang aking nga katanungan.

[leletmd]

@hushush:
Healed previous pulmonary infection - infection sa lungs na gumaling na like bacterial cough or Pneumonia pero hindi pa lumiliit ang kulani na lumaban ng infection na ito kaya nakikita pa ito sa chest xray. Hindi kasi mabilis lumiit ang kulani.

Were you able to ask why only Isoniazid was prescribed? As I mentioned earlier, hindi kaagad lillit ang mga kulani within 3 days of taking it unless this is really due to an old lung infection that is not necessarily PC and the lymph nodes were really regressing already.
I suggest you clarify the diagnosis with your pedia on your next visit so that she can fully explain to you the reason for the treatment.