Primary Complex Thread 3

[vuzhia]

^Dc yun kaseng 2.5 yo boy ko hanggang ngayun may kulani pa rin, last year May 2015 nag x-ray at PPD sya negative pareho, then after 3 mos nag PPD ulit negative pa rin pero, lahat kaming adult na kasama nya nag X-Ray din lahat negative,  hanggang ngayun may kulani pa rin

sabi ni Pedia normal lang daw yun hanggang mag 7 YO, madalang lang magka ubo & sipon si baby, magana kumain pero hindi sya katabaan kase sobrang likot then nag gain naman sya weight sa monthly visit namin sa Pedia

need ko ba mag worry sa kulani nya? I mean wala namang pinapagawang ibang test si Pedia, need ko ba mag second opinion? thank you Dc. Lelet

[hushush]

Thank you po Doc Lelet

Will clarify po kapag nakabalik kami this weekend para ipakita yun xray results na nirequest sa amin mag-ina..yun sakin po ay normal po at walang findings..yun sa panganay ko naman po ang finding ng radioligist ay "perihilar pneumonitis"..

Kapag ganun po ang findings kailangan po ba kami i-PPD test din pareho or ibang case po ba ang pneumonitis?
Prior to his xray ay nagkaubo po sya at nilagnat for 3 days at binigyan po sya sa azithromycin kasi maga daw po tonsil nya at yun ubo nya nun time na yun dry at hindi makalabas yun plema kaya parang hirap sya.then nun natake sys nun antibiotic ay lumambot yun plema nya at nawala ang lagnat then gumaling na after a week.then as of now may maliit na kulani sya sa leeg.nung monday ko pa po nakapa at hindi naman po lumaki..with regards sa appetite at weight nya wala pong changes at malakas sya kumain ng rice at gulay at di naman sya payat. 23kg po sya @5.1yo

Regarding po pala sa kulani nun bunso ko ay mayron pa po pala na dalawang maliit akong nakapa..akala ko po nawala pero lumiit lang pala..

Salamat po ulit Doc Lelet..

[leletmd]

@vuzhia:
Nag decrease ba ang size ng lymph nodes or same size pa rin as last year? Wala siyang sirang ngipin? How about cat scratches? Marami kasing cause ang pag increase ng size ng lymph nodes.
The lymph nodes increase in size so it can produce antibodies needed to fight infection or help wounds heal faster.

@hushush:
Perihilar pneumonitis findings on chest xray point to a viral pneumonia. Iba ito sa Primary complex. Better to have it interpreted by your pedia para may clinical correlation. Pwede kasi that the findings are still due to his previous cough/infection.

[vuzhia]

@vuzhia:
Nag decrease ba ang size ng lymph nodes or same size pa rin as last year? Wala siyang sirang ngipin? How about cat scratches? Marami kasing cause ang pag increase ng size ng lymph nodes.
The lymph nodes increase in size so it can produce antibodies needed to fight infection or help wounds heal faster.

sa observation ko Dc same size pa rin sya, wala syang sirang ngipin at wala rin namang malaking sugat...minsan minsan lang sya nag kaka sugat minsan sa ilong pag nakamot nya at matalas ang kuko yung ganun po, sabi kase ng sister kong RN abroad baka need ng blood test or someting, wala rin namang kaming na observe na kakaiba sa health nya kase nga nitong last check-up nya "healthy child" pa yung remarks ni Pedia kase next year February na ulit kami babalik for Vaccine after 3rd birthday nya, worry lang ako kung may need na additional test or something...maraming salamat po

[hushush]

Good evening po Doc Lelet...tagal ko po hinintay ang reply nyo..

ipi-pm ko na po sana kayo last week kaya lang di pa pala ako pede mag-pm..
nadala ko na po ulit sa pedia yun anak ko at sabi nya ay hindi daw pneumonitis kundi may PC din daw ang anak ko tulad sa bunso ko.then kinlarify ko kung may PC ba yun bunso or for prevention lang yun med.sabi nya meron daw.then ask ko sya bakit isoniazid lang yun binigay nya.tho hindi ko sinabi na sa pagkakalam ko kung ay PC ay dapat 3meds dahil nagbabasa ako dito sa thread.ayoko kasi sabihin nya na nagmamarunong ako.syempre siya yun doktor eh...then sabi nya kaya nga daw after 3mos ay i-ppd test ulit sya..nalalabuan po ako sa mga explanation nya...then my son underwent ppd test at negative naman.angkaso hindi naman matignan nun pedia yun result kasi lagi sya wala sa clinic.pumunta kami after 48hrs then wala sya.balik na lang daw.then balik kami kahapon wala din sya.then ngayon sana tapos wala pa rin at bumagyo pa.e di invalid na yun result kasi di nya personally nakita.pero pinakita ko sa nurse na walang bump at vinideo at pinicturan ko pa.ayoko po kasi uulit pa kami ng test kasi di nman namin fault na wala sya lagi sa clinic.atsaka wala na ako cash pampa-ppd ulit..with regards sa sinabi nya na hindi un pneumonitis then kayo po kasi ang 2nd opinion ko due to limited budget po naubos po ang cash ko kapapaxray at consulation.meds..test..kaya di ko po ako makapunta sa iba pedia at makahingi ng 2nd opinion..kaya maraming salamat po sa reply nyo po..

then dahil po sa sinabi nyo na ibang case sya at sa gut feeling ko din po.ano po ba ang dapat kong gawin.punta po ba ako sa iba pedia na ititreat yun case as p neumonitis?dapat ko po ba sabihin yung case ng bunso ko?di po kaya magbago yun treatment sa pneumonitis kung sasahihin ko na yun bunso ay binigyan ng anti-tb med?
kasi po [textspeak!] nun pedia ay kung negative sa ppd test ay isoniazid din ang ibbigay nya sa anak ko..ayoko naman po magtake sya ng isoniazid kung wala nman talaga syang PC.salamat po ulit Doc Lelet..

[leletmd]

@hushush:
If the explanations are not clear, you can bring your son to a pedia pulmo or a pediatric infectious disease specialist so he can be examined further. When you go for consult, it is better to disclose everything to the doctor which means you should tell the doctor previous history, meds, family history, etc. It will help guide the doctor in making an informed decision.

@vuzhia:
No allergies like allergic rhinitis or asthma? If no other symptoms, you can opt to observe for now. His immune system is still developing so it may take time for the lymph nodes to regress. The immune system only gets fully developed by 7 years of age which is why kids under 7 are more susceptible to getting sick compared to older kids.

[vuzhia]

^thanks Dc Lelet, wala naman pong allergic rhinitis or asthma, siguro nga po observa na lang namin, ganun din po sabi ni Pedia usually nga daw po hanggang 7 yo merong kulani

medyo napaparaning lang ako minsan sa nababasa ko na minsan daw may kulani lang and no symptoms may iba na palang infection or yung iba pa nga leukemia pa daw sa bata na stage 3 na agad

basta po monitor na lang namin health status ni baby, thank you so much!

[ysuran]

Update ko lang yun case ng anak ko, After 6 months na gamutan, biglang lobo yung anak namin, malakas na sya kumain na ngayon, wala ng halak, wala na din yung parang maliit na bukol sa likod ng ulo niya. Salamat na din dun sa doctor sa PCMC, though mahal ang consultation fee niya at mga prescribed na medicine brands, masasabi ko na worth it naman yung mga nagastos namin. Ngayon ay may peace of mind na kami, di na undeweight yun anak ko, yun nga lang sa lakas niya kumain ngayon, baka lumagpas siya sa Body Mass Index niya, hehe.

[hushush]

Hello mga sis! Doc Lelet. Thanks for the advice..just want to give update about my son who was diagnosed with pneumonitis at kine-claim na may PC din like my daughter... I wasnt able to bring him back sa pedia na yun dahil naging mabagyo ang panahon. After a week of feeding him with moringa leaves na hinahalo ko sa tinola or any masabaw na ulam, gumaling sya at til now ay hindi naman na sya nagkakaubo na may kasamang fever..then his appetite and weight are both fine.. Then i boosted the kids' vitamins. Aside from ceelin+zinc. Nag-add ako ng appebon at nutri10+.

My youngest naman na katatapos lang sa kanyang PC med ay inubo ulit.but without kulani sa neck or fever.so OTC meds lang like mucolytic.ang suspetsa ko ay dahil exposure nya sa 2nd hand smoking na rampant sa kalsada kung san sya madalas maglaro.then natutuyuan ng pawis..kaya binabantayan ko na sya at kapag may nagyoyosi ay inilalayo ko na.napansin ko din na inuubo mga bata kapag naeexpose sa chalk dust.mahilig pa naman sila magsulat sa chalkboard or sa kalsada kaya itinago ko na lang ang chalks at board at sa paper na lang sila pinagsusulat...

Lagi ko din kinakapa ang head at neck nila kung may kulani.lately ay may nakapa ako sa kanila na kulani sa bottom part ng head na malapit sa ears..upon reading sa net na it may be caused by ear infection ay dinala ko sa ENT ang mga bata. Then the ENT said na wala naman sya nakitang sugat or infections. Then ask nya ako kung may sipon at ubo mga bata.any signs like nagkakamot ng ilong.humahatsing.or nangungulangot.kapag ganun daw ay may impending cold or cough.so binigyan ng antihistamine then observe daw for 2weeks.then ayun nga after few days nagkasipon pareho.then ayun unti unti nagsubside ang kulani.

[leletmd]

^ Exposure to 2nd hand and 3rd hand smoke can weaken the immune system and cause frequent episodes of cough and colds. Sa 3rd hand smoke, kahit nagsmoke sa labas, kapag pumasok ang tao na nagsmoke inside, anything he or she comes into contact with can carry the smoke pollutants for weeks to months causing indirect exposure to others. Kaya, dapat talaga no smoking at all times. 
As I mentioned before, not all lymph node enlargement is due to PC. It depends on the area involved. So better pa rin to have the kids checked out.

[ysuran]

^salamat sa info doc. yung anak ko gumaling na sa PC, dating payat, ngayon ang taba na, nawala na rin yun bukol sa likod ng ulo nya. problema ko talaga biyenan ko, ayaw tumigil sa pagyoyosi, nun gumaling anak ko bumalik nanaman sa pagyoyosi sa loob ng bahay. Eto, di nawawala ang isang buwan na hindi sya inuubo at sinisipon. Kawawa din naman yung baby ko na madalas umiinom ng gamot sa ubo at sipon, kawawa ang liver at kidney. At isa pa yung pinapanggastos pa sa gamot imbes sa maipon o mabili ng ibang bagay. Ang hirap talaga pangaralan ang ibang matanda. 

[Kuikai99]

Good day Lelet,

I sent the message below as PM pero mahirap pala makita messages dito sa Femalenetwork so I decided na ipost na lang sa thread:

Hello Dra! @Leletmd!  Hope you are well. Ive seen your post regarding PC and I was wondering if you could also help us. My baby was given a repeat BCG kasi wala daw pong scar dun sa una. We also did not notice any redness po dun sa unang Bcg vaccine. Pedia said that if there is redness swelling or pus within 1-3 weeks positive daw sya sa PC. Nagkaron po ng redness a day after, at ngaun po gusto ng pedia na magstart ng tratment for PC.
Ang concern po namin na baka nagkaredness dahil sa unang Bcg? Nawala po ang pamumula at the 3rd day at sa ngaun po parang flat sya, may maliit lang na parang tudlok sa site of injection.
As much as possible po,we dont want to give meds to our baby if its not necessary. Sabi po ng pedia namin when i asked her kung may iba pang test para malaman kung talagang may Pc , yung BcG test tells that baby is already positive for PC.

Additional info:
The reason po kung bakit nagsuspect ang pedia na may PC was bec sabi nya walang weight gain si baby since no. 
Weight in Nov 6.3 Kg  Height 63cm
Weightin Dec 6.6 kg  Height: 65cm
Weight in Jan 6.9 kg   Height 67cm
Weight 3 days ago 7.1 kg   Height 67cm
SHe's currently teething and very active that's why we're thinking na baka dahil dun kaya hindi masyado tumataba. Her formula is Nutramigen due to possible cow's mil allergy (she has mld eczema and constipation)
No swollen nodes, a little cough and sipon due to colds a few weeks ago.
Other than that, wala na po...

We live in Makati po and our pedia is at MmC. If you have a clinic po nearby we can go to your clinic for consultation. Thank you po.

[leletmd]

@ysuran:
As long as there is someone smoking in your household kahit sa labas pa mag-smoke, there will always be someone there with cough or colds. Ang mahirap, ang kids talaga ang pinaka susceptible.

@Kuikai99:
There is such as thing as accelerated BCG response that points to the baby having PC or at least getting exposed to PC while still in the womb but we say that there is BCG accelerated response if the BCG site forms redness, pus and scarring within 1 week from injection. Normally kasi, the redness, pus formation and scarring would occur within 2 to 4 weeks (sometimes 2 months after pa) from the time of BCG vaccination.
You said it turned red the day after. Was there pus formation? Usually for those with accelerated BCG response, talagang malaki ang area affected and maraming pus.
How old is  your baby? There was no ppd done prior to BCG vaccination? There is no one in your household who has TB or been treated for TB from the time you were pregnant till now?
Your baby is getting longer although minimal talaga ang weight gain niya. The fact that he or she is getting longer means that kahit papaano, she is still thriving. Kasi kung pati yung height affected na, that means, there really is malnutrition for a long time already.

[Kuikai99]

Thank you so much Dra Lelet! We just had our chest xrays done at negative po kami lahat sa bahay. About sa redness po mga 1cm po ang redness, unti unting nawala at nung 3rd day na wala na po ang redness. May maliit na tuldok sa site of injection at may konting matigas kapag hinipo. There are times na parang flat at wala po ako makapa. Today is the 11th day po ng vaccine wala pong pus at wala naman pong pamamaga.
Nahahawa po ba ang bata sa TB kung may visitor kami na nagstay sa bahay ng 3 days? Hindi rin po nahahawakan ng iba si baby dahil extreme ang stranger anxiety nya.  Walang pong PPD or other tests done aside from Bcg kasi sabi ng pedia yun na daw po ang test.
Magffalse positive po ba sa PPD in case kung kakabigay lang ng BCG? Meron po bang ibang test other than xray kasi 2nd xray na po ito ni baby? We are worried about the effects of radiation on her.

Is it safe din po ba to proceed with the medications kung BCG test lang po ang basehan?

Salamat po ng marami. 

[leletmd]

^ Infection develops when there is prolonged exposure to someone with TB so there is very little chance that the child will acquire infection from a 3 day exposure.
For patients more than 3 months of age who didn't develop a BCG scar after vaccination, one of the things usually done is to do a PPD to determine if there is already exposure. If negative, BCG can be given. If positive, better to evaluate for infection and treat rather than repeating the BCG vaccination.
There is a different size reading for BCG vaccinated patients compared to those who didn't get vaccinated.
When was the first chest xray done?
Other tests that may be done: PCR TB blood testing, sputum tests, ct scan but these are more invasive than doing a chest xray
I suggest you talk to your pedia again kasi baka may other reasons siya why she is suspecting PC. Do not be afraid to ask questions and just be honest regarding your reservations.

[hazz]

good am. new comer to this thread po ako, my baby boy diagnosed po na may primary last jan2017. nagsstart na po kami mag-take ng medicine HRZ Kid kit po bigay ng pedia. 12.4 kgs sya. itake po da ng isoniazid-3ml rifampicin-4ml pyrazinamide-4ml (500mg/5ml)

dra lelet ask ko lang po, humingi po kase kami sa center ng medicine.
sa 13kgs na weight na baby ko they give
isoniazid- 3.2ml rifampicin-4.8ml and pyrazinamide- 7.8ml (250mg/5ml size ng med)

thank you po.

[forumera]

^^doc kapag, tapos na sa gamutan, as in 6 months, paano makasigurado na wala na?na clear na?na negative na?

[sweetarwen07]

hi doc leletmd,

3 days pong nilagnat ang baby ko.  pero nawala na po kahapon ang lagnat nya,  wala po sya prob sa throat, chest and bowel movement nya.  so sabi ng pedia namin, it could be viral.  pero eto po result ng urinalysis. pasuyo naman po.  may ketones ++ sya at mataas medyo ang WBC   si yaya po kasi ang kasama nya the whole day. kaya di ko masyado namomonitor ang kinakain nya aside from milk po.

thank you.

color:  yellow
transparency:  hazy
specific gravity:  1.025
ph:  6.0
odor:  aromatic
occult blood:  negative
protein:  trace
glucose:  negative
ketone:  (++)
wbc:  6-8 / hpf
epithelial cells:  occasional
mucus threads:  moderate
bacteria:  few
hyaline:  none / lpf
fine granular:  none / lpf
course granular:  none / lpf
waxy:  none / lpf
amorphous urates:  few
remarks:  ketone checked twice

[leletmd]

@hazz:
Weight and preparation changed which is why there is a change in dosage. Please inform your pedia regarding this.

@forumera:
The patient should be brought to the pedia before the 6 months is up for re-assessment. Usually, we rely on clinical findings: there should be improvement of initial symptoms such as after 6 months, lumiit na yung mga lymph nodes, mas magana na kumain, hindi na sakitin, etc. Chest xray is only done if hindi malaki ang improvement or if there is not much change from initial symptoms.

@sweetarwen07:
This is the PC thread so medyo out of topic ang question mo, but ketones in the urine may mean either dehydration or poor nutrition. Fever in itself can cause dehydration. Please bring your child 
back to the pedia so she can be re-assessed together with the urinalysis results. Labs should always be interpreted together with clinical findings.

[sweetarwen07]

^ salamat po doc leletmd!  mali nga po ang pagpost ko at naligaw ako.  thank you po ulit!