By Tedler D. Depaynos, MD
Diagnosis of Primary Complex is usually given to children below 5 years old. During our younger days when we basically practiced as a family physician we ascribed this on children who had non-specific body malaise, anorexia, night or evening low grade fever or sweating and failure to thrive or are losing weight without any reason. No signs of obvious infection could be found clinically and because of the high incidence of Tuberculosis during that time, the impression was routinely given.
At present we always now refer our pediatric patients to younger Pediatric Specialists who are well versed on the present common or rare diseases we now encounter and their current diagnostic procedures and treatment. From our interview of Dra. Corazon “Pinky” Lopez, a well known pediatrician in one of our former radio program, we had a rare review of Primary Complex.
Tuberculosis or T.B. is basically spread by droplets. It may be due to sneezing, coughing and even talking. It is said that more droplets are spread by coughing (5 million bacteria) than by sneezing (2.5 K bacteria). The Tuberculous Mycobacteria may survive even if the droplets dried up and may continue to float for days on air. It is recommended that the rooms the patients occupy should be airy to lessen their concentration and better that they are exposed to sunlight to kill the bacteria. Patients are likewise advised to wear masks.
Adult patients with cavitations are the ones who are infectious. Since pediatric patients seldom have these cavitations and do not cough like adults, they do not spread the disease by droplets. Extra pulmonary lesions are non-infectious.
Dra. Lopez cautioned therefore the exposure of children to relatives with the disease. Likewise it is recommended that hired helpers should routinely have a chest x-ray.
Most medical practitioners are contented by a reliable chest x-ray but definitive diagnosis in adults is thru a positive sputum smear. This test is easily done in most Municipal Health Centers. In pediatric patients, it is thru bronchial or gastric aspirations although these are rarely done. It is usually thru clinical manifestations as mentioned above with positive PPD tests and significant chest x-rays. History of exposure and absence of BCG immunization which are supposed to be routinely done are also considered.
Diagnosis of Primary Complex is still given to pediatric patients under 5 yrs. old. Because of strong resistance or immunity, they may apparently recover without medications. The disease is sometimes described erroneously as self limiting. Actually, the disease may be “latent” and resurgence may occur when the resistance later goes down. Decreased immunity or resistance may occur when other diseases may infect the patient like HIV, pneumonia, chicken pox, etc. Resurgence maybe pulmonary or extra pulmonary like meningitis, Pott’s Disease, tuberculosis of the intestine, kidney, etc.
Standard treatment is usually for 6 months. For the first 2 months, INH, Rifampicin and Pyrazinamide are given. For the next 4 months, only INH and Rifampicin are given. The variations and dosages of the standard medicines are however computed strictly so that it is preferable that they are prescribed by experienced pediatricians. Follow up is likewise strictly advised because non-compliance may contribute to the appearance of resistant strains.**
