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FAQ's on Tuberculosis
Introduction to Primary
Complex ?
Primary Complex ( or Childhood
Tuberculosis infection ) is a fairly common disease in India and is
commoner than one would be led to believe.
In any child who is Failing to Thrive ( i.e. not doing well , having
repeated chest infections or fevers and a host of other related or
unrelated symptoms , the Pediatrician may like to think about this
infection and may order some laboratory tests / investigations.
What
is the medical background of Primary Complex ?
The germ that causes Tuberculosis in adults ( Mycobacterium
Tuberculosis ) may infect the child and the infection is usually
first contacted in the Lungs.
The germ is usually spread through the coughing of an infected person.
The germ
( Mycobacterium Tuberculosis) usually resides in the lungs of a
patient .When he coughs , the air particles expelled are rich in these
germs. Anybody in the vicinity of a patient who is coughing is liable
to contact the infection. However , if the immunity if good , he may
not be affected – just the way one may not contact Typhoid / Jaundice
even after coming in contact with a patient .
If the child has received BCG vaccine and if his immunity is good ,
the infection is arrested in the lungs and there may be no major
impact of it on the body. However, in case the immunity is weak for
some reason and the infection spreads , it may involve any part of the
body.
What are
symptoms of Primary Complex ?
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Repeated coughs with / without fever
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Repeated coughs with / without fever –
and not getting well on routine antibiotics prescribed by your
Pediatrician.
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Repeated fevers – unexplained through usual
medical examination and routine investigations/tests.
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Weight loss / nil weight gain / poor weight
gain .
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Nodes in the neck
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In many children , there may be no specific
symptoms. These are known as cases of “ Silent Childhood
Tuberculosis “ . This is a very common symptom of Primary
Complex. Your Pediatrician will examine the child thoroughly ,
order some laboratory tests and keep in his mind what is known
was a “ high index of suspicion” while dealing with such a
situation.
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Symptoms of serious and widespread infection
may include : convulsions ( fits / fainting) , paralysis ,
unconsciousness and a whole spectrum of disorders.
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What is the prevention
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Timely BCG vaccination
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Identify and report to your Pediatrician any
suspected contact : THIS IS A VERY IMPORTANT PREVENTIVE STEP.
The contact would usually be having symptoms like : prolonged
cough with / without fever , weight loss , “ weakness “ ,
coughing out of sputum( and especially if the sputum if blood
tinged )
Once you understand that the infection spreads from an infected
adult to another adult or child – you have now understood that
the best prevention is avoiding contact with a person having
suspected or diagnosed symptoms of Tuberculosis.
It usually helps to have a medical examination of any new house
staff / servant / maid servant/ employee that is likely to come
in contact with children at home. If your Doctor feels some
laboratory tests are needed – please do get them done so as to
remove the doubt. In case infection is detected – it is
important for you to ensure treatment of the employee. The same
applies to any member of the family suffering from suggestive
symptoms.
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Good , nutritious diet for your child and
general hygiene. A nutritious diet helps keep the immunity high.
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Some
myths surrounding Tuberculosis
:
There are several myths and wrong notions related
to Tuberculosis and it is common for Pediatrician to see parents
hitting the panic button whenever Primary Complex is doubted in a
child.
Medicine has taken long strides since the time when a diagnosis of
Tuberculosis carried with it horrific notions of having to relegate
the patient to a Sanatorium , there being no effective treatment and
the future usually hopeless.
Treatment is now as easy as it is for , say Jaundice or Typhoid though
it lasts much longer.
With this background , you may now address your own bag of myths and
find answers and reassurance in the following :
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“ My neighbour’s grandma said it is God’s Curse”
: It is just an infection and all it needs is treatment as any
other infection does.
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“ I need to separate my child with Primary
Complex from my other child / children “ :
We have already understood that this infection usually spreads from
adults to adults or from adults to children and not the converse.
Child to child transfer of infection being very uncommon , you do
not need to separate the child with Primary Complex.
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“ I shall now need separate utensils , glasses
and crockery ” : No, not at all. Germs do not spread through saliva
contact – thus no separate crockery etc.
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“That neighbour was nasty enough to say that
there is no cure” : We have already talked about it at the opening
of this section. Rest assured and leave it your Pediatrician to
address these ( and other ) doubts.
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“ I have heard that the drugs have a lot of side
effects” : True , for that matter any drug has the potential for
side effects. Whenever a Doctor offers you a treatment for any
problem – there is always the issue of side effects. Before
prescribing , he usually applies his mind to the possible side
effects and weighs the risks of not treating against treating and
taking the potential risk of side effects. This is a general rule in
the whole of Medicine.
Fortunately, the side effects listed in the text books and in the
drug literature do not always occur ! Were it so , the poor Doctor
may not be able to prescribe even for a Common Cold.
The side effects are always borne in the Pediatrician’s mind and he
is aware of the risk – potential and would , during each check up
visit look for evidences of side effects.
The commonest side effect is related to the Liver and in some cases
there may be jaundice. The jaundice , if it occurs , subsides easily
with medication and a temporary stoppage of medicines being given
for Primary Complex.
It may help you to dump the burden of side effects at the
Pediatrician’s doorstep and have a good night’s sleep !
Some
comments on medication :
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The medication will last long – maybe 6-9 months
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The most important thing is regularity and
periodic check up at your Pediatrician’s
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Any break in medication is likely to disrupt the
whole course so much as to re-start the dose all over again
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The medicine needs to be taken empty stomach ,
every morning
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The urine and stools of the child will usually
appear red or orange – you need not get scared at this sight. It is
simply the colour of the medicine getting excreted in the
stools/urine.
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You need to see your Pediatrician immediately if
you notice any of the following :
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Vomiting
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Jaundice ( yellow eyes )
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Pain in abdomen
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Sudden drop in appetite
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Fits / unconsciousness / convulsions /
fainting
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Feeling of tingling / numbness in hands /
feet
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Anything else that you feel is way out of
the usual for the child.
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