khorshid
Forum Guru
Topics: 32
Posts: 591
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A 2 year old child was recently adopted from India. She appears to be healthy, and there are no abnormal symptoms. Her weight and height are at 25th percentile for her age. Her examination is normal.On screening, you find a positive PPD with 20-mm induration.She has a history of recieving a BCG vaccination at birth. Your management plan is:
A)obtain CXR and only treat if that is abnl
B)Obtain CXR and initiate prophylactic tx with INH
C)repeat the test in 3-6 mo
D)attribute the pos PPD to BCG and do serial yearly x-rays.
E)obtain sputum cultures
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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We have to treat this child with INH prophylaxis since PPD is positive--
So, I go with B!
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| fudoc_20
Forum Newbie
Topics: 3
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ahh that is anice question and any way iam not sure of the answer but lets think together and if iam wrong in somethig .tell me .
that pt visited an endemic area and ppd is strongly positive .
so 1st we have to exlude the infection by chest xray and gastric aspirtae .so .sputum cultures sound good to confirm TB !.but the pt i s young so we cannt do it !.and chest xray ,sometimes may not be conclousive so we do after it ct !but here there is no choice of ct !.
and regarding the proppylaxis i dont agree much with it becuse it would be good before the child visiting .india(propylactic antibiotics is indicated to persons who gonna stay in endmic are for awehile )not after the pt visited inida !.and my last option which i would go with is .
that the patent recieved .bcG vaccine and that leads to devleopment of immunity and when she visited india she was exposed there with more sestization and activation of memory cells with overproduction of antibodies that i why when we did ppd was strongly positve like that so !i would go with D hope to discuss what i said
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| fudoc_20
Forum Newbie
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ahh sorry the pt didnot visit india she was adopted from there which ..dont change anything regarding what i said ..hope to hear opinions soon
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| khorshid
Forum Guru
Topics: 32
Posts: 591
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Correct answer is B, for the following reasons:
So she has a positive PPD.
Always remember interpretation of PPD test is regardless of BCG history.
You should obtain CXR anyways. If CXR is pos, then the child has TB, so you'll treat her, but if CXR is neg and like here there is no signs and symptoms, this goes into category of latent tuberculosis, and here 9 months of INH therapy is needed. So the best option is B.
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| sss sss
Forum Senior
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Posts: 203
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B
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| fudoc_20
Forum Newbie
Topics: 3
Posts: 45
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ok do wee do chest xray even ..there are no esymptoms .no cough no dyspnea no expectorations !!?i mean may we see mediastinal shadow with no symptoms at all !!
and if !.chest xray !is postive !we start treatment with combined rigemn !4 month os (INH + RIFAMPICIN+PYRNAZIMIDE !THEN 2 moonths of INH and rifampicin not only,INH !
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| fudoc_20
Forum Newbie
Topics: 3
Posts: 45
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ohhh yeah .u are right khorshid got your poin thanks !!
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