Dealing with children and TBC

Dear Dr. Donya,

We have had some bad news. It emerged based on the initiative of my wife, who had brought my daughter's stool to a laboratory. It turned out that my daughter had amoebae. On the same occasion, discussing the matter with the family doctor where we lived, we decided to make her take a PPD (skin test for tuberculosis). The result was positive.

Afterwards, we consulted a pediatrician in Jakarta, who made her undergo two chest x-rays and a blood test. The result is that she seems to have broncho-pneumonia in one lung for which she has started to be treated. After two weeks treatment with antibiotics, according to the pediatrician, if the x-ray does not show any more signs of infection in the lung, she won't need to be treated for TB.

However, I am confused. The first doctor consulted was absolutely sure of his diagnosis of a mild form of TB and proposed that treatment be started immediately. From the moment of my daughter's birth, we have been careful with the personnel we employ at home.

Please, could you be so kind to give me your personal advice on the above matters? This is in order to clarify my doubts and try to identify, if it is the case, or prevent in future, the cause of the disease's spread. Could you also suggest to me other practical steps to could be considered, like seeing a lung specialist?

-- Reader

Dear Reader,

I am very sorry to hear about what happened to your daughter. Listen, there is nothing in this world that cannot be done. First of all, amoebic infection can be treated and I am sure that your doctor has already treated her for it.

As for TB, did your daughter receive a BCG (tuberculosis vaccine) at birth? You can look at her book. Can you see her scar? A positive skin test depends on how big the skin test scar was, how wide? If she has a BCG scar (but not more than 10 mm), this means she is immune.

About the CXR (chest x-ray), it's not definite there is TB, but its more likely to be TBC or bacteria. Not seeing the CXR for myself makes it difficult to diagnose. I agree with the doctor in Jakarta, that you should find the source who give it to her. All the family should have CXRs and skin tests. Adults can give the disease to children through coughing and respiratory droplets.

Try treating the bacterial infection for two weeks. If the symptoms shown by the CXR clear up, this means she doesn't have TB. If she gets treatment for TB, it takes at least six months of medication. Wait for another two weeks and then your doctor can recheck her again. I am here to help so always feel free to ask.

-- Dr. Donya