TB incubation period varies in people
Dear Dr. Donya,
Thanks a lot for your kind and quick answer. It makes me feel more relaxed, because it seems you are in complete agreement with the action from the doctor in Jakarta. The treatment for amoeba is already finished and the results seem OK. (We arranged for another stool test.)
We have also started the treatment for bronchopneumonia, with a specific antibiotic. So let us see the results after too weeks. My daughter has been regularly vaccinated for everything, including having a BCG (tuberculosis vaccination).
The PPD (skin test) result made the skin quite swollen and hardened, covering an area of more than one square centimeter.
My concern now is to find the source, or reason of the infection. From the CXR's (Chest X-Ray) of all the persons who are often in our house (house owner, maid, babysitter) none indicated TBC infection. Only the owner's results indicated bronchitis. My wife and I have undergone a radio and blood test and had a negative result (I did this in June 2002. Should I be checked again?)
I have a few questions:
1. Should we await the results of the two-week treatment to examine more people in the house who could be infected, (as you suggest, the skin test), or is it better to make this examination as soon as possible?
2. What is the normal or shortest incubation period for TB? I ask this because the big problems for my daughter started after she came back from Italy less than 2 months ago. The day after our arrival from Italy we started to employ a babysitter, a 27- year-old woman whose husband died about seven to eight months ago from TB.
In the beginning we made her have the normal CXR plus two visits to a doctor, who treated her for bronchitis (two weeks on antibiotics). Could there be some connection with her present problem?
--Reader
Dear reader,
Being PPD-positive for more than 1 cm, with a strong reaction, is of real concern. I would suggest that you try PPD on the babysitter and repeat a CXR on her too. Is it possible for you to send me CXR photos by digital camera and download them to me?
The incubation period for TB can vary but the experience of the babysitter and her husband's TB infection makes it a possible source of infection.
--Dr. Donya
Dear Dr. Donya,
The latest developments in my daughter's disease are quite confusing to me.
At the time of my latest e-mail my daughter was under antibiotic treatment (abbotic granules) for broncopneumonia. After 12 days of treatment, however, there was no improvement in the X-ray, and the pediatrician decided to start TB treatment, with an estimated therapy duration of 9 months.
At the same time, he suggested a repeat X-ray of two people who have frequent contacts with my daughter (the house owner and maid). The babysitter, the main "suspect", didn't return to work after the Lebaran holiday. Following the doctor's advice, on Dec. 21, I accompanied the above-mentioned two to the TB hospital in Cisarua, not far from Bogor.
There, I explained my case to the doctor on duty (a lung specialist), who, based on my daughter's X-rays and other information I provided, expressed doubts about Maria's disease.
In particular, looking at her mother's blood analysis, he found that my wife is an allergic person. This fact could explain the strong reaction of my daughter to the PPD test, which in children is the most significant test for TB.
As the X-rays of my daughter did not give any clear result, he has considered other aspects such as weight and activity of the child, neither of which indicates TB. Therefore, he suggested I carefully monitor the child's weight during the following week, to observe the reaction to the therapy she is undergoing, and then take her to him.
I am very surprised to see how easy it can be to make a wrong diagnosis for an important sickness such as TB, with the consequence that my daughter, instead of healthy food, could be given a lot of medicines, which she doesn't need.
Could you give me your personal advice on the matter? Thank you very much for your support and availability.
--Reader
Dear Reader
I am sorry for not responding faster and I do appreciate that you have given me your trust. The worst thing is I am not there to see your daughter; also her CXR and her condition.
I have tried hard to understand your daughter's situation and I have to admit that I cannot comment on it because I have not examined her.
If I can put your mind at rest, I can say that she is in a good environment with good parenting, has normal weight and height, and has been coughing on and off, but that is quite common these days for children. I do not think that she has TB infection. Regularly consulting a lung specialist would be a good idea. One thing about TB in children is that it is self-limited, with no symptoms. We have to treat it properly because the complications can be worse than, say, meningitis or spinal infection.
Best regards and best wishes to you and your family
-- Dr. Donya