Preventing Primary Complex (Tuberculosis) in Children

EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42www.eac.edu.ph
SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

QUALITY MANAGEMENT SYSTEMS
Topic: Primary Complex (Tuberculosis) in Children

Target Audience: Parents with Infants/Toddlers with or at high risk for the Primary Complex (Tuberculosis)
infection.
Venue: Cardinal Village, Salitran III. Covered court Phase 2
Objectives: By the end of the discussion the participants are expected to possess knowledge of how to identify,
treat, and prevent Primary Complex (Tuberculosis) infection and disease in children.
Learning Content Time Teaching- Resources Evaluation
Objectives Frame Learning
Strategy
Define Primary Children exposed to 10 Lecture- PowerPoint Oral Test
Complex Mycobacterium tuberculosis minutes Discussion Presentation
may sometimes develop a
tuberculosis (TB) infection HandOut
called Primary Complex.
The child with this infection
remains healthy and usually
has no symptoms. They
may remain symptom free
until their immune system
declines and the disease
becomes active.
Identify the  Primary complex is 10 Lecture- PowerPoint Oral Test

preventive transmitted through droplet minutes Discussion Presentation,
measures and infection or inhalation.
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mode of Preventing infection can be Handout

transmission for done through methods of
Primary Complex avoiding contact with
carriers of disease,
 using medicines as a
preventive measure,
 maintaining good living
standards, and screening
programs
Explain how Primary Complex is 10 Lecture- PowerPoint Oral Test

Primary Complex diagnosed through a minutes Discussion Presentation
is diagnosed tuberculin skin test (also
HandOut
called a Mantoux test or
PPD test). A small amount
of purified protein derivative
(a.k.a. PPD) of the TB germ
is injected superficially into
the forearm. An itchy,
raised, red reaction past a
certain size (this changes
depending on other
conditions) is considered
positive
Recognizes the The importance of knowing 3 Minutes Lecture- PowerPoint Introspection
need for the nature of the infection, Discussion Presentation Oral test


awareness about its threat to health, HandOut

Primary Complex treatment, and the
infection in preventive measures such
children as getting a BCG vaccine
for their children to increase
the probability of preventing
the infection
Participate in the Treatment, diagnosis, who 5 minutes Lecture- PowerPoint Oral Test
discussion by is at risk, and prevention of Discussion Presentation
answering primary complex
questions
Show desire to Knowing the importance of 2 minutes Lecture- PowerPoint Introspection
prevent their vaccination and applying Discussion Presentation
Oral Test
children from preventive measures is
getting infected critical for the prevention of
Primary Complex
Display knowledge Follows the order of their 3 minutes Lecture- PowerPoint Oral Test
on what to do if Physician through taking Discussion Presentation
their child got several anti-TB medicines
infected for 6 to 9 months. It is
important to note that if a
child stops taking the drugs
before completion, the child
can become sick again.


INSTRUCTIONAL DESIGN
ON PRIMARY COMPLEX
(TUBERCULOSIS)
IN CHILDREN
Submitted By: Jan Kyle S. Oteda

BSN 2-1


Narrative Report
Tuberculosis is an infectious disease caused by a type of bacteria called Mycobacterium tuberculosis. It is

often called as “TB” and mainly infects the lungs; however, it is also possible that it would affect other organs. This
disease is the most common cause of infection-related death worldwide. This disease occurs disproportionately
among disadvantaged populations, such as homeless individuals, malnourished individuals, and those living in
crowded areas. Most cases of TB occur in the South-East Asia (35%), African (30%), and Western Pacific (20%)
regions. Children exposed to the mycobacterium bacteria may sometimes develop a tuberculosis infection called
Primary(Ghon) Complex. The primary complex is a kind of primary infection of Tuberculosis wherein it indicates the
first contact of the child with the particular disease.
A primary (Ghon) complex is formed, consisting of a granuloma (inflammation), typically in the middle or
lower zones of the lung (primary or Ghon focus). The primary complex usually resolves within weeks or months,
leaving signs of fibrosis and calcification (calcium salts) detectable on chest X-ray. In general, the risk of disease
progression following primary infection is low, but young children and immunocompromised patients are at
increased risk.
In the Philippines, having TB is considered a major health problem and is actually the sixth leading cause of
death and illness in the country. It is estimated that 200,000 to 600,000 Filipinos have active Tuberculosis. This
condition makes the person sick and is very contagious to others. Active TB can occur on either in the first few
weeks after infection with the bacteria, or in a few years later. The danger of TB is real. According to a report in the


World Health Organizations (WHO), out of 196 countries, the Philippines has the distinction of being included in the
top 22 high-burden tuberculosis countries in the world -- being ranked as the 9th worldwide. TB prevalence is high
among the high risk groups such as the elderly, urban poor, smokers, and those with compromised immune
systems such as people living with HIV, malnutrition, and diabetes. It is estimated that 10 600 patients have multi-
drug resistant TB (MDR-TB) in 2011.
TB disease in children under 15 years of age (also called pediatric tuberculosis) is a public health problem of
special significance because it is a marker for recent transmission of TB. In addition to it being significant, infants
and young children are more likely to develop life-threatening forms of TB disease (e.g., disseminated TB, TB
meningitis) than older children and adults. Among children, the greatest numbers of TB cases are seen in those
less than 5 years of age. On the other hand, with concern to adolescents, TB cases is more common with those
older than 10 years of age. The most common route of infection is through inhalation. A person with active TB
coughs up the germ which can be inhaled by a healthy child. The TB then travels to the lungs of the child; following
with the immune system that kicks in and “quarantines” the germ at the local site and at the neighboring lymph
nodes (this forms the “walled-in” complex or also called as the primary complex). The child remains healthy and
usually does not exhibit any of the symptoms. They may remain free of symptoms until their immune system
declines and the disease becomes active.
People with TB disease of the lungs or throat can spread bacteria to others especially with those people that
they spend time every day. However, children are less likely to spread TB bacteria to others. This is because the
forms of TB disease most commonly seen in children are usually less infectious than the ones seen in adults. Many
children infected with M. tuberculosis never develop active TB and remain in the latent TB stage. TB bacteria is


spread through the air when an infected person coughs, sneezes, speaks, sings, or laughs. A child usually does
not become infected unless he or she has repeated contact with the bacteria. TB is not likely to be spread through
personal items, such as clothing, bedding, cups, eating utensils, a toilet, or other items that a person with TB has
touched. Good air flow is the most important way to prevent the spread of TB. To prevent primary complex
tuberculosis be sure to: avoid contact with people who have the active disease; use medicines as a preventive
measure in high-risk cases; maintain good living standards; wash hands well and often; sneeze or cough into a
tissue or on the elbow and not into the hands; and use separate towels, drinking glasses, and eating utensils rather
than sharing these items.
As most patients of this disease does not show noticeable symptoms, they only find out the presence of a
Primary Complex through a tuberculin skin test (also called a Mantoux test or PPD test). A small amount of purified
protein derivative (a.k.a. PPD) of the TB germ is injected superficially into the forearm. An itchy, raised, red reaction
past a certain size (this changes depending on other conditions) is considered positive. In 20% of cases, a PPD
test will be negative in patients with TB infection. Other times, children will have a falsely positive PPD test because
they had the BCG (Bacillus Calmette-Guerin) vaccine. If primary complex is left untreated, it may eventually evolve
into active tuberculosis. Drug treatment choices vary depending on the drug resistance to tuberculosis.
Symptoms of TB disease in other parts of the body depend on the area affected. Signs and symptoms of TB
disease in children includes: coughing for 3 weeks or longer, chest pain, feelings of sickness or weakness,
lethargy, and/or reduced playfulness; weight loss or failure to thrive; fever; poor growth, swollen glands, blood in
sputum and/or night sweat.


A pediatric TB expert should be involved in the treatment of TB in children and in the management of
infants, young children, and immunocompromised children who have been exposed to someone with infectious TB
disease. It is very important that children or anyone being treated for latent TB infection or TB disease finish the
medicine and take the drugs exactly as instructed. For Latent TB infection, treatment is recommended for children
to prevent them from developing TB disease. Infants, young children, and immunocompromised children with latent
TB infection or children in close contact with someone carrying infectious TB disease, require special consideration
because they are at an increased risk for acquiring the TB disease. Consultation with a pediatric TB expert is
recommended before treatment begins. Children over 2 years of age can be treated for latent TB infection with
once-weekly isoniazid-rifapentine within the course of 12 weeks. Alternative treatments for latent TB infection in
children include 4 months of daily rifampin or 9 months of daily isoniazid.
The treatment of TB disease is through taking several anti-TB medicines for 6 to 9 months. It is important to
note that if a child stops taking the drugs before completion, the child can become sick again. If drugs are not taken
correctly, the bacteria that are still alive may become resistant to the drugs. A Tuberculosis that is resistant to drugs
is harder and more expensive to treat, and with its treatment lasting for a much longer period of time (up to 18 to 24
months).


Evaluation:
1. How will you describe Primary Complex in children?

2. How is Primary complex in children acquired?
3. What are the preventive measures for Primary complex tuberculosis?
4. What are the symptoms of tuberculosis in children?
5. What can you do after the discussion to prevent or treat the disease?
6. What have you learned from the discussion?
Attachments:
References:
University of Rochester Medical Center Rochester. (2019). Retrieved from https://www.urmc.rochester.edu
Division of Tuberculosis Elimination. (2014, October 1). Retrieved from

https://www.cdc.gov/tb/topic/populations/tbinchildren/default.htm
Navas, A. (September 2019). Tuberculosis. Retrieved at https://kidshealth.org/en/parents/tuberculosis.html

NA (2019, December 18). How to Deal with Children’s Primary Complex. Retrieved from
https://www.smartparenting.com.ph/
CreveI, R(2017), Infectious Diseases 4th Edition Volume 1. Retrieved from
https://www.sciencedirect.com/topics/medicine-and-dentistry/primary-tuberculosis


Heemskerk D, Heemskerk Caws M, Marais B, et al (2017). Tuberculosis in Adults and Children. Chapter 3, Clinical
Manifestations. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK344404/?fbclid=IwAR0jv1LeKD5aqQJWxQxMWxisDywMmhFUhM9
7AS3iRd_yWITcFKc2r_GKXk4
Batra, B (April 2018). Pediatric Tuberculosis. Retrieved from (April 2018). Pediatric Tuberculosis. Retrieved from
https://emedicine.medscape.com/article/969401-overview#a5

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EMILIO AGUINALDO COLLEGE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

Topic: Primary Complex (Tuberculosis) in Children

Identify the  Primary complex is 10 Lecture- PowerPoint Oral Test

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

mode of Preventing infection can be Handout

Explain how Primary Complex is 10 Lecture- PowerPoint Oral Test

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

awareness about its threat to health, HandOut

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

Submitted By: Jan Kyle S. Oteda

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

Tuberculosis is an infectious disease caused by a type of bacteria called Mycobacterium tuberculosis. It is

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

1. How will you describe Primary Complex in children?

Division of Tuberculosis Elimination. (2014, October 1). Retrieved from

Navas, A. (September 2019). Tuberculosis. Retrieved at https://kidshealth.org/en/parents/tuberculosis.html

• VIRTUE • EXCELLENCE • SERVICE

SCHOOL OF NURSING ISO 9001:2015 CERTIFIED

• VIRTUE • EXCELLENCE • SERVICE

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