Q: My daughter is 2 years old. She weighs 12.5 kg. Her blood report shows the following values: Haemoglobin - 11.0; Leucocytes: Total Leucocytes - 11,400; Neutrophils - 23%; Eosinophils - 3%; Basophils - NIL; Lymphocytes - 72%; Monocytes - 2%. A peripheral smear test was also done. The report is as follows: RBCs are normocytic and slightly hypochromic. They show mild degree of anisocytosis. White cell count is slightly increased with a differential count of polymorphs 23%, Eosinophils 3%, Monocytes 2%, Lymphocytes 72%. Platelets appear adequate in number and they have normal morphology. There are no abnormal cells or parasites. The impression in the report says - Blood smear shows mild hypochromic normocytic anaemia and mild leukocytosis. The report was shown to a paediatrician who has prescribed Trifer drops - 6 drops once daily. She says further tests need be conducted only if there is weight loss and frequent bouts of fever. There seems no loss of appetite or weight loss and she is quite active. However she catches cold frequently (at times once a month) and has to be given a course of antibiotics (Althrocin) after which she recovers. Is it a case of primary complex? Do we need to do anything further?

A:TB occurs when an individual inhales bacteria, which have been aerosolised by infected persons (droplet infection). The primary infection is of the respiratory tract due to inhalation of infected droplets. The chances of infection increase in small, enclosed spaces and in areas with poor ventilation. Following inhalation, the bacteria are ultimately deposited in the terminal part of the respiratory tract, alveoli or the distal respiratory bronchiole where they are ingested by cells called alveolar macrophages. These cells are unable to kill the bacteria and the organism continues to multiply. The organism is then transported to the neighbouring lymph nodes by the infected cells. There is also the possibility of the bacteria spreading via the blood (or lymph) to other lymph nodes and distant parts of the body like bone, brain, kidney etc. The occurrence of lung infection with involvement of the draining lymph node is called a primary complex. TB of the lung can present in several forms: endo-bronchial TB with focal lymphadenopathy, progressive pulmonary disease, pleural involvement, and reactivated pulmonary disease. The symptoms of primary lung disease are more likely to be seen in infants who present with fever, night sweats, cough, failure to thrive, inability to gain weight etc. Please be guided by the treating physician, as TB seems unlikely.