Abstract
In developed countries, the incidence of TB is decreasing and the age of onset is delayed relying more on the reactivation of old infection. In 2014, the age-group >64 had the highest incidence in our area (21.4/100,000). The immunosenescence and comorbidities appear to play an important role.
Aim: To analyse the clinical aspects and treatment outcome of TB in our elderly patients.
Methods: Retrospective study. All patients with TB >75 years in the urban area of Bilbao between 2009-2013 were included. Controls were randomly selected from patients <65 years with TB from the same metropolitan area and period. VIH-positive patients were excluded. Variables collected were sociodemographic data, comorbidities, clinico-radiological and microbiologic features, toxicity and mortality.
Results: 50 patients with TB >75 years, mean age 82±5, with a Charlson index 2.9: COPD (38%), heart failure (36%), diabetes (24%), dementia (24%), neoplasms (20%). 19% were institutionalized. Previous history of TB was present in 44% of patients. Main results are shown in the table below.
Group <65 n=87 | Group>65 n=50 | ||
Pulmonary cavitation | 19 | 8 | |
Inespecific infiltrates | 33 | 22 | p=0,058 |
Pleural effussion | 17 | 9 | |
Miliary* | 3 | 8 | p<0,05 |
Only old healed TB | 6 | 18 | p<0,05 |
Hepatotoxicity | 7 | 15 | |
Severe hepatotoxicity | 0 | 4 | p<0,05 |
TB-related mortality | 1 | 12 | p<0,05 |
Diagnosis delay | 38 | 50 | |
Admission (days) | 4,3 | 14,9 | p<0,05 |
* All miliary forms died
CONCLUSIONS: TB in very elderly patients represents a major challenge for the future:
-Miliary presentations are more frequent
-Mortality and liver toxicity are higher
-Difficult and delayed diagnosis due to unespecific clinico-radiological features
-Institutionalized patients present a great epidemiological risk.
-More hospital admissions.
- Copyright ©the authors 2016