Clinico-radiological variability of pulmonary tuberculosis in young patients as compared to elder patients prior to RNTCP and after 18 years RNTCP

Abstract

Background: Tuberculosis, a chronic disease causing high morbidity and mortality with multiple host related and socio-demographic risk factors. Incidence is 3-4 times among in diabetics. HIV is considered to be a most powerful risk factor other being malnutrition, Tubercular contacts, smoking habits and alcoholism. Many ecological and societal threats increase a vulnerability to infection and succession of the disease. Objective was to study and compare various clinico-radiological presentations and clinical risk factors for pulmonary tuberculosis in the young (<50yrs) and elderly (>50yrs) patients.Methods: Total 300 pulmonary tuberculosis patients each admitted in hospital during 1999 (group ‘A’) and 2016 (group ‘B’) respectively were included in our study. Socio-demographic risk factors and presence of any existing co morbidities and clinical as well radiological presentation data were evaluated.Results: Majority patients in both group ‘A’ and ‘B’ were males (67% and 61.3%), younger (71.3% and 63.3%) patients. Elder patients had more smokers in both groups (48.8% and 33.6%). COPD trends seems to be receding in group ‘B’ as compared to group ‘A’ in younger (6.3% vs. 8.9%) as well elder (13.6% vs. 29.1%) but on the contrary lifestyle disease trends like DM increased in group ‘B’ than group ‘A’ patients more in elder subgroup (30% vs. 9.3%). HIV infected was more in younger 2.1 % (elder 0.9%) group ‘B’ patients. Haemoptysis (17.8% and 18.6% vs. 13.7% and 9.1%) and cough (~87% vs. ~85%) were almost similar but fever (~90% vs. ~65%) was seen significantly higher in the young patients. Radiologically bilateral upper lobe cavitations (15%-30%) was a higher in group A patients as compared to negligible less than ~3% cavitations in group B, on the contrary infiltrations (15%-32%) was more in group B.Conclusions: Young adults are more likely to have fever while haemoptysis cough and advanced lung field involvement is more common in elderly. Elderly patients had a higher number of co-morbidities like COPD and DM. The present study reveals that various demographic, socioeconomic and clinical risk factors have a potential role in causation/augmentation of pulmonary tuberculosis hence life style modification, prevention and timely management of these risk factors could be helpful to reduce the burden of disease.

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India

“…The proportion of elderly TB observed in our study (14.9%) is similar to that observed in previous studies conducted in India such as Karnataka (18.7%) [33], Tamil Nadu (14%) [34] and Punjab (12.3%) [35] and other countries such as Nigeria [36], Uganda [8], Taiwan [9] and United States [10]. However, this might be expected to increase over time given the increasing life expectancy in India.…”

“…This finding is in line with the epidemiological trend of TB in India (males are more affected than females) [37,38]. Previous studies conducted in India and other LMIC countries have also reported that elderly males have higher rate of TB than females [33][34][35][36]. Possible reasons for this pattern could be better healthcare service accessibility and higher rate of social interaction among males [39,40].…”

“…Though compliance to medication was better among the elderly patients, sputum conversion at end of intensive phase was lower among elderly patients compared to non-elderly patients. Though not statistically significant, a similar finding was reported in previous studies conducted in India where the sputum conversion was lower among the TB patients in elderly age group [33][34][35]. Possible reasons for this lower conversion rate could be due to the high bacillary load among the elderly patients leading to delayed clearance and sputum conversion, reported in some studies [43].…”

Comparison of Clinical, Radiological and Laboratory Parameters Between Elderly and Young Patient With Newly Diagnosed Smear Positive Pulmonary Tuberculosis: A Hospital-Based Cross Sectional Study

“…As per a study by Lee et al, there was a significant association of hemoptysis and breathlessness in the younger and elderly age groups, respectively [11]. Studies from Patiala, India as well as from Egypt demonstrated a significant association of fever, hemoptysis, and weight loss in younger patient, and dyspnea and chest pain in the older age group [12,13]. Potential explanations for this disparity may be the variation in patient characteristics, smaller sample size, and single-center data.…”

Assessment of Effective Anti-TB Regimens and Adverse Outcomes Related Risk Factors in the Elderly and Senile-Aged TB Patients

“…28 Despite having better compliance with drug therapy, the elderly patients showed a lower sputum conversion rate at the end of 2 months of treatment when compared to younger patients. [29][30][31] The results of some studies suggest that the high incidence of adverse drug reactions, drug interactions, and complications may lead to dose reduction and malabsorption of anti-TB drugs. 32 Other studies attribute the low sputum negative conversion rate at the end of the intensive phase to the delayed sputum conversion and excretion caused by high bacterial loads.…”