Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

Abstract

Background The proportion of tuberculosis (TB) patients who are older adults is increasing worldwide. Nearly 60% of TB patients in Japan are 70 years or older, and the TB incidence rate in Japan is one of the highest among high-income countries. The previous TB treatment guidelines prior to 2018 in Japan recommended excluding pyrazinamide (PZA) from the initial regimen for patients aged over 80 years. Objectives We aimed to examine differences in TB treatment outcomes among different age groups, and between those who received PZA and those who did not. Methods We performed a retrospective cohort study of patients with pulmonary TB who were managed at a single medical center in Japan. We compared treatment outcomes and adverse events that resulted in treatment interruption across the age groups. Results Of 246 patients, 117 (48%) were aged 75 years or older. Compared with patients aged < 74 years, those ≥ 75 years were less likely to have PZA in the initial regimen (53.0% vs 89.9%; p < 0.0001), more likely to die during treatment (38.5% vs 6.2%; p < 0.0001), and more likely to experience adverse events (30.8% vs 19.4%; p < 0.05). The mortality rate related to TB at 2 months after TB treatment initiation was 28% in those aged ≥ 84 years. Furthermore, among patients aged ≥ 84 years, those who did not receive PZA were significantly more likely to die than those who did (65.8% vs 36.8%; p < 0.05). Conclusions Patients aged ≥ 75 years with pulmonary TB experienced increased mortality related to TB during treatment and more frequent adverse events than younger patients, even though PZA was often avoided among older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00880-4.

Tuberculosis in the Elderly

“…Because pyrazinamide is most frequently responsible for liver damage [62,65,66], the American Thoracic Society, the Centers for Disease Control and Prevention and the Infectious Diseases Society of America assess that in the elderly with a moderate TB disease with low risk of drug resistance, the benefits of pyrazinamide use in the initial dosing regimen is less than the risk of serious adverse events [62,67]. Therefore, American guidelines do not recommend the use of pyrazinamide during the intensive phase in patients aged >75 years for moderate disease and low resistance risk [68,69]. In this setting, the initial regimen consists of isoniazid, rifampicin and ethambutol.…”

A clinical profile of sputum positive pulmonary tuberculosis among elderly patients

“…In a study by Abbara A et al, 11 Miliary mottling (4.1%) was common radiological feature in elderly patients while Cavitaiton on chest radiograph was in 27 % and 40% respectively in studies by Hase I et al 12 and Elineni JL. 13 As ZN staining was the primary modality for diagnosis of tuberculosis in our study.…”

Pulmonary Tuberculosis Mortality and Its Risk Factors Among Patients With Type 2 Diabetes and Pulmonary Tuberculosis in Four Community Hospitals, Central Thailand

“…Our finding reported that the pulmonary TB mortality rate among participants aged ≥70 years was higher than that among those aged <70 years which was compatible with recent evidence from Japan indicating that patients aged ≥75 years with pulmonary TB experienced increased mortality related to TB during treatment. (22) However, another report in Thailand presented that older patients were not associated with unsuccessful pulmonary TB outcomes including death, default, treatment failure, and transfer due to multidrug-resistant TB. (23) We found that individuals with first follow-up sputum AFB positive had a higher mortality rate when compared with those with first follow-up sputum AFB negative.…”