Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case control study

BMC Infectious Diseases

Young Chul Kim¹  Sung Chul Lim¹  Yu Il Kim¹  Kyu Sik Kim¹  In Jae Oh¹  Su Young Chi¹  Yong Soo Kwon¹ 

[1] Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea

关键词: Tuberculosis;    Treatment outcome;    Diagnosis;    Clinical presentations;    Age;   

Others  :  1171002
DOI  :  10.1186/1471-2334-13-121

 received in 2012-11-06, accepted in 2013-03-01,  发布年份 2013

【 摘 要 】

Background

The purpose of this study was to evaluate the differences in clinical characteristics and treatment outcomes between older and younger tuberculosis (TB) patients in Korea.

Methods

We retrospectively analyzed the medical records of 271 younger (20–64 years old at diagnosis) and 199 older (≥65 years) TB patients who had been newly diagnosed and treated at Chonnam National University Hospital from May 2008 to August 2010.

Results

Dyspnea and comorbid medical conditions were more frequent and positive TB culture rates were higher in older TB patients. In chest computed tomography (CT) scans of pulmonary TB patients, older patients were less likely to have micronodules (<7 mm in diameter), nodules (<30 mm in diameter), masses (>30 mm in diameter), and cavities compared with younger patients, but were more likely to have consolidations. Incidence of adverse drug reactions did not differ between the two groups, except for severe gastrointestinal disorders. There were no significant differences in favorable treatment outcomes between younger and older TB patients (97% vs. 94%, respectively; p = 0.251).

Conclusions

Older TB patients had more frequent dyspnea and less frequent active TB findings on chest CT. Treatment success and adverse drug reaction rates were similar in older and younger TB patients.

【 授权许可】

   
2013 Kwon et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Annual report on the notified tuberculosis patients in Korea. Seoul: Korean Center for Disease Control and Prevention, Korean Institute for Tuberculosis; 2010.
• [2]Morris CD: The radiography, haematology and biochemistry of pulmonary tuberculosis in the aged. Q J Med 1989, 71(266):529-536.
• [3]Morris CD: Pulmonary tuberculosis in the elderly: a different disease? Thorax 1990, 45(12):912-913.
• [4]Perez-Guzman C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H: Does aging modify pulmonary tuberculosis?: a meta-analytical review. Chest 1999, 116(4):961-967.
• [5]Davies PD: TB in the elderly in industrialised countries. Int J Tuberc Lung Dis 2007, 11(11):1157-1159.
• [6]Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, Noma S: Pulmonary tuberculosis: CT findings–early active disease and sequential change with antituberculous therapy. Radiology 1993, 186(3):653-660.
• [7]Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH: Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol 1993, 160(4):753-758.
• [8]Lee KS, Im JG: CT in adults with tuberculosis of the chest: characteristic findings and role in management. AJR Am J Roentgenol 1995, 164(6):1361-1367.
• [9]Lee JJ, Chong PY, Lin CB, Hsu AH, Lee CC: High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy. Eur J Radiol 2008, 67(1):100-104.
• [10]Seung KJ, Bai GH, Kim SJ, Lew WJ, Park SK, Kim JY: The treatment of tuberculosis in South Korea. Int J Tuberc Lung Dis 2003, 7(10):912-919.
• [11]Ryu WJ: Treatment guidelines for tuberculosis. Seoul: The Korean Academy of Tuberculosis and Respiratory Disease; 2005.
• [12]Kee S-J, Kim S-M, Kim S-H, Shin M-G, Shin J-H, Suh S-P, Ryang D-W: Multiplex PCR assay for identification of mycobacterial species isolated from liquid cultures. Chonnam Medical Journal 2009, 45(1):19-26.
• [13]Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, Webb WR, Zerhouni EA: Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996, 200(2):327-331.
• [14]World Health Organization: Treatment of Tuberculosis: guidelines for national programmes (4th edition). Geneva: WHO/HTM/TB/2009420; 2009.
• [15]Wang CS, Chen HC, Yang CJ, Wang WY, Chong IW, Hwang JJ, Huang MS: The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection 2008, 36(4):335-340.
• [16]Pratt RH, Winston CA, Kammerer JS, Armstrong LR: Tuberculosis in older adults in the United States, 1993–2008. J Am Geriatr Soc 2011, 59(5):851-857.
• [17]Humphries MJ, Byfield SP, Darbyshire JH, Davies PD, Nunn AJ, Citron KM, Fox W: Deaths occurring in newly notified patients with pulmonary tuberculosis in England and Wales. Br J Dis Chest 1984, 78(2):149-158.
• [18]Korzeniewska-Kosela M, Krysl J, Muller N, Black W, Allen E, FitzGerald JM: Tuberculosis in young adults and the elderly. A prospective comparison study. Chest 1994, 106(1):28-32.
• [19]Chan CH, Woo J, Or KK, Chan RC, Cheung W: The effect of age on the presentation of patients with tuberculosis. Tuber Lung Dis 1995, 76(4):290-294.
• [20]Stead WW, Dutt AK: Tuberculosis in elderly persons. Annu Rev Med 1991, 42:267-276.
• [21]Zevallos M, Justman JE: Tuberculosis in the elderly. Clin Geriatr Med 2003, 19(1):121-138.
• [22]Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC: The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis 1998, 2(1):27-36.
• [23]Packham S: Tuberculosis in the elderly. Gerontology 2001, 47(4):175-179.
• [24]Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH: Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am J Respir Crit Care Med 2000, 162(5):1738-1740.
• [25]Collins J, Blankenbaker D, Stern EJ: CT patterns of bronchiolar disease: what is "tree-in-bud"? AJR Am J Roentgenol 1998, 171(2):365-370.
• [26]Poey C, Verhaegen F, Giron J, Lavayssiere J, Fajadet P, Duparc B: High resolution chest CT in tuberculosis: evolutive patterns and signs of activity. J Comput Assist Tomogr 1997, 21(4):601-607.
• [27]Patel YR, Mehta JB, Harvill L, Gateley K: Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population. J Am Geriatr Soc 1993, 41(6):629-632.
• [28]Tamura A, Shimada M, Matsui Y, Kawashima M, Suzuki J, Ariga H, Ohshima N, Masuda K, Matsui H, Nagai H: The value of fiberoptic bronchoscopy in culture-positive pulmonary tuberculosis patients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses. Intern Med 2010, 49(2):95-102.
• [29]Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P: Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000, 117(4):1049-1054.
• [30]Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D: Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med 2003, 167(11):1472-1477.
• [31]Huang YS, Chern HD, Su WJ, Wu JC, Lai SL, Yang SY, Chang FY, Lee SD: Polymorphism of the N-acetyltransferase 2 gene as a susceptibility risk factor for antituberculosis drug-induced hepatitis. Hepatology 2002, 35(4):883-889.
• [32]Dossing M, Wilcke JT, Askgaard DS, Nybo B: Liver injury during antituberculosis treatment: an 11-year study. Tuber Lung Dis 1996, 77(4):335-340.
• [33]Teleman MD, Chee CB, Earnest A, Wang YT: Hepatotoxicity of tuberculosis chemotherapy under general programme conditions in Singapore. Int J Tuberc Lung Dis 2002, 6(8):699-705.
• [34]Schaberg T, Rebhan K, Lode H: Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J 1996, 9(10):2026-2030.
• [35]Hwang SJ, Wu JC, Lee CN, Yen FS, Lu CL, Lin TP, Lee SD: A prospective clinical study of isoniazid-rifampicin-pyrazinamide-induced liver injury in an area endemic for hepatitis B. J Gastroenterol Hepatol 1997, 12(1):87-91.
• [36]Chang KC, Leung CC, Yew WW, Lau TY, Tam CM: Hepatotoxicity of pyrazinamide: cohort and case–control analyses. Am J Respir Crit Care Med 2008, 177(12):1391-1396.
• [37]Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, Peloquin CA, Gordin FM, Nunes D, Strader DB: An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 2006, 174(8):935-952.