CLINICAL SPECTRUM OF TUBERCULOSIS IN OLDER PATIENTS

OBJECTIVE: To investigate the clinical differences between old and you ng patients infected with Mycobacterium tuberculosis in a developing c ountry. DESIGN: Retrospective chart and chest radiograph review. SETTI NG: A university-affiliate teaching hospital. PATIENTS: The medical re cords of patients with documented tuberculosis (TB) from January 1990 through December 1991 were analyzed. Clinical assessment included sex, age, diagnosis at first visit, past history, symptoms and signs, labo ratory data, X-ray findings, bacteriological examinations, outcome, ti me elapsed from first visit to initiation of anti-TB therapy and the m ajor determinants for starting anti-TB therapy. Statistical significan ces were analyzed by Student's t test and chi(2) tests. RESULTS: Among 205 patients with culture-proven TB, 57 were 65 years of age and olde r (range, 65 to 91; mean, 73) and 148 under 65 years of age (range, 16 to 64; mean, 41). There was a higher incidence of previous TB (26.3% vs. 16.2%) and diabetes mellitus (24.5% vs. 14.3%) in the elderly pati ents. Initial diagnosis of TB at first visit was less frequent in the elderly than in the young group (38.6% vs. 47.3%), although symptoms a nd signs at first visit were similar in each of the age groups. Radiog raphic presentation with mass lesions was more frequently encountered in elderly patients (10.5% vs. 2.1%, P < .05). Elapsed time from the f irst visit to suspicion of TB and the initiation of anti-TB therapy wa s frequently delayed in elderly patients (22 +/- 23 vs. 13 +/- 20 days , P < .05). The incidence of drug-resistance (39% vs. 16%, P < .05) an d unfavorable response to anti-TB therapy (17.5% vs. 3.4%, P <.05) wer e significantly higher in the older patients. CONCLUSIONS: Although cl inical presentation of TB in the elderly did not differ significantly from that in younger patients, this study showed that diagnosis and tr eatment were more often delayed in the elderly, and there was a higher incidence of treatment failure.