DIAGNOSTIC CHALLENGE OF TUBERCULOSIS OF THE ELDERLY IN-HOSPITAL - EXPERIENCE AT A UNIVERSITY-HOSPITAL-IN-SAUDI-ARABIA

We studied retrospectively 80 elderly patients who had been admitted t o hospital with tuberculosis (TB) between January 1988 and June 1993. There were 64 with pulmonary TB and 16 with miliary tuberculosis (MTB) . The mean age was 70 +/- 7.5 years (range 60-88 years) with 56% over 70 years of age. Underlying disease preceding TB was present in 86.3% patients. in the majority of patients clinical manifestations were sub tle. Chest X-ray showed involvement of lower lung fields and miliary s hadowing in 41.2% (33/80) and 20% (16/80) patients, respectively. The organism was detected in expectorated sputum specimens in 62.5% (50/80 ). Of the specimens obtained by flexible fibreoptic bronchoscopy (FOB) , 61% were positive for acid-fast Bacilli (AFB) by films and culture. Drug-induced adverse effects were observed in 17.6% (6/34). In 18 pati ents (22.5%), the diagnosis of TB was delayed or missed. The overall m ortality of 21% (9/43) included seven patients with MTB and two with p ulmonary TB. TB was the direct cause of death in the former and a sign ificant contributory cause in the latter.