Weaning of cell-mediated immunity and age related pathophysiological respiratory changes predisposes to reactivation or re-infection tuberculosis. This comparative prospective study evaluated clinicoradiological presentation of tuberculosis in elderly (>65 years).METHOD: 104 elderly and 100 adults were included. Medical documentation including microbiology, radiography, MT, USG and Bronchology were analysed. FNAC, Biopsy of lung/ pleura and pleural fluid analysis were done to confirm the diagnosis.
There was no statistically significant difference in symptoms however, high frequency of dry cough and low frequency of night sweats and chills was noticed in elderly patients (EP) p<0.01. Hemoptysis was present in 15.2% EP v/s 34% adults p<0.01. Sputum smear and culture positivity for AFB was 47% and 41% in EP. Radiologically non-cavitory disease, pleural effusion, miliary TB and fibrocavitory disease was in 87.5%, 21% 17% & 12.5% of elderly and in 43%, 10% 15%, and 57% of controls respectively. Lesions located in UZ/MZ (53.8%) with MZ/LZ (21.1%) preponderance. 62% of EP had comorbid conditions [COPD/ Asthma- 21%, Diabetes- 14%, hypertension- 12%, Bronchogenic CA - 5%. HIV seropositivity was less (2.8% v/s 8%). XPTB was common in EP [pleural effusion (21%), abdominal TB (16.3%)]. MT with 10 TU was positive in 50.9% cases. Sputum AFB was positive in 47% EP (v/s 68%) BAL for AFB was positive in 3 EP. Eight EP were diagnosed by FNAC / biopsy.
Tuberculosis is very common in elderly. Because of socio psychological and medical aspects of ageing, co-morbid states, ignorance and misperception of symptoms, poor attention by care givers and atypical manifestation of disease the diagnosis is difficult and delayed in this population. Our study confirms the importance of considering tuberculosis as a diagnosis in elderly even in the absence of classical clinicoradiological presentation.CLINICAL IMPLICATION: A high index of suspicion with appropriate investigations may lead to early diagnosis and prompt institution of treatment, thereby significantly decreasing the morbidity and mortality attributed to tuberculosis in elderly.
M. Vats, None.