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Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes

2012; Oxford University Press; Volume: 41; Issue: 4 Linguagem: Inglês

10.1093/ageing/afs028

1468-2834

Luis Pablo Cruz‐Hervert, Lourdes García‐García, L. Ferreyra-Reyes, Miriam Bobadilla-del-Valle, Bulmaro Cano‐Arellano, Sergio Canizales‐Quintero, Elizabeth Ferreira-Guerrero, Renata Báez-Saldaña, Norma Araceli Téllez-Vázquez, A. Nava-Mercado, Luis Juárez-Sandino, Guadalupe Delgado-Sánchez, C. A. Fuentes-Leyra, Rogelio Montero-Campos, Rosa Areli Martínez‐Gamboa, Peter M. Small, José Sifuentes‐Osornio, Alfredo Ponce‐de‐León,

Diagnosis and treatment of tuberculosis

Background: worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults. Objective: to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people. Methods: we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status. Results: eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR = 5.37; 95% CI: 1.06–27.23; P = 0.042), and death due to tuberculosis (HR = 3.52; 95% CI: 1.78–6.96; P < 0.001) adjusting for sociodemographic and clinical variables. Conclusions: community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.