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Tuberculosis in the very old: a ten-year experience

Abstract number: 1732_308

Salvadó M., Garcia-Vidal C., Martinez-Lacasa J., Rodriguez-Carballeira M., Freixas N., Riera M., Nicolás C., Garau J.

Objectives: It has been suggested that tuberculosis (TB) in the elderly is often atypical and difficult to diagnose. There is a lack of information about TB in people over 80 years of age. The aim of this study was to examine current clinical manifestations, time to diagnosis and outcomes in old (≥65 years) and in very old (≥80 years) patients with TB.

Methods: An observational study of prospectively collected data of consecutive patients with tuberculosis from January 1995 to December 2004 in a single institution. Patients under the age of 18 with immunodeficiency (HIV, transplant, infliximab use) or suspected imported disease (less than five years of residence in Spain) were excluded.

Results: Out of a total of 449 patients with documented TB, 319 adult patients were included; of these, 210 (65.8%) were under the age of 65 and 109 (34.2%) were ≥65 [27 (8.4%) were ≥80 years]. The mean age of the younger group was 37.1 (range 18–64), and that of the older group was 75.5 (range 65–98). Comorbidities (measured by Charlson index) were significantly associated with older age (1.43 vs. 0.43; p < 0.001). Pulmonary tuberculosis was more frequent in the younger group (73.8% vs. 49.5%; p < 0.001) and had a higher rate of cavitation in the chest X-ray (27.6% vs. 2.75%; p < 0.001). Extra-pulmonary and disseminated tuberculosis were more common in the elderly (50.4% vs. 26.1%; p < 0.001). No significant differences were observed between groups in time to diagnosis (65.34 vs. 59.44 days; p = 0.66). Drug toxicity was significantly higher in the elderly (22% vs. 9.8%; p = 0.006), mainly due to hepatic toxicity. Tuberculosis-related mortality (30-day mortality) was higher in the elderly (18.3% vs. 1.6%; p < 0.001), mainly due to acute respiratory failure (30%). The subset of patients older than 80 years had a significant higher TB-related mortality (44.4% vs. 9.8%; p = 0.01) compared with those between 65 and 79 years. No significant differences in co morbidities or in clinical manifestations were observed.

Conclusion: Tuberculosis in the elderly and in the very old had a higher frequency of atypical features and disseminated TB, more adverse drug reactions and increased TB-related mortality. Data suggest that TB in the ninth decade has a mortality rate 2-fold higher than in the age group of 65 to 79 years.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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