Abstract
Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12–3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08–2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08–1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13–1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.
Highlights
Despite extensive tuberculosis-control efforts of the World Health Organization (WHO) and local health departments, the tuberculosis (TB) epidemic continues to ravage the world, affecting susceptible individuals including the elderly (>65 years old), and representing a global health problem [1,2].infection across all sexual and gender subgroups
Having risk factors for TB (O.R. = 1.45; 95% confidence intervals (CIs) 1.12–3.65) and presence of cavities on chest x-ray (CXR) (O.R. = 1.42; 95% CI 1.08–2.73) resulted in being more likely to be associated with adverse events in elderly patients
Previous data showed that co-morbidities such as diabetes, COPD, and cardiac disease, which are prevalent in aging populations, increase the risk of developing active TB disease [16,17]
Summary
Despite extensive tuberculosis-control efforts of the World Health Organization (WHO) and local health departments, the tuberculosis (TB) epidemic continues to ravage the world, affecting susceptible individuals including the elderly (>65 years old), and representing a global health problem [1,2].infection across all sexual and gender subgroups. Elderly people are both at especially high risk for reactivation of latent TB, and susceptible to new TB infection. Tuberculosis diagnosis in the elderly can be challenging; elderly patients may have an absent or attenuated febrile response with a high frequency of nonspecific clinical manifestations or co-morbidities and less frequently “classical” radiological presentations that can result in delay in diagnosis [4]. The mortality rates of older patients have been reported as up to 51% [7]. These mortality rates have been decreasing recently, the rate remains high [8,9]. Age represents a risk factor connected to the development of adverse drug reactions due to polypharmacy, pill burden, existing co-morbidities, and a lower efficiency of renal and hepatic drugs clearance. Age represents a risk factor connected to the development of adverse drug reactions due to polypharmacy, pill burden, existing co-morbidities, and a lower efficiency of renal and hepatic drugs clearance. [6,10]
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