Clinical Manifestations Of Pulmonary Tuberculosis In Different Age Groups

Abstract

Background: The incidence of tuberculosis (TB) is increasing globally. The diagnosis of TB in older children and elderly is often delayed due to the atypical presentation. There is also therapeutic problems because of presence of comorbidity, nutritional and socio-economic factors and increased incidence of adverse drug reactions and mortality There is scarcity of published literature on manifestations of pulmonary tuberculosis (PTB) among elderly patients in pakistan.Objective:To study and compare the clinical, radiological and laboratory manifestations of PTB among younger-aged, middle-aged and elderly patients.Materials and Methods: By Non-Probability convenient sampling we sampled 100 patients with pulmonary tuberculosis presented in outpatient and inpatient department of medicine of CDA Hospital Islamabad Pakistan from May 1st, 2007 to April 30th, 2008. There were 37 young (mean age 22 years), 29 middle-aged (mean age 45 years) and 34 elderly (mean age 72 years) patients of pulmonary tuberculosis. The difference in presentations between the three study groups were analyzed for statistical differences using statistical package for social sciences (SPSS, version 13.0). The p-value of significance used for this study was p-value < 0.05.Results: The elderly patients were more likely to have dyspnea (94% p<0.000), weight loss (70% p<0.000) and anorexia (97% p<0.000). In the younger-aged group, hemoptysis (64% p<0.01) and fever (97% p<0.002) were common. Long duration of symptoms was common in the elderly group. Sign of malnourishment was common (58% p<0.000) in the elderly group. Lower zone and bilateral involvement was observed in the chest x-ray and this was common in the elderly group while the upper zone involvement was common in the younger-aged groups and middle zone in middle-aged group. Increased total lung capacity (TLC), elevated ESR, low Hb, and low serum albumin were present in the elderly. Conclusion: The elderly patients presented with dyspnea, non-specific symptoms, atypical radiographic appearance and low serum albumin as compared to younger-aged and middle- aged patient groups.