Tuberculosis In Elderly Patients Research Articles

Trends of type 2 diabetes with pulmonary tuberculosis patients,2013–2022, and changes after the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo describe the trends of Type 2 Diabetes with Pulmonary Tuberculosis (T2DM-TB) patients from 2013 to 2022 and to investigate the impact of COVID-19 lockdown on glycemic control and associated factors in T2DM-TB. MethodsIn this population-based study of the First Affiliated Yijishan Hospital of Wannan Medical College in China, we described the 10-year trends of patients diagnosed with T2DM-TB. We included patients diagnosed with TB, T2DM-TB and T2DM-TB patients for comparative analysis, aged 15 years or older. Data were missing, and both multidrug-resistant (MDR) TB patients and non-T2DM patients were excluded from our study. ResultsWe pooled Type 2 Diabetes (T2DM) and Tuberculosis (TB) data from The First Affiliated Yijishan Hospital of Wannan Medical College in China, gathered between January 1, 2013, and December 31, 2022. The data included 14,227 T2DM patients, 6130 TB patients, and 982 T2DM-TB patients. During the past 10 years, the number of inpatients with TB decreased, while the number of patients with T2DM and T2DM-TB increased year by year. To rule out any influence factors, we analyzed the ratio of the three groups. The ratio of TB/T2DM decreased year by year (p < 0.05), while the ratio of TB-T2DM/TB increasing year by year (p = 0.008). During the COVID-19 epidemic period, there was no significant change in the ratio of TB-T2DM/T2DM (p = 0.156). There was no significant change in the proportion of male patients with TB and TB-T2DM (p = 0.325; p = 0.190), but the proportion of male patients with T2DM showed an increasing trend (p < 0.001). The average age of TB patients over the past 10 years was 54.5 ± 18.4 years and showed an increasing trend year by year (p < 0.001). However, there was no significant change in the age of T2DM or TB-T2DM patients (p = 0.064; p = 0.241). Patients data for the first (2013–2017) and the last (2018–2022) five years were compared. We found that the number of T2DM and TB-T2DM in the last five years was significantly higher than in the first five years, but the number of TB was significantly lower than in the first five years. There is a significant statistical difference in the proportion of TB/T2DM and TB-T2DM/TB, which is similar to the previous results. The average age (56.0 ± 17.6 years) of TB patients in the last five years is significantly higher than in the first five years (53.1 ± 18.9) (p < 0.001). The number of male patients with T2DM in the last five years is higher than that in the first five years, with significant difference (p < 0.001). ConclusionThe trends of T2DM-TB among hospitalized TB patients have increased significantly over the past 10 years, which may be related to the increase in the number of T2DM cases. The COVID-19 pandemic has been effective in controlling the transmission of TB, but it has been detrimental to the control of T2DM. Male patients with T2DM and elderly TB patients are the key populations for future prevention and control efforts.

Relationship between Side Effects of Anti-tuberculosis Drugs (ATDs) and Adherence to Medication in Elderly Patients with Tuberculosis

One of the obstacles to the treatment of tuberculosis (TB) patients is the sideeffects of anti-tuberculosis drugs (ATDs) which cause patients to be reluctant to continue the medication. The elderly experience various physical and physiological changes in the bodysystem, including susceptibility to drug side effects, decreased knowledge and memory,resulting in non-compliance with taking the medication. This study aims to determine therelationship between ATDs side effects and compliance with taking medication for elderlypatients at the Tanjung Selor Health Center, Bulungan Regency, North Kalimantan Province.This study used a quantitative cross-sectional approach. The sample was taken by totalpopulation, namely elderly tuberculosis patients undergoing tuberculosis treatment as many as30 respondents. The research instrument was a questionnaire of drug side effects and ATDscompliance. Statistical test used Fisher's Exact. The results showed that most patients (76.7%)complained of OAT side effects and the rest without OAT side effects (23.3%). Treatmentcompliance was 20% compliant, and 80% were non-compliant. Fisher's Exact statistical testobtained p-value = 0.016 (&lt; α = 0.05). It was concluded that there was a significant relationship between OAT side effects and treatment compliance in elderly patients with tuberculosis. Recommendations for health workers to give special attention to elderly patients with medication monitoring and compliance motivation. Future researchers should identify the involvement of family and health workers to monitor the side effects of anti-tuberculosis drugs.

Effect of depression on treatment adherence among elderly tuberculosis patients: A prospective interventional study

BackgroundTuberculosis is a major public health concern, especially in the geriatric age group. Up to one-third of the population with serious medical illness are prone to depression and risk increases with increased severity of underlying illness. Treatment nonadherence is another major concern in elderly tuberculosis patients. Hence this study was focused to assess depression and non-adherence due to depression in elderly tuberculosis patients, and reassessing treatment adherence by giving intervention to improve depression. Materials and methodsThis prospective interventional study was done on 100 elderly TB patients. Depression was assessed by using Hamilton Depression Rating Scale (HDRS) and medication adherence by using Morisky's 8-item Medication Adherence Questionnaire (MMAS-8). Risk for low to medium adherence was expressed in odds ratio (OR) with an appropriate 95% confidence interval (CI). ResultsThe overall prevalence of depression among the participants was 55% and 28% of the participants had low adherence. A significantly higher proportion of depressed patients (41.8% > 11.1%) were with lower adherence to the medication. On the regression model, participants with depression (adjusted OR 43.6, 95% CI 9.5–199) have a significantly higher chance of low to medium adherence with medication. With intervention for depression, the risk of low to medium adherence was reduced by 50.9% (95% CI: 35.9%–65.9%). ConclusionAlmost one in every two elderly TB patients suffers from comorbid depression. Around 90% will have low to moderate treatment adherence, which makes them treatment defaulters and increases the risk of drug-resistant tuberculosis.

Assessment of Effective Anti-TB Regimens and Adverse Outcomes Related Risk Factors in the Elderly and Senile-Aged TB Patients.

Compared to younger patients with tuberculosis (TB), elderly and senile-aged patients with TB had a higher incidence of adverse outcomes particularly in terms of lost to follow-up and deaths. Our study aimed to gain insight into the effectiveness of anti-tuberculosis (anti-TB) treatment in the elderly or senile-aged patients and identify the risk factors for adverse outcomes. The case information was obtained from the "Tuberculosis Management Information System". From January 2011 to December 2021, this retrospective analysis was conducted in Lishui City, Zhejiang Province to observe and record the outcomes of elderly patients diagnosed with TB who agreed to receive anti-TB and(or) traditional Chinese medicine(TCM) treatment. We also employed a logistic regression model to analyze the risk factors for adverse outcomes. Among the 1191 elderly or senile-aged patients with TB who received the treatment, the success rate was 84.80% (1010/1191). Using logistic regression analysis, several risk factors for adverse outcomes (failure, death, loss to follow-up) were identified, including age ≥ 80 years (OR 2.186, 95% CI 1.517~3.152, P<0.001), lesion area ≥ 3 lung fields (OR 0.410, 95% CI 0.260~0.648, P<0.001), radiographic lesions failing to improve after 2 months of treatment (OR 2.048, 95% CI 1.302~3.223, P=0.002), sputum bacteriology failing to turn negative after 2 months of treatment (OR 2.213, 95% CI 1.227~3.990, P=0.008), lack of a standardized treatment plan (OR 2.095, 95% CI 1.398~3.139, P<0.001), and non-involvement of traditional Chinese medicine (OR 2.589, 95% CI 1.589~4.216, P<0.001). The anti-TB treatment success rate in the elderly and senile-aged patients is suboptimal. Contributing factors include advanced age, extensive lesions, and low sputum negative conversion rate during the intensive treatment phase. The results will informative and could be useful for policy maker for to control of reemergence of TB in big cities.

Factors associated with adverse drug reactions or death in very elderly hospitalized patients with pulmonary tuberculosis

The aging of patients with tuberculosis and better therapeutic management for them are recent concerns. This study aimed to identify risk factors for adverse drug reactions (ADRs) or death in very elderly patients with pulmonary tuberculosis and to assess the association between the dosage of antituberculosis drugs and outcomes. We conducted a multicenter retrospective study at two hospitals. Hospitalized patients (≥ 80 years old) with pulmonary tuberculosis who were treated with antituberculosis drugs were enrolled. Multivariate analysis was performed to assess factors associated with ADRs or death within 60 days after treatment initiation. In total, 632 patients were included. The primary endpoint occurred in 268 patients (190 ADRs and 78 deaths). A serum albumin level < 2.5 g/dL, respiratory failure, and dependent activities of daily living were independent risk factors for ADRs or death. However, a low dosage (< 8 mg/kg/day) of rifampicin was associated with a lower risk of the primary outcomes. Delayed time to negative sputum culture conversion was not observed in the lower dosage of rifampicin group. Very elderly hospitalized tuberculosis patients with the aforementioned risk factors should be carefully monitored to receive safer treatment. Rifampicin dosage reduction may be considered for very elderly tuberculosis patients to prevent ADRs/death.

Effectiveness and safety of a modified short-term regimen of antimycobacterial therapy to treat rifampicin-resistant tuberculosis in elderly patients with concomitant diabetes (a clinical case)

Aim. To analyze the effectiveness and safety of a modified short-term regimen (mSTR) of antimycobacterial therapy (AMBT) for rifampicin-resistant tuberculosis (RR-TB) in a 71-year-old patient with type 2 diabetes mellitus (T2DM) on the clinical case example of own observation. Materials and methods. A clinical case from own observation of the patient who was treated at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University – Pulmonary Tuberculosis Department No. 2 of the Communal Non-profit Organization “Zaporizhzhia Regional Phthisio-Pulmonology Clinical Treatment and Diagnostic Center” is presented. Results. The presented case demonstrates the high safety and efficacy of all oral mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in the elderly person with RR-TB and concomitant decompensated T2DM who was smear-negative after 4 months as a result of treatment with 9-month mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs). Positive radiological dynamics were observed all the time and residual changes in the lungs after tuberculosis were diagnosed at the end of the treatment course. These results complement indications for the use of mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in RR-TB patients. Conclusions. mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs) is effective and safe in elderly patients with RR-TB and concomitant decompensated type 2 diabetes mellitus when adequate treatment of diabetes and timely correction of antimycobacterial drug side effects are undertaken.

Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study.

This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review. In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking). The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.

Psychological stress creates an immune suppressive environment in the lung that increases susceptibility of aged mice to Mycobacterium tuberculosis infection.

Age is a major risk factor for chronic infections, including tuberculosis (TB). Elderly TB patients also suffer from elevated levels of psychological stress. It is not clear how psychological stress impacts immune response to Mycobacterium tuberculosis (M.tb). In this study, we used social disruption stress (SDR) to investigate effects of psychological stress in young and old mice. Unexpectedly, we found that SDR suppresses lung inflammation in old mice as evidenced by lower pro-inflammatory cytokine levels in bronchial lavage fluid and decreased cytokine mRNA expression by alveolar macrophages. To investigate effects of stress on M.tb infection, mice were subjected to SDR and then infected with M.tb. As previously reported, old mice were better at controlling infection at 30 days than young mice. This control was transient as CFUs at 60 days were higher in old control mice compared to young mice. Consistently, SDR significantly increased M.tb growth at 60 days in old mice compared to young mice. In addition, SDR in old mice resulted in accumulation of IL-10 mRNA and decreased IFN-γ mRNA at 60 days. Also, confocal microscopy of lung sections from old SDR mice showed increased number of CD4 T cells which express LAG3 and CD49b, markers of IL-10 secreting regulatory T cells. Further, we also demonstrated that CD4 T cells from old SDR mice express IL-10. Thus, we conclude that psychological stress in old mice prior to infection, increases differentiation of IL-10 secreting T cells, which over time results in loss of control of the infection.

Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995-2016.

Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy. This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia. A retrospective study was conducted. All TB patients aged ≥60years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant. Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024). A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.

Evaluation of epidemiological and clinical characteristics of pulmonary tuberculosis in elderly patients of Yazd city

Due to the fact that tuberculosis is one of the most important diseases in Iran and also due to the re-emergence of tuberculosis in the world, this disease has received more attention. This study was aimed to investigate epidemiological and clinical characteristics of pulmonary tuberculosis in elderly patients of Yazd city. After the laboratory diagnosis, the doctor visited the patients and after confirming the diagnosis, the patients were referred to a specialist to complete the file and receive anti-tuberculosis drugs. Necessary information including: history, history of risk factors, history of treatment, diagnostic radiography, drug resistance and results of pulmonary tuberculosis treatment were reviewed by referring to patients' files. Finally, statistical analysis was performed using SPSS (version 16). Most of the participants were 75 years old. Most of the participants were illiterate and housewives. Nearly 59% had no underlying disease. Diabetes was the most common underlying disease among individuals. The results showed that knowledge of personal health care was lower in people with lower levels of literacy, which further increases the incidence of this disease in this group.

Psychological Stress of aged mice has long-term impact on Mycobacterium tuberculosis infection by altering composition of lung T cell populations

Abstract Aging is a major risk factor for chronic infections, including tuberculosis (TB). Elderly TB patients also suffer from elevated levels of psychological stress. It is not known how psychological stress impacts TB pathogenesis. To study the effects of stress on Mycobacterium tuberculosis (M.tb) we used a social disruption stress (SDR) model which involves repeated social defeat in subordinate mice. Young (3 month) and Old (18 month) C57BL/6 mice were subjected to SDR and infected with M.tb. Mice were sacrificed at 30 and 60 days post infection and M.tb burden analyzed by CFU assay and lung pathology by HE staining of lung sections. At day 30, M.tb burden was lower in control old mice compared to young mice and SDR did not significantly alter M.tb burden. However, at day 60, SDR in old mice significantly increased M.tb burden compared to SDR in young mice, indicating that SDR in old mice has a detrimental effect on the ability to control the infection. Our gene expression analysis revealed that T cell genes (JAK3 and LCP2) in the lungs of old SDR infected mice were increased but not in young SDR mice, suggesting that SDR in old mice increased T cell recruitment in the lung. Additionally, we found that Tbet (Th1) and GATA3 (Th2) gene expression were unchanged by SDR, in contrast the expression of RORγT (Th17) was increased by SDR in old mice at day 60. Also, mRNA levels of IL-10 at day 60 were increased by SDR in old mice, but not in young mice, while SDR decreased IFN-γ in both young and old mice. To further define T cell populations, we are analyzing lung sections by confocal microscopy. In conclusion, our studies suggest that psychological stress prior to M.tb prior to infection has long-term impact by altering composition of T cell populations in the lung. Supported by NIH grants (PO1-AG051428, AI146252 and AI146690)

P6‐47: Adverse drug reactions and their impact on the treatment of pulmonary tuberculosis in elderly patients

P6‐47: Adverse drug reactions and their impact on the treatment of pulmonary tuberculosis in elderly patients

Predictors of delayed sputum smear conversion among pulmonary tuberculosis patients in Kota Kinabalu, Malaysia: A retrospective cohort study.

Smear-positive pulmonary tuberculosis (SPPTB) is the major contributor to the spread of tuberculosis (TB) infection, and it creates high morbidity and mortality worldwide. The objective of this study was to determine the predictors of delayed sputum smear conversion at the end of the intensive phase of TB treatment in Kota Kinabalu, Malaysia.This retrospective study was conducted utilising data of SPPTB patients treated in 5 TB treatment centres located in Kota Kinabalu, Malaysia from 2013 to 2018. Pulmonary TB (PTB) patients included in the study were those who had at least completed the intensive phase of anti-TB treatment with sputum smear results at the end of the 2nd month of treatment. The factors associated with delayed sputum smear conversion were analyzed using multiple logistic regression analysis. Predictors of sputum smear conversion at the end of intensive phase were evaluated.A total of 2641 patients from the 2013 to 2018 periods were included in this study. One hundred eighty nine (7.2%) patients were identified as having delayed sputum smear conversion at the end of the intensive phase treatment. Factors of moderate (advanced odd ratio [aOR]: 1.7) and advanced (aOR: 2.7) chest X-ray findings at diagnosis, age range of >60 (aOR: 2.1), year of enrolment 2016 (aOR: 2.8), 2017 (aOR: 3.9), and 2018 (aOR: 2.8), smokers (aOR: 1.5), no directly observed treatment short-course (DOTS) supervisor (aOR: 6.9), non-Malaysian citizens (aOR: 1.5), and suburban home locations (aOR: 1.6) were associated with delayed sputum smear conversion at the end of the intensive phase of the treatment.To improve sputum smear conversion success rate, the early detection of PTB cases has to be fine-tuned so as to reduce late or severe case presentation during diagnosis. Efforts must also be in place to encourage PTB patients to quit smoking. The percentage of patients assigned with DOTS supervisors should be increased while at the same time ensuring that vulnerable groups such as those residing in suburban localities, the elderly and migrant TB patients are provided with proper follow-up treatment and management.

CLINICO-RADIOLOGICAL PATTERN OF PULMONARY TUBERCULOSIS AMONG ELDERLY AND YOUNG ADULTS IN A TERTIARY CARE CENTER.

Background: Clinical and radiographic manifestation of tuberculosis in elderly patients varies from young adults and not specic, often mistaken with other disease which may cause delay of therapy. For this we conducted study on clinical and radiographic manifestation of pulmonary tuberculosis in elderly patients. This study Methods: analyzed 100 pulmonary tuberculosis cases. We divided these patients in 2 groups i.e young adults (aged &lt;60 years) and elderly(aged ≥60 years). This study was conducted in the Department of TB &amp; Respiratory Diseases, RNT Medical College, Udaipur and analyzed by using Microsoft excel. We found that this study is Result: dominated by male patients. Chest pain, cough, dyspnoea, hemoptysis were found in-signicantly, while expectoration was found signicantly higher in young adults (p &lt; 0.01). Fever was more in young whereas anorexia was more common in elderly group and in physical signs, icterus was found signicantly more in young adults as the p value is &lt;0.05. Radiological bilateral involvement was found more in elderly group compared to adults (p = 0.67). Mixed and upper zone in adult patients consist majority patients. Elderly patients of PTB presented Conclusion: with recognized clinical and radiological features of disease.

Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019.

BackgroundWith an aging population, China is facing a huge burden of elderly patients with drug resistant tuberculosis (DR-TB), which has become a significant obstacle for the global TB control. There is still little study on DR-TB in the elderly in China so far. Thus, more research on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary.MethodsA retrospective study was conducted in Shandong, China from 2004 to 2019. We collected 12,661 primary TB cases, of which 4368 elderly (≥60 years) primary TB cases were involved. Clinical characteristics including age, sex, cavity, smoking, drinking, comorbidity and drug susceptibility data were collected from 36 TB prevention and control institutions of Shandong Province. Sputum samples were collected by each surveillance site, and examined in the TB Reference Laboratory of SPCH. Descriptive statistical analysis, chi-square and linear regression were used for analyzing.ResultsAmong 4368 elderly patients with primary TB, the DR-TB and multi-resistant tuberculosis (MDR-TB) accounted for 17.19% and 2.29%, respectively. During 2004–2019, the proportions of MDR-TB, polydrug resistant tuberculosis (PDR-TB), rifampin (RFP)-resistance increased by 160.00%, 18.18%, 231.82%, respectively and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%. Among the elderly with primary DR-TB during 2004–2019, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP-resistance (from 3.70 to 21.88), and streptomycin (SM)-resistance (from 37.04 to 62.5) increased significantly (P<0.05). And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81), INH-resistance (from 66.67 to 57.81) decreased significantly (P<0.05).ConclusionAmong the elderly, the proportions of MDR-TB, PDR-TB, RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity, RFP or SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to male, smoking, drinking, chronic obstructive pulmonary disease (COPD) and diabetes subgroups and take targeted measures to control these subgroups.

Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital.

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.

A Clinico-radiological presentation of smear positive pulmonary tuberculosis in elderly patient in tertiary care hospital of Bikaner, Rajasthan

A Clinico-radiological presentation of smear positive pulmonary tuberculosis in elderly patient in tertiary care hospital of Bikaner, Rajasthan

Delay on care-seeking and related influencing factors among tuberculosis patients in Wuhan, 2008-2017

Objective: To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017. Methods: Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study. Results: Days of delay among TB patients appeared as M=10 (P(25)-P(75): 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ(2)=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue. Conclusions: Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.

Comprehensive Intervention for Anxiety and Depression among the Community Elderly with Tuberculosis

Anxiety and depression are common comorbidities in the elderly who have tuberculosis. We conducted a community-based trial to explore the effect of comprehensive interventions on anxiety and depression of the elderly tuberculosis patients. The control group (n = 122) received health education, and the intervention group (n = 61) received health education, psychotherapy, home visit, peer support, and psycho-educational workshops. Compared with the control group, the anxiety (βGroup×Time = −0.79) and depression (βGroup×Time = −1.13) declined more pronounced in the intervention group. The results suggested that comprehensive interventions could alleviate the anxiety and depression of the elderly tuberculosis patients sustainably and effectively.

Detecting tuberculosis clusters in urban neighborhoods, Taipei, Taiwan: Linking geographic and genotyping evidence

Tuberculosis (TB) clusters, defined as two or more active TB cases with epidemiological links and the same genotype of Mycobacterium tuberculosis strains, are direct evidence of recent TB transmission. We analyzed TB cases newly diagnosed in 2006–2008, confirmed by the diagnostic laboratory, at a university-affiliated hospital in Taipei metropolitan area where TB is endemic in elderly populations. Numbers of randomly selected non-TB patients (as controls) from each district were proportional to the district population (Pearson's correlation coefficient = 0.8), which supports that patients who visited the hospital represent a spatially independent sample of total population in this area. We used the nearest neighbor hierarchical (NNH) clustering method and the spatial scan statistics to identify spatial TB clusters among 969 cases within the 10-km buffer, adjusting for the elderly population. One cluster with 10 TB cases from different households in geographic proximity to each other was detected by both NNH clustering and spatial scan statistics. Spoligotyping and mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping showed that four of the six M. tuberculosis strains from this spatial cluster were identical. Three of those four patients were older than 70 years, but none were nursing home residents. The identical genotypes of M. tuberculosis strains in clustered elderly TB patients living in neighborhoods indicate that recent transmission plays a significant role in TB endemicity among elderly populations in Taiwan.