Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Int J Tuberc Lung Dis. 2017 Dec 1;21(12):1251-1257. doi: 10.5588/ijtld.17.0161.
Reports on tuberculosis (TB) presentation among the elderly in sub-Sahara Africa are scarce at a time when the elderly population is increasing. This dearth of information is likely to lead to an increase in the number of undetected TB cases in the region.
To describe TB presentation and response to anti-tuberculosis treatment at 2 months among elderly patients.
Consecutive patients referred to TB centres in Dar es Salaam, Tanzania, underwent clinical, microbiological and chest X-ray (CXR) evaluations at baseline and after 2 months of anti-tuberculosis treatment. Patients aged 60 years were considered elderly and those aged 18-59 years formed the comparison group.
Elderly patients with TB were more likely to have smear-negative TB (76.7% vs. 49.3%, P < 0.0001) and lower-zone lesions on CXR (41% vs. 17%, P < 0.001), but less likely to have cavities on CXR (77.6% vs. 50.4%, P < 0.0001) than the comparison group. Hypertension and diabetes mellitus were more common among the elderly than among controls. Mortality at 2 months was respectively 18.6% and 8.1% among the elderly and among controls. Human immunodeficiency virus infection and smoking increased mortality, while hypertension was associated with reduced mortality.
TB in the elderly was associated with atypical clinical and radiological presentations. A high index of suspicion could minimise delays in diagnosis and treatment.
在撒哈拉以南非洲地区，老年人群体不断增加，但有关该人群结核病（TB）表现的报告却很少。这种信息匮乏很可能导致该地区未被发现的结核病病例数量增加。
描述老年患者结核病的临床表现和抗结核治疗 2 个月时的反应。
坦桑尼亚达累斯萨拉姆的结核病中心连续纳入患者，在基线和抗结核治疗 2 个月后进行临床、微生物学和胸部 X 线（CXR）评估。年龄≥60 岁的患者被视为老年患者，年龄 18-59 岁的患者为对照组。
与对照组相比，老年结核病患者更有可能患有涂片阴性结核病（76.7% vs. 49.3%，P<0.0001）和 CXR 下区病变（41% vs. 17%，P<0.001），但 CXR 上有空洞的可能性更小（77.6% vs. 50.4%，P<0.0001）。与对照组相比，高血压和糖尿病在老年患者中更为常见。2 个月时的死亡率分别为老年组 18.6%和对照组 8.1%。人类免疫缺陷病毒感染和吸烟会增加死亡率，而高血压与死亡率降低相关。
老年结核病的临床表现和影像学表现不典型。高度怀疑可以最大程度地减少诊断和治疗的延误。
