Alsehali Afrah, Alrajih Haneen, Al-Jahdali Hamdan, Al-Safi Eiman, Layqah Laila, Baharoon Salim
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
J Epidemiol Glob Health. 2024 Dec;14(4):1591-1601. doi: 10.1007/s44197-024-00311-8. Epub 2024 Oct 29.
Tuberculosis (TB) is a significant contributor to morbidity and mortality. With a progressively aging population, TB is increasingly encountered in older adults. Understanding the clinical presentation and optimal treatment strategies for TB in this population is essential.
Clinical, radiological features, treatment, and outcome of patients aged 75 and above who were diagnosed with tuberculosis at King Abdulaziz Medical City in Riyadh in the period between January 2015 to December 2021wereevaluated retrospectively.
Among 92 elderly tuberculosis patients, most were male (76.1%) with a mean age of 82.5 years. Pulmonary TB was diagnosed in 52.2% of patients, Extra Pulmonary TB in 32.6%, and Disseminated TB in 15.2%. Comorbidities included Diabetes Mellitus (59.8%) and Congestive Heart Failure (41.3%). The most common presentation symptoms included cough (51.1%), fever (43.5%), dyspnea (39.1%), and weight loss (31.5%). Delay of TB diagnosis for up to 3 months was observed in 31.5% of patients. Weight loss and male gender were significant predictors of delayed diagnosis. Laboratory findings varied among TB types, with disseminated TB showing higher eosinophilia and thrombocytopenia. Completion of an initial RIPE treatment protocol was achieved in 67.6% of patients. Mortality during treatment occurred in 23.9% of patients. Pulmonary TB was associated with higher mortality compared to extrapulmonary TB (p = 0.007).
Tuberculosis is associated with high mortality in patients above the age of 75. There is still a substantial delay in TB diagnosis in the elderly. RIPE regimen is frequently changed due to side effects. Alternative regimen choices were quite variable. More studies on tuberculosis in this patient's population are needed to define the most effective therapeutic approach.
结核病是发病和死亡的重要原因。随着人口逐渐老龄化，老年人中结核病的发病率日益增加。了解该人群结核病的临床表现和最佳治疗策略至关重要。
回顾性评估2015年1月至2021年12月期间在利雅得阿卜杜勒阿齐兹国王医疗城被诊断为结核病的75岁及以上患者的临床、放射学特征、治疗及预后情况。
在92例老年结核病患者中，大多数为男性（76.1%），平均年龄82.5岁。52.2%的患者被诊断为肺结核，32.6%为肺外结核，15.2%为播散性结核。合并症包括糖尿病（59.8%）和充血性心力衰竭（41.3%）。最常见的症状包括咳嗽（51.1%）、发热（43.5%）、呼吸困难（39.1%）和体重减轻（31.5%）。31.5%的患者结核病诊断延迟长达3个月。体重减轻和男性是诊断延迟的重要预测因素。实验室检查结果因结核类型而异，播散性结核显示嗜酸性粒细胞增多和血小板减少更为明显。67.6%的患者完成了初始的RIPE治疗方案。治疗期间死亡率为23.9%。与肺外结核相比，肺结核的死亡率更高（p = 0.007）。
75岁以上患者结核病死亡率较高。老年人结核病诊断仍有显著延迟。由于副作用，RIPE方案经常更改。替代方案选择差异很大。需要对该患者群体的结核病进行更多研究，以确定最有效的治疗方法。
