Pulmonary Tuberculosis in the Elderly

Despite the increased rate of tuberculosis (TB) in the elderly, few publications have presented the clinical characteristics of TB in this specific age group in our country. This study aimed to compare the clinical features, predisposing factors and imaging findings of pulmonary TB in the elderly and in young adults, and to determine if any difference exists between the two groups. We retrospectively reviewed the records of all patients with the diagnosis of pulmonary TB at Ghaem Hospital and outpatient clinics during a 6-year period. Ninety-five patients were studied and divided into two groups, 33 patients were in the young group (mean age, 29.3 yrs.) and 40 patients in the elderly group (mean age, 69.6 yrs.). Patients aged 46-64 were excluded from the study. Predisposing factors were more prevalent in the elderly who had a significantly higher frequency of chronic obstructive pulmonary disease, ischemic heart disease, congestive heart failure, malignancy and diabetes mellitus. Pregnancy and postpartum status were the predisposing conditions in young females. The classic symptoms and signs of TB were noted in a higher proportion of the younger group. Fever (78% vs. 57.5%), and weight loss(94% vs. 80%) were significantly higher (p<0.05),while night sweats(24% vs. 22.5%),cough (100% vs. 92.5%) and hemoptysis(30% vs. 15%), were seen more in the younger group but with no significant differences. Lower lung infiltrates were higher in the elderly; whereas, cavitation was seen significantly more in the young age group(63% vs. 25%, p<0.05). To prevent delay in diagnosis and treatment, TB should be considered among the differential diagnosis of any type of pulmonary infiltrates seen in the elderly, even when the clinical presentation is atypical.