Features of patients older than 65 years with pulmonary tuberculosis

Abstract

Introduction. The distribution of patients with tuberculosis in age groups is very heterogenous worldwide. It reflects the social inequalities, barriers in health care accessibility and the rate of comorbid groups. Individuals older than 65 years are more predisposed for the sickness in countries with low burden of tuberculosis and those younger than 35 years–in high burden countries. Aim of the study. To study the particularities of patients with pulmonary tuberculosis older than 65 years and to identify the final outcome in mun. Chisinau. Materials and methods. A retrospective, longitudinal and selective study which included 92 patients diagnosed with tuberculosis during 2018 in Chisinau was performed. Results. Assessing the gender distribution men were 66 (72%) and women 26 (28%). The average age was 73 years. One half, 43 (46%) were detected by the family doctor through the examination of symptomatic cases and through the active screening - 12 (13%) cases. Pulmonologist detected 15 (16%) investigating the symptomatic cases and 10 (18%) through the radiological screening. Were addressed to the specialized hospital 12 (13%) cases. Associated to tuberculosis were diagnosed in 87 (94%) one or more comorbidities. Distribution by groups depending on the type of case: new cases 64 (70%), cases of relapse 18 (19%), recovered after loss of supervision 6 (6%), after therapeutic failure 4 (5%). Distribution according to the social economical level identified that 70 (76%) were retired individuals. People with disabilities were 10 (11%). No financial support was established in 12 (13%) cases. Harmful habits were established in 38 (42%) cases with active smoking. Chronic alcohol consumption was identified in 18 (20%) cases. Intravenous drug use in anamnesis was established in 1 (1%) cases. Were in tuberculous contact 12 (13%) cases. Assessing the tuberculosis anamnesis was detected a previsous antituberculosis treatment in 28 (30%). The majority 78% were diagnosed with infiltrative form, however sever, extended with bilateral localisation were diagnosed in 33 (36%) cases. Microbiological positive were 25 (27%), however the conventional cultures established mycobacteria in 45 (49%) cases. All patients were treated with first line antituberculosis drugs which conducted to a successful outcome in 70 (75%). Low outcome included death 6 (6%), failure 3 (2%) and lost to follow up of 6 (6%). Conclusions. People older than 65 years are an age group affected by TB if there are several common risk factors established: male sex, social vulnerable state, harmful habits (active smoking, alcohol consumption) and comorbidities. One third of the group resulted in poor treatment outcome. It can be concluded that a complex approach to patients older than 65 should be done, not only in mun. Chisinau, considerating the epidemiological state of tuberculosis in the Republic of Moldova.