Chest
Volume 106, Issue 1, July 1994, Pages 28-32
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Clinical Investigations
Infection
Tuberculosis in Young Adults and the Elderly: A Prospective Comparison Study

https://doi.org/10.1378/chest.106.1.28Get rights and content

Objectives: To compare the clinical, bacteriologic, and radiologic features of pulmonary and pleural tuberculosis in young adults and the elderly and determine if any differences exist between both groups.

Design: Prospective recruitment of all patients diagnosed as having pulmonary and pleural tuberculosis in British Columbia, Canada.

Setting: A population-based sample from a provincial control program TB registry.

Patients: A total of 218 consecutive patients whose conditions were diagnosed between January 1990 and May 1991. We excluded 15 HIV-positive patients whose conditions were diagnosed during this study.

Intervention: Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical and epidemiologic data.

Main results: There were 142 young adult patients and 76 elderly patients. The young adults had a mean age of 41.2 years and the elderly group had a mean age of 75 years of age. Fever (p=0.002) and night sweats (p=0.02) were more common in young adults. In culture-proven disease, hemoptysis, fever, and cough were more common in young adult (p=0.03, 0.02, and 0.01, respectively). There was no difference in the duration of symptoms between the two groups. The odds ratio for cancers other than lung cancer, 3.98 (confidence interval, 1.49, 10.65) in the elderly group was the only significant risk factor to differ between the two groups. Skin test responses to 5TU PPD were positive in 86.2 percent of young adults and 67.6 percent of elderly patients tested (p=0.03). A total of 79.6 percent of young adults and 88.15 percent of the elderly patients (not significant) were culture positive. Comparison of radiologic findings in young adults vs elderly patients showed no significant differences apart from those with miliary TB 0.7 percent vs 6.7 percent (p=0.04).

Conclusions: In this population-based study, young adults were more likely to have hemoptysis, fever, and cough and to have a positive PPD response. Cancer was significantly associated as a risk factor in the older age group. There was no difference in bacteriologically proven disease or radiologic findings between the two groups, apart from the more common occurrence of miliary TB in the elderly.

Section snippets

Methods

All cases of pulmonary and pleural TB reported to the Registry, Division of Tuberculosis Control, Ministry of Health, BC, between January 1990 and May 1991 formed the study group. The definition of active TB included disease proved by isolation of Mycobacterium tuberculosis by culture from a patient and disease diagnosed by clinical and radiologic criteria with an appropriate response to therapy but without bacteriologic confirmation. The cases in which M tuberculosis was isolated are called

Statistical Analysis

Statistical analysis was done using a software package (SPSS). Differences between means were compared using a one-way analysis of variance. The χ2 test was also used to determine the significance of relationships between measurements on the nominal scale.

Demographics

During the study period, there were 233 cases of TB. One hundred forty-two cases occurred in young adults and 76 cases occurred in the elderly patients. Fifteen patients with confirmed HIV positive serologic tests were also diagnosed during the study period but were excluded. The mean age of the young adults was 41.6 years (median, 40.5 years; range, 16 to 64 years; SD± 13.45). The elderly group had a mean age of 75 years (median, 74 years; range, 65 to 96 years; SD±8.09). The major ethnic

Discussion

Although recent attention has focused on TB associated with HIV infection,3 TB continues to cause significant disease in the elderly, such that in 1988 the incidence of cases in patients older than 65 years was close to twice as high as any other age group.16,17 Prior to the recent onset of HIV-associated TB, the elderly, newly arrived immigrants, and minority populations were the groups in North America whose rates of disease continued to rise.6 The elderly have documented very high rates of

ACKNOWLEDGMENT

We would like to thank Dawn Sedmak for her secretarial assistance.

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    Supported in part by the B. C. Lung Association.

    This study was funded by the B.C. Lung Association.

    Manuscript revision accepted December 7.

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