Chest
Volume 116, Issue 4, October 1999, Pages 961-967
Journal home page for Chest

Clinical Investigations
TUBERCULOSIS
Does Aging Modify Pulmonary Tuberculosis?: A Meta-Analytical Review

https://doi.org/10.1378/chest.116.4.961Get rights and content

Study objectives

To evaluate the differences in the clinical, radiologic, and laboratory features of pulmonary tuberculosis (TB) in older patients, as compared to younger patients.

Design

A meta-analysis (the Schmidt-Hunter method) of published works found in MEDLINE and other sources was performed. A total of 12 studies were collected, and each variable was submitted to meta-analysis.

Results

No differences were found between older (≥ 60 years old) and younger TB patients with respect to male predominance, evolution time before diagnosis, prevalence of cough, sputum production, weight loss, fatigue/malaise, radiographic upper lobes lesions, positive acid-fast bacilli in sputum, anemia or hemoglobin level, and serum aminotransferases. A lower prevalence of fever, sweating, hemoptysis, cavitary disease, and positive purified protein derivative, as well as lower levels of serum albumin and blood leukocytes were noticed among older patients. In addition, the older population had a greater prevalence of dyspnea and some concomitant conditions, such as cardiovascular disorders, COPD, diabetes, gastrectomy history, and malignancies.

Conclusions

This meta-analytical review identified the main differences of older TB patients, as compared to younger TB patients, that should be considered during the diagnostic evaluation. Most of these differences are explained by the already known physiologic changes that occur during aging.

Section snippets

Materials and Methods

A search for comparative studies related to pulmonary TB in older and younger subjects was made in June 1998 using the entire MEDLINE database (from 1966 to 1998) through the Internet site of the National Library of Medicine (http://www.ncbi.nlm.nih.gov). The terms“ pulmonary TB AND (aged OR aging OR old OR older OR elder OR elderly)” appearing in any field of the database records retrieved 7,440 articles. Further searching for “comparative OR comparison OR compared” in any field yielded 1,011

Results

As can be seen in Table 1, all of the studies included inpatients in their populations, while outpatients were also included in half of them. The pooled number of patients was comprised of a total population of 859 older and 1,801 younger patients. There was a noticeable variability in the results obtained by these studies, both in the clinical features and the auxiliary tests (Table 2), as well as in the radiologic findings (Table 3). Because many variables were not uniformly present in all of

Discussion

In this work, a meta-analytical review was performed of the main clinical, radiologic, and laboratory features of TB in older patients, as compared to younger patients. In relation to the gender of the patients, we found that male predominance was consistently described by most of the analyzed reported series, and the magnitude of this predominance, as indicated by the meta-analysis, was not different between younger and older patients. The reason for the higher frequency of TB in male subjects

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