Age and ageing · 2012
Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Cruz-Hervert Luis Pablo, García-García Lourdes, Ferreyra-Reyes Leticia, Bobadilla-del-Valle Miriam, Cano-Arellano Bulmaro, Canizales-Quintero Sergio, Ferreira-Guerrero Elizabeth, Báez-Saldaña Renata, Téllez-Vázquez Norma, Nava-Mercado Ariadna, Juárez-Sandino Luis, Delgado-Sánchez Guadalupe, Fuentes-Leyra César Alejandro, Montero-Campos Rogelio, Martínez-Gamboa Rosa Areli, Small Peter M, Sifuentes-Osornio José, Ponce-de-León Alfredo
Аннотация
BACKGROUND: worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults.
OBJECTIVE: to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.
METHODS: we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.
RESULTS: eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; P<0.001) adjusting for sociodemographic and clinical variables.
CONCLUSIONS: community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.
OBJECTIVE: to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.
METHODS: we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.
RESULTS: eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; P<0.001) adjusting for sociodemographic and clinical variables.
CONCLUSIONS: community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.
Предметные рубрики MeSH
AdolescentAdultAge DistributionAge FactorsAgedAgingAntitubercular AgentsChi-Square DistributionCluster AnalysisCoughHumansIncidenceLatent TuberculosisLogistic ModelsMass ScreeningMexicoMicrobial Sensitivity TestsMiddle AgedMultivariate AnalysisMycobacterium tuberculosisOdds RatioPredictive Value of TestsProportional Hazards ModelsRisk AssessmentRisk FactorsSputumTreatment FailureTuberculosis, PulmonaryYoung Adult