Rising case fatality of bacteriologically proven pulmonary tuberculosis in The Netherlands

Analysis of registration cards from the Tuberculosis Control Program (TCP) showed a four-fold increase in case fatality of bacteriologically proven pulmonary tuberculosis in Dutch patients in the period 1973-1984. Registered data of 125 deceased patients whose primary cause of death was pulmonary tuberculosis were analyzed. Increased case fatality predominantly occurred in the elderly. Elderly patients presented often with other, less specific, complaints than coughing, but had a shorter combined patient's and doctor's delay than younger patients. The elderly were more often treated with 3 tuberculostatic drugs (INH, pyrazinamide, rifampin). Bacterial resistance was found in only 2%. Probably the most important factor concerning the raised case fatality in the elderly is the decline in immune response, due to ageing of the Dutch population. An effective response to tuberculostatic drugs needs a reasonably intact immune response. Declining immunity of the elderly group will increase incidence and mortality of pulmonary tuberculosis in this group.