Tuberculosis in the elderly: Challenges in a low-incidence area

Tuberculosis (TB) in the elderly poses unique challenges, especially in low-incidence areas. This study examines the characteristics, diagnostic processes, and outcomes of TB cases in individuals over 65 years in our centre over the last 15 years. Our objective was to identify factors influencing TB outcomes in the elderly to improve clinical management and highlight risk factors for poor evolution in our environment.

We conducted a retrospective cohort study from 2010 to 2024, involving patients over 65 years with culture-confirmed TB. Data on demographics, clinical presentation, diagnostics, treatment, and outcomes were collected and analysed.

Among 821 TB cases, 130 (15.83%) involved patients over 65, of them 124 were included for the analysis. The median age was 78 years, with a male predominance (54.8%). Atypical presentations were frequent (75%) leading to prolonged diagnostic delays, median 84 days. Only 47.6% cases were exclusively pulmonary disease, while 23.4% were extrapulmonary and 19.4% disseminated. Overall mortality was 23.4%. Of these deaths, 18.5% were directly attributable to tuberculosis. Being older than 85 years, chronic kidney disease (CKD), and disseminated disease were independent predictors of mortality.

Tuberculosis in elderly patients is linked to elevated mortality rates and frequently presents with atypical clinical features, leading to delays in diagnosis and suboptimal outcomes. Enhanced awareness, improved diagnostic approaches, and multidisciplinary management are essential in our context.