Tuberculosis in young adults and the elderly. A prospective comparison study

Area of Science:

• Pulmonology
• Infectious Diseases
• Geriatrics

Background:

• Tuberculosis (TB) presents differently across age groups, impacting clinical presentation and outcomes.
• Understanding these age-related variations is crucial for effective TB diagnosis and management.

Purpose of the Study:

• To compare clinical, bacteriologic, and radiologic features of pulmonary and pleural tuberculosis in young adults and the elderly.
• To identify age-specific differences in tuberculosis presentation and risk factors.

Main Methods:

• Prospective, population-based study of 218 patients diagnosed with pulmonary or pleural tuberculosis in British Columbia.
• Data collection included symptoms, bacteriology, and radiology, with blinded review of imaging.
• Exclusion of 15 HIV-positive patients from the analysis.

Main Results:

• Young adults (mean age 41.2) more commonly presented with fever, night sweats, hemoptysis, and cough compared to the elderly (mean age 75).
• Positive purified protein derivative (PPD) skin test responses were more frequent in young adults (86.2%) than the elderly (67.6%).
• Cancer (non-lung) was a significant risk factor in the elderly (OR 3.98); miliary tuberculosis was more prevalent in the elderly (6.7%) than young adults (0.7%).

Conclusions:

• Young adults with TB exhibit distinct clinical symptoms and immunological responses compared to the elderly.
• Cancer is a notable comorbidity and risk factor in older TB patients.
• While bacteriologically confirmed disease and general radiologic findings were similar, miliary TB prevalence differed significantly by age group.