Clinical spectrum and outcomes of geriatric tuberculosis emergencies in North India

Abstract

OBJECTIVES: Despite the acute and life-threatening repercussions that tuberculosis (TB) may have on the burgeoning older population in endemic countries like India, the spectrum of geriatric TB emergencies is not adequately understood. METHODS: We performed a prospective observational study at the emergency department of an academic hospital in north India between January 2019 and June 2020, investigating the clinical and laboratory features and outcomes of active TB in older patients aged 60 years and above. RESULTS: Out of 71 geriatric TB emergencies, central nervous system disease predominated ( n = 41, 57.7%), followed by pulmonary ( n = 16, 22.5%), pleural TB ( n = 8, 11.3%), and multisite involvement ( n = 6, 8.4%). Nearly 71.8% were male, and 77.4% belonged to low socioeconomic status (lower-middle or lower class). Usual predisposing factors were tobacco smoking (38.0%), chronic alcohol use (27.0%), and diabetes mellitus (23.9%). Atypical features were more frequent with extrapulmonary TB. Only 28.2% were microbiologically confirmed cases, and rifampicin resistance was seen in only one case. The mortality rate was considerably high (24.0%), highest with pulmonary TB (37.0%). CONCLUSION: Older patients with TB emergencies have atypical presentations, diagnostic difficulties, and high mortality.

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

“…А розвиток резистентності при використанні нестандартних схем лікування призводить до несприятливих наслідків і збільшує смертність, рівень якої серед людей похилого віку в 6 разів вищий, аніж серед молодих осіб [8]. На високий рівень смертності від ТБ серед людей похилого віку вказують й інші дослідники [1,9,10]. Для зниження смертності від ТБ із множинною лікарською стійкістю (МЛС-ТБ) у людей похилого віку, які проходять лікування, E. Kizito та співавтори [6] рекомендують приділяти увагу наданню соціальної підтримки.…”

Tuberculosis epidemic in India – a systematic review

“…11,57,58 In addition to gender differences in TB prevalence, mortality rates increased dramatically with age, being 17 times higher in children under 15 years and more than twice as common in adults 60 and older than in those between the ages of 15 and 59. 1,3,4,[10][11][12]20,28,38,41,43,46,59 Furthermore, the COVID-19 reaction-induced lockdown has resulted in poverty and economic hardship, worsening food shortages and making it more difficult to provide various TB services such as prevention, surveillance, and treatment to the vulnerable segment. 13,22,31,44,60 Children with TB had significant implications or problems during the COVID epidemic, such as requiring more mechanical breathing, being hospitalized for longer periods of time, and having poorer outcomes.…”

“…15,16,28,48,49,63 Additionally, several studies found that more than two-thirds of TB cases are observed in the economically productive age range (14-59 years). 1,3,4,9,10,20,31,37,38,40,41,43,46,59,73,74 The international health community, which has established multiple 5-year targets for TB elimination, has proposed a method combining improved diagnostics, medications, and vaccinations to identify and treat both latent and active TB infections in order to meet the 2050 target. 15,48,49,51 The Joint Effort for Tuberculosis Elimination Program, with TB professionals, NGOs, and private practitioners all playing crucial roles in assisting patients seeking TB treatment, has also proven successful in providing quality TB services and facilities to patients.…”

“…1). 7,9,10 In the same vein TB is commonly prevalent in 0-9-year-old children in India, consisting 0.11 million pediatric cases especially among those who have immunological weaknesses. [11][12][13][14][15] The COVID-19 pandemic, on the other hand, has occasionally hampered the access to essential healthcare services, resulting in an increase in the incidence of various community-borne diseases, mortality, and morbidity.…”