Progressive Age-related Changes in Pulmonary  Tuberculosis Images and the Effect of Diabetes

Pérez-Guzmán, Carlos; Torres-Cruz, Alfredo; Villarreal-Velarde, H; Vargas, Mario H.

doi:10.1164/ajrccm.162.5.2001040

Cited by 115 publications

(91 citation statements)

References 21 publications

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“…Diabetes mellitus was also found to be strongly associated with advancing age, in accordance with the findings of other authors, (19,20) who include this disease in the list of those which increase the susceptibility to pulmonary tuberculosis, even causing alterations in the usual radiological aspect of the disease, such as involvement of the lower lobes. (5,20,21) The cardiovascular diseases evaluated in the present study were also strongly associated with being elderly, although no causal relation with pulmonary tuberculosis was established. This might be another confounding factor, since such diseases are quite frequently present in any elderly population and not only in that with pulmonary tuberculosis.…”

Section: Discussionsupporting

confidence: 89%

“…(6,15) Within this context, we found that more diseases associated with the elderly, especially diabetes, lung diseases, and cardiovascular diseases, which is in accordance with the findings of other authors. (16)(17)(18)(19)(20) Other lung diseases, present in 38% of the elderly patients with concomitant diseases, might be confounding factors in the diagnosis of pulmonary tuberculosis, since they present similar symptoms. Diabetes mellitus was also found to be strongly associated with advancing age, in accordance with the findings of other authors, (19,20) who include this disease in the list of those which increase the susceptibility to pulmonary tuberculosis, even causing alterations in the usual radiological aspect of the disease, such as involvement of the lower lobes.…”

Section: Discussionmentioning

confidence: 99%

“…(16)(17)(18)(19)(20) Other lung diseases, present in 38% of the elderly patients with concomitant diseases, might be confounding factors in the diagnosis of pulmonary tuberculosis, since they present similar symptoms. Diabetes mellitus was also found to be strongly associated with advancing age, in accordance with the findings of other authors, (19,20) who include this disease in the list of those which increase the susceptibility to pulmonary tuberculosis, even causing alterations in the usual radiological aspect of the disease, such as involvement of the lower lobes. (5,20,21) The cardiovascular diseases evaluated in the present study were also strongly associated with being elderly, although no causal relation with pulmonary tuberculosis was established.…”

Section: Discussionmentioning

confidence: 99%

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Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

2007

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Objective: To describe the clinical and therapeutic aspects of pulmonary tuberculosis and compare the adverse effects of the treatment and its outcome in elderly and nonelderly patients. Methods: This was a case-control study of 117 elderly individuals (over the age of 60 years) and 464 nonelderly individuals (aged 15-49 years). All subjects presented pulmonary tuberculosis that had been diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 1980 and 1996. Results: In the elderly group, pulmonary tuberculosis was found to be correlated with diabetes (OR = 3.98; 95% CI = 2.07-7.65; p = 0.001), lung disease (OR = 7.24; 95% CI = 3.64-14.46; p = 0.001) and heart disease (OR = 5.86; 95% CI = 2.88-11.95; p = 0.001). Smoking (OR = 2.07; 95% CI = 1.26-3.42; p = 0.002) and alcohol abuse (OR = 1.63; 95% CI = 1.01-2.68; p = 0.041) were also more common in the elderly group. In the elderly group, the treatment more frequently resulted in adverse reactions (OR = 1.62; 95% CI = 1.04-2.54; p = 0.024), especially gastrointestinal reactions (OR = 1.64; 95% CI = 1.01-2.77; p = 0.047), and treatment efficacy was lower: cure rate, 51%; mortality rate, 24%. Treatment adherence was low (approximately 77%) in both groups. Conclusions: In the elderly group, adverse reactions were more common, treatment outcomes were less favorable, there was a greater frequency of clinical complications and deaths related to drug toxicity, and the prevalence of concomitant diseases was higher.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

2007

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“…However, there have been studies in which the symptomatic period did not differ among age brackets but did differ in relation to radiological findings. (25,26) In the present study, there was no difference between the two groups in terms of the infiltrates and cavitations seen on chest X-rays. Therefore, we can conclude that, radiologically, suspicion of the disease in the sample observed was possible in the two groups, and no atypical radiological forms (lesions in lower lobes, masses, atelectasis, etc.)…”

Section: Discussioncontrasting

confidence: 55%

Aspectos clínicos da tuberculose pulmonar em idosos atendidos em hospital universitário do Rio de Janeiro, RJ, Brasil

2007

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Objective: To evaluate clinical aspects and the diagnosis of pulmonary tuberculosis (PT) in the aged. Methods: We compared 117 patients over 60 years of age (elderly group) and 464 patients aged 15 to 49 years old (nonelderly group) treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, from 1980 to 1996. Results: Previous history of PT was predominant in the elderly group (OR = 2.09; 95% CI = 1.26-3.45; p = 0.002), whereas household contact with PT was predominant in the nonelderly group (OR = 0.26; 95% CI = 0.10-0.66; p = 0.002). Mean time for diagnosis was 90 days in the elderly group and 60 days in the nonelderly group. In the elderly group, dyspnea (OR = 1.64; 95% CI = 1.06-2.53; p = 0.018) and weight loss (OR = 1.66; 95% CI = 1.01-2.82; p = 0.047) were predominant. In the nonelderly group, hemoptysis (OR = 0.51; 95% CI = 0.32-0.81; p = 0.002), chest pain (OR = 0.62; 95% CI = 0.40-0.97; p = 0.027) and fever (OR = 0.55; 95% CI = 0.35-0.86; p = 0.006) were more common. The most common radiological abnormalities were infiltrates and cavitations. Bilateral involvement was more common in the elderly patients (OR = 1.76; 95% CI = 1.12-2.78; p = 0.009). There were no differences between the two groups regarding positivity for Mycobacterium tuberculosis identified through tuberculin skin testing, sputum smear microscopy and culture. Conclusions: There are few clinical and laboratory differences between the age groups. The delayed diagnosis in the elderly group can be explained by the low clinical suspicion in these patients.

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“…(21) One group of authors also described the atypical presentation of pulmonary TB in patients with diabetes. (22) Among the patients with diabetes included in our study, a history of weight loss was less common. However, there was not a higher prevalence of other unusual clinical and radiological changes in this group.…”

Section: Discussionmentioning

confidence: 94%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients. Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host. ResumoObjetivo: Investigar as características de pacientes imunocomprometidos não HIV com diagnóstico intrahospitalar de tuberculose e determinar os fatores de risco para mortalidade. Métodos: Durante um período de dois anos, foi realizado um estudo de coorte retrospectivo que incluiu os pacientes com diagnóstico de tuberculose após a internação. Os fatores preditores de mortalidade foram coletados. Resultados: Durante o período do estudo, 337 pacientes foram internados e diagnosticados com TB, e desses, 61 apresentavam imunossupressão não decorrente da infecção pelo HIV. A tuberculose extrapulmonar estava presente em 47,5% dos casos. Nesse grupo, a taxa de mortalidade intra-hospitalar foi de 21,3%, e a mortalidade após a alta foi de 18,8%. Os pacientes imunocompetentes tiveram sobrevida em um ano maior que os pacientes com HIV (p = 0,008) e que os imunocomprometidos não HIV (p = 0,015), mas não houve diferença na sobrevida entre esses dois últimos grupos (p = 0,848). Entre os pacientes imunocomprometidos não HIV, o único fator estatis...

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Progressive Age-related Changes in Pulmonary Tuberculosis Images and the Effect of Diabetes

Cited by 115 publications

References 21 publications

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

Aspectos clínicos da tuberculose pulmonar em idosos atendidos em hospital universitário do Rio de Janeiro, RJ, Brasil

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

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