Tuberculosis in elderly patients in the city of Cali, Colombia: a hospital-based cohort study

García-Goez, José Fernando; Vélez, Juan D.; Mora, Bárbara; Parra-Lara, Luis Gabriel; Pino-Escobar, Jessica; Caylà, Joan A.; Miró, José M.

doi:10.36416/1806-3756/e20200072

Cited by 7 publications

(8 citation statements)

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“…TB delayed diagnosis or misdiagnosis and high mortality rates in the elderly are attributed to their increased likelihood of absent, altered, or delayed clinical symptoms, presence of ageassociated conditions such as cognitive impairment, and clinical symptoms shared by active TB and old age such as fatigue, and weight loss [5,30,52,53]. In our elderly cohort, we found clinical differences such as a lower prevalence of fever and chills, and longer duration of cough and weight loss.…”

Section: Plos Onementioning

confidence: 63%

“…Despite the lack of association between diabetes and TB in the elderly population, we recommend the screening for diabetes in all newly diagnosed elderly TB patients given that management of acute hyperglycemia is important for proper immune function against M. tuberculosis [40][41][42]. Furthermore, diabetes may be associated with adverse TB treatment outcomes in the elderly, as is the case for adults [5,43].…”

Section: Plos Onementioning

confidence: 99%

“…Approximately one-fourth of the world's population has latent Mycobacterium tuberculosis infection (LTBI) [3]. The relative risk of TB in the elderly is 1.5-fold higher than in adults (21 to 64 years old), and the risk of mortality is � 5-fold higher, with rates ranging from 20 to 30% [4][5][6]. Elderly patients are difficult to diagnose due to the lack of classical symptoms and to impaired or reduced responses to diagnostics such as the tuberculin skin test.…”

Section: Introductionmentioning

confidence: 99%

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A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Scordo

Aguillón-Durán²,

Ayala³

et al. 2021

PLoS ONE

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Background Aging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics. Methods Cross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression. Results LTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45). Conclusions We report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.

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Section: Plos Onementioning

confidence: 63%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Scordo

Aguillón-Durán²,

Ayala³

et al. 2021

PLoS ONE

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“…2 The elderly have a 1.5-fold risk of progressing to TB when compared to adults, and are prone to severe treatment outcomes with 20-30% mortality. [3][4][5] TB risk factors in the elderly include higher prevalence of LTBI and a dysfunctional immune system, marked by inflammaging and oxidative stress. 3,6 Higher LTBI prevalence in older people is largely attributed to their lifetime-accumulated risk of exposure to M.tb.…”

Section: Introductionmentioning

confidence: 99%

Interferon gamma release assays for detection of latent Mycobacterium tuberculosis in older Hispanic people

Scordo

Aguillón-Durán

Ayala³

et al. 2021

International Journal of Infectious Diseases

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“…2 The elderly have a 1.5-fold risk of progressing to TB when compared to adults, and are prone to severe treatment outcomes with 20-30% mortality. 3-5 TB risk factors in the elderly include higher prevalence of LTBI and a dysfunctional immune system, marked by inflammaging and oxidative stress. 3,6 Higher LTBI prevalence in older people is largely attributed to their lifetime-accumulated risk of exposure to M .…”

Section: Introductionmentioning

confidence: 99%

Interferon Gamma Release Assays for Latent Mycobacterium tuberculosis Detection in Elderly Hispanics

Aguillon

Ayala³

et al. 2021

Preprint

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SUMMARY Background. Aging is a tuberculosis comorbidity. Interferon Gamma Release Assays (IGRAs) are used to detect latent Mycobacterium tuberculosis (M.tb) infection (LTBI) in adults, but their performance in the elderly is not well established. We aim to evaluate the performance of IGRAs for LTBI detection in healthy elderly Hispanics with recent, remote or no history of M.tb exposure. Study Design and Methods. Cross sectional study in Hispanic elderly (60+y) and adult (18-50y) recent TB contacts (ReC) or community controls (CoC). LTBI was based on a positive T-SPOT.TB and/or QuantiFERON-Gold in-tube or Plus assay. Results. We enrolled 193 CoC (119 adults/74 elderly) and 459 ReC (361 adults/98 elderly). LTBI positivity increased with age in CoC (range 19-59%; trend p <0.001), but was similar in ReC (range 59-69%; trend p=0.329). The elderly had lower concordance between IGRAs (kappa 0.465 vs. 0.688 in adults) and more inconclusive results (indeterminate/borderline; 11.6% vs. 5.8% in adults; p=0.012). Exclusion of inconclusive results improved concordance between assays, notably in elderly ReC, who have the highest TB risk (from kappa 0.532 to 0.800). When both IGRAs were done simultaneously, inconclusive results were resolved in all cases as positive or negative with the other IGRA. The magnitude of the response to M.tb peptides used in the assays was similar between age groups, but responsiveness to mitogens was lower in the elderly. Conclusions. IGRAs are suitable for LTBI detection in the elderly. Discordant and inconclusive findings are more prevalent in the elderly, but results were resolved when performing different IGRAs simultaneously in the same participant.

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Tuberculosis in elderly patients in the city of Cali, Colombia: a hospital-based cohort study

Cited by 7 publications

References 0 publications

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Interferon gamma release assays for detection of latent Mycobacterium tuberculosis in older Hispanic people

Interferon Gamma Release Assays for Latent Mycobacterium tuberculosis Detection in Elderly Hispanics

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