Clinical spectrum and outcomes of geriatric tuberculosis emergencies in North India
1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
2Department of Medical Microbiology, Postgraduate Institute of Medical Educationand Research, Chandigarh, India
3Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
Keywords: Cartridge-based nucleic acid amplification test, diagnosis, emergency, geriatrics, mortality, older, spectrum, tuberculosis, Xpert
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.
Ethical approval obtained. Name: Institutional Ethics Committee, PGIMER, Chandigarh, Date of the ethical approval: 09/08/2019, Number of ethical approval: INT/IEC/2019/001528). A written informed consent form was obtained from all study participants.
NR patient management, collected patient data, drafted the manuscript. RY patient management, collected patient data. SS patient management, revised the manuscript. AS patient management, revised the manuscript. AB patient management. AB patient management, revised the manuscript. MG patient management, revised the manuscript. AKP conceived the idea, patient management, drafted and revised the manuscript.