Elderly patients with tuberculosis in a low-incidence country - clinical characteristics, inflammation and outcome.
elderly
immunity
inflammatory markers
survival
tuberculosis
Journal
The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424
Informations de publication
Date de publication:
18 Jun 2024
18 Jun 2024
Historique:
received:
19
12
2023
revised:
29
05
2024
accepted:
11
06
2024
medline:
21
6
2024
pubmed:
21
6
2024
entrez:
20
6
2024
Statut:
aheadofprint
Résumé
Susceptibility to respiratory infections increases with age. Diagnosing and treating tuberculosis in the elderly comes with the challenges of fewer specific symptoms and possibly more side-effects of treatment. Much is unknown when it comes to tuberculosis in the elderly, especially in relation to inflammation, which may impact mortality. We therefore investigated a clinical cohort of elderly tuberculosis patients. Patients aged ≥ 65 years, admitted to our tuberculosis reference centre between 2005 and 2021, were retrospectively included in our cohort. Sociodemographic data, clinical characteristics, laboratory results including inflammatory markers at baseline (monocyte, neutrophil, lymphocyte count and CRP levels), and treatment outcomes were collected. They were compared to the National Dutch TB Registry and analyzed using descriptive statistics. Survival analysis was performed using univariate Cox regression analysis and a log-rank test. Results were visualized in Kaplan-Meier curves. 104 elderly tuberculosis patients, mostly European, with a mean age of 75 years were included. None were HIV-infected. Miliary tuberculosis cases were overrepresented (14%) compared to the National Dutch TB Registry (5% in elderly, 2% adults). Fever occurred in 77% (57/74) and the duration of fever decreased with age. Innate immune markers, including monocyte/lymphocyte-ratio, moderately correlated with CRP. Overall mortality was 15%, and highest (33%) in patients with CRP levels >100mg/mL. In elderly tuberculosis patients in a low-incidence setting, mortality rates are higher in comparison to younger patients. The overrepresentation of miliary tuberculosis may suggest waning immunity, with a subset of patients exhibiting strong inflammation associated with increased mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Susceptibility to respiratory infections increases with age. Diagnosing and treating tuberculosis in the elderly comes with the challenges of fewer specific symptoms and possibly more side-effects of treatment. Much is unknown when it comes to tuberculosis in the elderly, especially in relation to inflammation, which may impact mortality. We therefore investigated a clinical cohort of elderly tuberculosis patients.
METHODS
METHODS
Patients aged ≥ 65 years, admitted to our tuberculosis reference centre between 2005 and 2021, were retrospectively included in our cohort. Sociodemographic data, clinical characteristics, laboratory results including inflammatory markers at baseline (monocyte, neutrophil, lymphocyte count and CRP levels), and treatment outcomes were collected. They were compared to the National Dutch TB Registry and analyzed using descriptive statistics. Survival analysis was performed using univariate Cox regression analysis and a log-rank test. Results were visualized in Kaplan-Meier curves.
RESULTS
RESULTS
104 elderly tuberculosis patients, mostly European, with a mean age of 75 years were included. None were HIV-infected. Miliary tuberculosis cases were overrepresented (14%) compared to the National Dutch TB Registry (5% in elderly, 2% adults). Fever occurred in 77% (57/74) and the duration of fever decreased with age. Innate immune markers, including monocyte/lymphocyte-ratio, moderately correlated with CRP. Overall mortality was 15%, and highest (33%) in patients with CRP levels >100mg/mL.
CONCLUSION
CONCLUSIONS
In elderly tuberculosis patients in a low-incidence setting, mortality rates are higher in comparison to younger patients. The overrepresentation of miliary tuberculosis may suggest waning immunity, with a subset of patients exhibiting strong inflammation associated with increased mortality.
Identifiants
pubmed: 38901573
pii: S0163-4453(24)00134-8
doi: 10.1016/j.jinf.2024.106200
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106200Informations de copyright
Copyright © 2024. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Declarations of interest None