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ORIGINAL ARTICLE
Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 71-74

Comparative analysis of tuberculosis in geriatric and younger age group: An experience from rural West Bengal, India


1 Department of Community Medicine, Burdwan Medical College and Hospital, Burdwan, India
2 Department of Community Medicine, IQ City Medical College and Narayana Hrudayalaya Hospital, Durgapur, West Bengal, India

Date of Web Publication13-Jun-2014

Correspondence Address:
Swapnil Shivam
House No 66, 2nd Floor, Ananya Apartment, Picnic Garden Road, Kolkata 700 039, West Bengal
India
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DOI: 10.4103/1118-8561.134487

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  Abstract 

Introduction: Tuberculosis differs clinically and radiologically in the geriatrics compared with young. Objective: The objective of the following study is to compare the profile and treatment outcome of geriatric and young tuberculosis patients. Materials and Methods: A retrospective analysis of 58 tuberculosis patients seen from November 2010 to December 2011. Study period was October to December 2012 in tuberculosis unit of Burdwan district of West Bengal Data were analyzed using Statistical Package for the Social Sciences  software (version 19.0 Inc., IBM, Chicago, IL, USA). Results: Male populations were significantly more among geriatric patients. New smear positive sputum conversion and relapse cases were found more in the geriatric age group Overall, unfavorable outcome was significantly higher in geriatric compared with younger age population (33.3% vs. 17.8%). Conclusion: Geriatric and pediatric tuberculosis patients differ in diseases characteristics and outcome.

Keywords: Geriatric, outcome, tuberculosis


How to cite this article:
Shivam S, Saha I, Mondal TK, Dasgupta S, Bhattacharyya KD, Roy RN. Comparative analysis of tuberculosis in geriatric and younger age group: An experience from rural West Bengal, India. Sahel Med J 2014;17:71-4

How to cite this URL:
Shivam S, Saha I, Mondal TK, Dasgupta S, Bhattacharyya KD, Roy RN. Comparative analysis of tuberculosis in geriatric and younger age group: An experience from rural West Bengal, India. Sahel Med J [serial online] 2014 [cited 2021 Jun 19];17:71-4. Available from: https://www.smjonline.org/text.asp?2014/17/2/71/134487


  Introduction Top


Elderly population has been steadily increasing all over the world. In India, although the percentage of aged persons to the total population is low in comparison to developed countries, the absolute size of aged population is nevertheless considerable due to huge size of Indian total population. There has also been a steady rise in the life expectancy from 36.7 years in 1951 to 64.6 years in 2000 in India. [1] In the year 2003, the sample registration system estimated that 7.2% of total Indian population was above the age of 60 years. This number is expected to rise to 1.2 billion by 2025. [2]

Tuberculosis is a major global public health problem. [3] It has been suggested that tuberculosis differs clinically and radiologically in the geriatrics compared with the young. Decreasing cellular immune responses and high incidence of old age related co-morbidities partly contribute to poor outcome tuberculosis in the elderly This is compounded by the increased incidence of atitubercular adverse effects resulting in increased morbidity and default from therapy in the elderly.

The Revised National Tuberculosis Control Programme (RNTCP) has been operational in India since 1993 as pilot projects in 5 states. [4] It has covered the entire country since 2006. Over the last several years, all patients are being treated with Directly Observed Treatment Short (DOTS) Course Chemotherapy under the RNTCP. Few studies conducted outside Burdwan District of West Bengal, India have shown that the profile and treatment outcome of geriatric and younger age population is different. [5] The present study was undertaken to compare the clinical profile and treatment outcome of tuberculosis in the geriatric and younger age group treated under DOTS in a tuberculosis unit (TU) of Burdwan district, West Bengal, India.


  Materials And Methods Top


It was a retrospective cross-sectional study carried out in West Bengal, India. The study was conducted at a TU of Burdwan district, namely the Bhatar TU. Bhatar is rural health field practice area of department of Community Medicine, Burdwan Medical College, Burdwan. Study tools were pre-designed schedule and tuberculosis register. All the 775 cases diagnosed to have tuberculosis during the period under review (November 2010-December 2011) constituted the study population. 10 transferred out cases and 7 with incomplete records were excluded. This Bhatar TU covers two blocks namely Bhatar and Monteswar of Burdwan district. The unit cater for 4, 82,127 people. Data retrieved included age, gender, form of tuberculosis (pulmonary or extra pulmonary tuberculosis), type of tuberculosis (smear positive or smear negative), category of tuberculosis: New cases (Category I) and retreatment cases (Category II) and treatment outcome. Treatment outcome was evaluated in accordance with RNTCP and classified as: Cure, treatment completed, default, treatment failure and death.

Operational definition

Unfavorable outcome included death, defaulter or failure; whereas favorable outcome comprised of both cure and treatment completed.

Statistical analysis

Collected data were compiled on Microsoft Excel worksheets (Microsoft, Redwoods, WA, USA). All cases were divided into two groups as age below 60 years and age 60 years or more for analysis and comparison. (Statistical Package for the Social Sciences software, version 19.0 Inc., Chicago, IL, USA) was used for analysis. P <0.05 was considered to be statistically significant.


  Results Top


Of the total 758 cases, 668 (88.1%) were below 60 years (younger one) while 90 (11.1%) patients were in the geriatric age group (age ≥ 60 years). Among 90 geriatric patients, 88.8% were male with mean age of 66.46 ± 6.54 years; while 11.2% were females (mean age 67.60 ± 9.29 years). Among 668 younger age patients, male were 74.4% with mean age 35.79 ± 12.62 years and females were 25.6% with mean age 30.61 ± 12.21 years. The proportion of male patients was significantly higher in geriatric age group compared with the younger population (P < 0.001) [Table 1].

Under Category I, the proportion of new sputum positive cases were significantly more among geriatric age group (65.75% vs. 52.06%; P = 0.01) [Table 2]. As under Category II, four type of patients get treatment, relapse, drug failure, treatment after default and others, in which relapse cases were present more among geriatric age group (52.9%) and younger age group patients were present in others (40.9%) group of Category II [Table 3]. Sputum conversion rate at end of 2 months was higher among geriatric population (100% vs. 96.35% P =>0.05).
Table 1: Distribution of geriatric and non-geriatric TB patients according to gender (N=758)

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Table 2: Distribution of geriatric and non-geriatric TB patients according to type of patients and treatment outcome within category I (N=609)

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Table 3: Distribution of geriatric and non-geriatric TB patients according to type of patients and treatment outcome within category II (N-149)

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In Category I patients cure, defaulter, death and failure were significantly higher in geriatric compared to younger age group. Treatment completion was significantly higher among young age group (42.9% vs. 21.9%; P = 0.000) [Table 2]. In Category II patients, treatment completion was higher in young one than geriatric age group (35.6% vs. 29.4%; P = 0.716); while cure, defaulter and death were not significantly higher in geriatric age group [Table 3]. Overall, unfavorable outcome was significantly higher in geriatric compared with younger population (33.3% vs. 17.8%; P = 0.001) [Table 4].
Table 4: Distribution of geriatric and non-geriatric TB patients according to treatment outcome (N=758)

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  Discussion Top


Tuberculosis in the elderly is most often associated with reactivation of endogenous infection. [6] Lymphocytes (mainly the T lymphocytes) and the proliferative responses decreases with increasing age. [7],[8],[9] Synthesis of gamma interferon levels, an important in activation of macrophage also decreases with aging. [10] These factors cause a progressive immune deregulation in the elderly. Environment factors including poverty, poor nutritional status and social neglect have been blamed for the high rates of tuberculosis in the elderly. [11]

A high index of clinical suspicion is important in diagnosis of tuberculosis in the elderly. [12]

In present study, it was found that in age group less than 60 years one extra pulmonary case was noted for every 3.46 pulmonary cases compared with one for every 23.3 cases of pulmonary tuberculosis in the elderly. These observations are similar to previous reports [13],[14] This may be due to that mild symptoms of extra pulmonary tuberculosis, elderly patients ignore it for longer time, that's why less reported to healthcare facility.

In the present study, incidence of default among patients less than 60 years of age was 9.9% versus 19.2% among geriatrics. Similar increased default rates have been seen in previous studies. [15] Poor compliance with therapy, irregular intake of drugs and interactions with concomitant drugs for co morbid illnesses are considered to be the principal reasons for default and poor disease outcome in the elderly. [16]

Death in tuberculosis under the RNTCP is defined as death due to any cause during the period that the patient is undergoing therapy for tuberculosis. Apart from the physiological causes of increased death in the elderly, other factors such as chronic obstructive pulmonary disease, diabetes and malignancy may be responsible for the increased incidence of death in these elderly patients. This finding also corroborates with the findings from other studies. [16]


  Conclusions Top


Our data demonstrate differences in the clinical presentation and outcome of tuberculosis in the geriatric and young patients with tuberculosis. We recommend special attention in the diagnosis, treatment and monitoring of elderly tuberculosis patients.

 
  References Top

1.National health policy 2002, Deptartment of Health, Ministry of Health and F.W.,Government of India, Nirman Bhawan, New Delhi.Government of India. Health action Eldercare. 2004;17:22.  Back to cited text no. 1
    
2.Nair PA, Bodiwala N, Arora TH, Patel S, Vora R. A Study of Geriatric Dermatosis at a Rural Hospital in Gujarat. Journal of The Indian Academy of Geriatrics, 2013;9:15-9.  Back to cited text no. 2
    
3.Park K. Textbook of Preventive and Social Medicine. 22 nd ed. Jabalpur, India: M/S Banarsidas Bhanot; 2013. p. 842, 843, 845, 847, 483-4.  Back to cited text no. 3
    
4.Revised National Tuberculosis Control Programme. Technical Guidelines for Tuberculosis Control. New Delhi, India: Central TB Division: Directorate General of Health Services. Ministry of Health and Family Welfare; 1997. p. 17-20.  Back to cited text no. 4
    
5.Mukherjee A, Saha I, Paul B. Tuberculosis in patients below and above 60 years and their treatment outcome under RNTCP-A study in rural West Bengal, India. J Indian Acad Geriatr 2008;4:60-3.  Back to cited text no. 5
    
6.Stead WW. Pathogenesis of first episode of chronic pulmonary tuberculosis in man: Recrudescence of residuals of primary infection of exogenous re-infection. Ann Intern Med 1968;68:731-45.  Back to cited text no. 6
    
7.Davies PD. The effects of poverty and ageing on the increase in tuberculosis. Monaldi Arch Chest Dis 1999;54:168-71.  Back to cited text no. 7
    
8.Lesourd B, Mazari L. Nutrition and immunity in the elderly. Proc Nutr Soc 1999;58:685-95.  Back to cited text no. 8
    
9.Ben-Yehuda A, Weksler ME. Host resistance and the immune system. Clin Geriatr Med 1992;8:701-11.  Back to cited text no. 9
    
10.Pedrazzini T, Hug K, Louis JA. Importance of L3T4+and Lyt-2+cells in the immunologic control of infection with Mycobacterium bovis strain bacillus Calmette-Guérin in mice. Assessment by elimination of T cell subsets in vivo. J Immunol 1987;139:2032-7.  Back to cited text no. 10
    
11.Frost WH. The age selection of mortality from tuberculosis in successive decades. Am J Hyg 1939;30:91-6.  Back to cited text no. 11
    
12.Khan MA, Kovnat DM, Bachus B, Whitcomb ME, Brody JS, Snider GL. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult. Am J Med 1977;62:31-8.  Back to cited text no. 12
    
13.Arora VK, Singla N, Sarin R. Profile of geriatric patients under DOTS in Revised National Tuberculosis Control Programme. Indian J Chest Dis Allied Sci 2003;45:231-5.  Back to cited text no. 13
    
14.Pardeshi G, Deshmukh D. Disease characteristics and treatment outcome in elderly tuberculosis patients on DOTS. Indian J Community Med 2007;32:292-4.  Back to cited text no. 14
  Medknow Journal  
15.Chan-Yeung M, Noertjojo K, Tan J, Chan SL, Tam CM. Tuberculosis in the elderly in Hong Kong. Int J Tuberc Lung Dis 2002;6:771-9.  Back to cited text no. 15
    
16.Sood R. The problem of geriatric tuberculosis. J Indian Acad Clin Med 2000;5: 156-62.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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