Clinico-radiological profile of new smear positive pulmonary tuberculosis cases among young adult and elderly people in a tertiary care hospital at Deheradun (Uttarakhand).

Abstract

SETTING: Patients of pulmonary tuberculosis (TB) attending the out and in patient department of pulmonary medicine, Himalayan Institute of Medical Sciences (HIMS), a post graduate institute and a large tertiary care center in Dehradun. OBJECTIVE: To compare the clinico-radiological pattern of pulmonary tuberculosis in the young adult (18-59 years) and elderly (> or = 60 years) patients. DESIGN: Prospective observational study of pulmonary and associated extra pulmonary tuberculosis cases, diagnosed between October 2005 to September 2006 in pulmonary medicine department of HIMS. RESULT: Mean age of young adult and elderly patients was 35.71 +/- 5.7 years and 68.57 +/- 3.03 years respectively. Elderly patients had a higher number of co-morbidities like diabetes mellitus, hypertension, and malignancy. Tuberculin positivity was less among elderly patients (36.0%) as compared to young adults (65.9%). Hemoptysis (29.5% vs. 6%), fever (95.4% vs. 76%) and night sweats (54.5% vs. 18.0%) were significantly higher in the young adult patients than the elderly. As for roentgenographic abnormalities, a higher involvement of lower zone (24.0% vs. 7.9%) and far advanced lesions (32.0% vs. 14.7%) were seen in the elderly patients as compared to young adults. The elderly showed a higher frequency of TB related mortality (8% vs. 1.1%) and associated extra pulmonary involvement (40% vs. 7%). CONCLUSION: Young adults are more likely to have hemoptysis, night sweats and positive PPD response while lower lung field involvement is more common in elderly.