Tuberculosis en pacientes mayores de 80 años atendidos en una institución de alta complejidad

Introduction: people older than 80 years are vulnerable to the development of tuberculosis; this is due to immunosenescence, comorbidities, malnutrition, and sedentariness, which predispose to primary infection or reactivation of latent infection. Its clinical presentation is unusual. Treatment of tuberculosis is difficult due to adverse events and drug interactions. Objective: to describe the clinical and microbiological characteristics and the most common outcomes of patients older than 80 years diagnosed with tuberculosis. Materials and methods: retrospective cohort study of patients older than 80 years diagnosed with tuberculosis. Information (clinical, microbiological, radiological, and regarding outcomes and response to treatment) from the institutional tuberculosis database was collected and analyzed. Results: between 2011 and 2016, 27 patients older than 80 years were diagnosed with tuberculosis. The median age was 84 years (IR 80-91); the following risk factors for this disease were identified: chronic obstructive pulmonary disease in 37%, tobacco use in 26%, diabetes in 11%, cancer in 11%, and previous infection by tuberculosis in 7%. Diagnosis was delayed (>30 days) in 74%. The sites of infection were: 52% pulmonary, 26% extrapulmonary, and 22% mixed. Of the patients with pulmonary involvement, 41% had positive sputum examinations and 50% had lung cavitations on chest radiographs. After treatment, tuberculosis was reported to be cured in 37%, death was reported in 15%, and follow-up was lost in 37%. Conclusions: there is evidence of delayed diagnosis, due to the fact that clinical and radiological presentation of tuberculosis in this age group is unusual with regard to the general population. Extrapulmonary tuberculosis was more common in older patients. The low rates of successful treatment, the high percentage of mortality, and the loss of follow-up are a challenge for the healthcare systems and professionals.