COMPARISON AND ANALYSIS OF CLINICAL PROFILE AND TREATMENT OUTCOME IN ELDERLY TB PATIENTS IN URBAN AND RURAL AREAS OF TAMILNADU -IMPLICATIONS IN MANAGEMENT
Abstract
INTRODUCTIONS - India accounts for one fourth of TB cases of the world. Demographic transition has resulted in an increase in the elderly, and so also a higher TB burden in elderly, given the increased vulnerability. At present TB in the elderly contributes to 14 percentage of total TB cases. Elderly TB is complicated by factors like alcoholism, drug reactions and DM, cancer etc, Persistence of infection in this subgroup may be an important source infection and may perpetuate the pool of infection in the community. Hence, it is crucial to understand the clinical profile and factors affecting treatment outcome, since they have important implications in management. OBJECTIVE To study the clinical profile in elderly patients and analyze the treatment outcomes and causes contributing to same in terms of association with comorbid illness, drug reactions and other factors.
METHODOLOGY - Retrospective analysis of TB patients treated from 2011 to 2013 and study the clinical profile of elderly TB patients and analysis of treatment outcomes and contributory factors, comparing one urban based and one rural Tuberculosis UNIT. RESULTS - Majority of the patients were pulmonary though extrapulmonary cases were higher in urban than rural TU. Higher number of patients were smear negative in Urban than Rural, probably reflecting higher case detection due to better access to health services in Urban set up. Failure of Treatment and switch over to MDR was less (0.5), At the same time, Death rate was higher in Elderly 8.5 percentage compared to 6 percentage in Non Elderly population. Alcoholism and DM and cancer were main causes of poor outcome in Urban and Rural TUs. HIV was not a significant factor in the Elderly. CONCLUSION - TB in Elderly is a significant problem. Elderly TB can remain as a source, allowing. perpetuation of TB in the community. Hence, warrants special attention. A refined and dedicated system to record l the comorbities, Drug reactions is required .Collaboration of TB and Non Communicable Diseases programmes, especially DMcancer and cardiac diseases for comprehensive management is need of the hour
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World Health Organization (2012) Global Tuberculosis Control 2012.
Central Tuberculosis Division (2012) Tuberculosis India 2012. Annual Report of the Revised National Tuberculosis Control Programme. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.
Mukherjee A, Saha I, Paul B (2008) 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
: 60–3.
Touré NO, Dia Kane Y, Diatta A, Ba Diop S, Niang A, et al. (2010) Tuberculosis in elderly persons]. Rev Mal Respir 27: 1062–8.
Pardeshi G, Deshmukh D (2007) Disease characteristics and treatment outcome in elderly tuberculosis patients on DOTS. Indian Journal of Community Medicine 32: 292.
Sood R (2000) The Problem of Geriatric Tuberculosis. Journal of Indian Academy of Clinical
Medicine 5: 156–62.
Rajagopalan S (2001) Tuberculosis and aging: a global health problem. Clin. Infect. Dis 33: 1034–9.
Registrar General and Census Commissioner (2012) Annual Health Survey- 2010–11. Ministry of Home Affairs, Government of India. New Delhi. Available: http://www.censusindia.gov.in/2011Common/AHSurvey.html. Accessed 2012 Oct 21.
Chan-Yeung M, Noertjojo K, Tan J, Chan SL, Tam CM (2002) Tuberculosis in the elderly in Hong Kong. Int. J. Tuberc. Lung Dis 6: 771–9.
Leung CC, Yew WW, Chan CK, Chau CH, Tam CM, et al. (2002) Tuberculosis in older people: a retrospective and comparative study from Hong Kong. J Am Geriatr Soc 50: 1219–26.
Gholamali G, Gholamhossain A, Esfahan A (2007) Comparison of Clinical and Radiology Manifestation of Pulmonary Tuberculosis in Younger and Elderly Patients. Journal of Medical Sciences (Faisalabad) 7: 888–91.
Morris CD (1990) Pulmonary tuberculosis in the elderly: a different disease? Thorax 45: 912–3.
Bhushan B, Kajal NC, Maske A, Singh SP (2012) Manifestations of tuberculosis in elderly versus young hospitalised patients in Amritsar, India. Int. J. Tuberc. Lung Dis16: 1210–3.
Gaur SN, Dhingra VK, Rajpal S, Aggarwal JR (2004) Meghna (2004) Tuberculosis in the elderly and their treatment outcome under DOTS. Indian J Tuberc 51: 83–7.
Arora VK, Singla N, Sarin R (2003) Profile of geriatric patients under DOTS in Revised National Tuberculosis Control Programme. Indian J Chest Dis Allied Sci. 45: 231–5.
World Health Organization. Treatment of Tuberculosis Guidelines, 4th Edition. World Health Organization (2010) Available: http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf.Accessed 2013 Feb 15.
Central TB Division (2011) RNTCP Performance Report, India: Second Quarter. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Available: http://tbcindia.nic.in/pdfs/2nd_Qtr_2011_PERF.pdf.
Monthly Bulletin on Family Welfare, Directorate of Family welfare, Tamil Nadu, (2006) Reproductive Child Health, District Level Household Survey, 2002–04, Tamil Nadu, IIPS,MOHFW, GOI, PRC Gandhigram.
Zachariah R, Harries AD, Srinath S, Ram S, Viney K, et al. (2012) Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients? Int. J. Tuberc. Lung Dis 16: 714–7.
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