Publication:

Clinico-radiological variability of pulmonary tuberculosis in young patients as compared to elder patients prior to RNTCP and after 18 years RNTCP

Background Tuberculosis, a chronic disease causing high morbidity and mortality with multiple host related and socio-demographic risk factors. Incidence is 3-4 times among in diabetics. HIV is considered to be a most powerful risk factor other being malnutrition, Tubercular contacts, smoking habits and alcoholism. Many ecological and societal threats increase a vulnerability to infection and succession of the disease. Objective was to study and compare various clinico-radiological presentations and clinical risk factors for pulmonary tuberculosis in the young ( 50yrs) patients.

Methods Total 300 pulmonary tuberculosis patients each admitted in hospital during 1999 (group ‘A’) and 2016 (group ‘B’) respectively were included in our study. Socio-demographic risk factors and presence of any existing co morbidities and clinical as well radiological presentation data were evaluated.

Results Majority patients in both group ‘A’ and ‘B’ were males (67% and 61.3%), younger (71.3% and 63.3%) patients. Elder patients had more smokers in both groups (48.8% and 33.6%). COPD trends seems to be receding in group ‘B’ as compared to group ‘A’ in younger (6.3% vs. 8.9%) as well elder (13.6% vs. 29.1%) but on the contrary lifestyle disease trends like DM increased in group ‘B’ than group ‘A’ patients more in elder subgroup (30% vs. 9.3%). HIV infected was more in younger 2.1 % (elder 0.9%) group ‘B’ patients. Haemoptysis (17.8% and 18.6% vs. 13.7% and 9.1%) and cough (~87% vs. ~85%) were almost similar but fever (~90% vs. ~65%) was seen significantly higher in the young patients. Radiologically bilateral upper lobe cavitations (15%-30%) was a higher in group A patients as compared to negligible less than ~3% cavitations in group B, on the contrary infiltrations (15%-32%) was more in group B.

Conclusions Young adults are more likely to have fever while haemoptysis cough and advanced lung field involvement is more common in elderly. Elderly patients had a higher number of co-morbidities like COPD and DM. The present study reveals that various demographic, socioeconomic and clinical risk factors have a potential role in causation/augmentation of pulmonary tuberculosis hence life style modification, prevention and timely management of these risk factors could be helpful to reduce the burden of disease.