Yonsei Med J.  2013 Sep;54(5):1227-1233. 10.3349/ymj.2013.54.5.1227.

Treatment Response and Adverse Reactions in Older Tuberculosis Patients with Immunocompromising Comorbidities

• Kim SY
• Lee SM
• Yim JJ
• Yoo CG
• Kim YW
• Han SK
• Yang SC

• KMID: 1793172
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1227

Abstract

PURPOSE
The aim of this study was to elucidate the effects of immunocompromising comorbidities on treatment response and adverse reactions in older tuberculosis (TB) patients.
MATERIALS AND METHODS
The medical records of 182 patients older than 65 years with proven TB by positive culture of Mycobacterium tuberculosis and with available drug susceptibility tests were reviewed retrospectively. These patients were subsequently assigned to either the comorbidity group (n=78) or non-comorbidity group (n=104) depending on whether they had immunocompromising comorbidities.
RESULTS
The mean durations of treatment were 9.9+/-3.3 months in the comorbidity group and 9.3+/-3.2 months in the non-comorbidity group (p=0.21). M. tuberculosis culture results converted to negative in most patients with available follow-up cultures at two months after treatment. The successful treatment rates were 94.9% and 98.9% in the comorbidity and non-comorbidity groups, respectively (p=0.30). The most common side effects of anti-TB treatment were skin rash/pruritus (13% in the comorbidity group vs. 11% in the non-comorbidity group, p=0.79), gastro-intestinal problems (14% vs. 9%, p=0.25) and hepatotoxicity (14% vs. 7%, p=0.09).
CONCLUSION
The present study shows that the successful treatment rate for TB is high and that immunocompromising comorbidities have no effect on the response to treatment and adverse effects in older TB patients.

Keyword

Tuberculosis; aged; comorbidity

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Antitubercular Agents/adverse effects/*therapeutic use
Comorbidity
Female
Humans
*Immunocompromised Host
Isoniazid/adverse effects/*therapeutic use
Male
Retrospective Studies
Rifampin/adverse effects/*therapeutic use
Risk Factors
Treatment Outcome
Tuberculosis/*drug therapy/epidemiology/immunology
Antitubercular Agents
Isoniazid
Rifampin

Reference

1. Rajagopalan S. Tuberculosis and aging: a global health problem. Clin Infect Dis. 2001; 33:1034–1039.

2. Hernandez-Pando R, Orozco H, Aguilar D. Factors that deregulate the protective immune response in tuberculosis. Arch Immunol Ther Exp (Warsz). 2009; 57:355–367.

3. North RJ, Jung YJ. Immunity to tuberculosis. Annu Rev Immunol. 2004; 22:599–623.

4. FitzGerald JM, Grzybowski S, Allen EA. The impact of human immunodeficiency virus infection on tuberculosis and its control. Chest. 1991; 100:191–200.

5. Pérez-Guzmán C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H. Does aging modify pulmonary tuberculosis?: a meta-analytical review. Chest. 1999; 116:961–967.

6. Ibrahim EM, Uwaydah A, al-Mulhim FA, Ibrahim AM, el-Hassan AY. Tuberculosis in patients with malignant disease. Indian J Cancer. 1989; 26:53–57.

7. Kim DK, Lee SW, Yoo CG, Kim YW, Han SK, Shim YS, et al. Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy. Chest. 2005; 128:2218–2222.

8. Singla R, Khan N, Al-Sharif N, Ai-Sayegh MO, Shaikh MA, Osman MM. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis. 2006; 10:74–79.

9. Choudhury D, Luna-Salazar C. Preventive health care in chronic kidney disease and end-stage renal disease. Nat Clin Pract Nephrol. 2008; 4:194–206.

10. Macallan DC. Malnutrition in tuberculosis. Diagn Microbiol Infect Dis. 1999; 34:153–157.

11. Thulstrup AM, Mølle I, Svendsen N, Sørensen HT. Incidence and prognosis of tuberculosis in patients with cirrhosis of the liver. A Danish nationwide population based study. Epidemiol Infect. 2000; 124:221–225.

12. Leung CC, Yew WW, Chan CK, Chau CH, Tam CM, Lam CW, et al. Tuberculosis in older people: a retrospective and comparative study from Hong Kong. J Am Geriatr Soc. 2002; 50:1219–1226.

13. Rocha M, Pereira S, Barros H, Seabra J. Does pulmonary tuberculosis change with ageing? Int J Tuberc Lung Dis. 1997; 1:147–151.

14. Teale C, Goldman JM, Pearson SB. The association of age with the presentation and outcome of tuberculosis: a five-year survey. Age Ageing. 1993; 22:289–293.

15. Vesosky B, Turner J. The influence of age on immunity to infection with Mycobacterium tuberculosis. Immunol Rev. 2005; 205:229–243.

16. Veen J, Raviglione M, Rieder HL, Migliori GB, Graf P, Grzemska M, et al. Standardized tuberculosis treatment outcome monitoring in Europe. Recommendations of a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting by cohort analysis of treatment outcome in tuberculosis patients. Eur Respir J. 1998; 12:505–510.

17. Shang P, Xia Y, Liu F, Wang X, Yuan Y, Hu D, et al. Incidence, clinical features and impact on anti-tuberculosis treatment of anti-tuberculosis drug induced liver injury (ATLI) in China. PLoS One. 2011; 6:e21836.

18. World Health Organization. Global tuberculosis control. WHO Report 2010. Geneva, Switzerland: World Health Organization;2010.

19. Korea Centers for Disease Control and Prevention. Annual report on the notified tuberculosis cases patients in Korea 2010. Seoul: Korea Centers for Disease Control and Prevention;2011.

20. Lee JH, Han DH, Song JW, Chung HS. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci. 2005; 20:784–789.

21. Korzeniewska-Kosela M, Krysl J, Müller N, Black W, Allen E, FitzGerald JM. Tuberculosis in young adults and the elderly. A prospective comparison study. Chest. 1994; 106:28–32.

22. Kobashi Y, Mouri K, Yagi S, Obase Y, Miyashita N, Okimoto N, et al. Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis. J Infect Chemother. 2007; 13:405–410.

23. Shao C, Qu J, He L. A comparative study of clinical manifestations caused by tuberculosis in immunocompromised and non-immunocompromised patients. Chin Med J (Engl). 2003; 116:1717–1722.

24. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003; 167:603–662.

25. Cegolon L, Maguire H, Mastrangelo G, Carless J, Kruijshaar ME, Verlander NQ. Predictors of failure to complete tuberculosis treatment in London, 2003-2006. Int J Tuberc Lung Dis. 2010; 14:1411–1417.

26. Baussano I, Pivetta E, Vizzini L, Abbona F, Bugiani M. Predicting tuberculosis treatment outcome in a low-incidence area. Int J Tuberc Lung Dis. 2008; 12:1441–1448.

27. Muñoz-Sellart M, Cuevas LE, Tumato M, Merid Y, Yassin MA. Factors associated with poor tuberculosis treatment outcome in the Southern Region of Ethiopia. Int J Tuberc Lung Dis. 2010; 14:973–979.

28. Wang CS, Chen HC, Yang CJ, Wang WY, Chong IW, Hwang JJ, et al. The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection. 2008; 36:335–340.