INT J TUBERC LUNG DIS 18(10):1220–1222 Q 2014 The Union http://dx.doi.org/10.5588/ijtld.14.0210
Tuberculosis in older adults in Soweto, South Africa A. S. Karstaedt, M. Bolhaar Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa SUMMARY
The impact of tuberculosis (TB) on older adults in Southern Africa is rarely emphasised. The case notification rate in 2004 among the elderly in Soweto was 262 per 100 000 population. The elderly comprised 5.8% of adults and 1.6% of adults notified. Among 110 elderly patients studied, 50% had pulmonary TB, 37% had extra-pulmonary TB (EPTB) and 13% had both. A
predisposing disease occurred in 46%. TB was microbiologically proven in 77%. Human immunodeficiency virus (HIV) status was known for 25 (23%) patients, with 10 (9% of the cohort) being HIV-infected. HIV-infected adults had more EPTB, anaemia and hyponatraemia. Older adults in Soweto bear a high burden of TB. K E Y W O R D S : Africa; epidemiology; HIV
TUBERCULOSIS (TB) in Africa as compared to the United States and Japan is epidemiologically different.1 In the United States and Japan, TB incidence rates rise with age, and are highest among the elderly. In Africa, peak incidence occurs in the 25–44 years age group and decreases steadily thereafter. In parallel, the elderly comprise a larger proportion of the general population in the industrialised world than in Africa. This leads to a downplay of the impact of TB on older adults in Africa.1,2 Predisposing conditions are more common in older patients.3,4 Pulmonary TB occurs in 75–89% of the elderly.3,5,6 Bacteriological confirmation varies in different geographic areas.3,6 No study on TB among the elderly in Southern Africa has been published since 1989.7 We aimed to describe the TB notification rate among the elderly in Soweto and to characterise the manifestations in a separate cohort seen at one hospital.
sector university hospital, is the main hospital serving Soweto. A retrospective cohort study was performed of patients aged 765 years notified with newly diagnosed TB from April 2003 to June 2004 at the hospital. Further patients had positive cultures for Mycobacterium tuberculosis but were not notified at the hospital. This retrospective cohort was not necessarily directly related to those notified in Soweto in 2004. Microbiological proof of TB was based on acid-fast smear or culture.
METHODS Notification rate The numerator was patients aged 765 years notified in 2004 in Region D of the Johannesburg metropolitan area. The denominator was the population of Region D abstracted from the 2001 Census of South Africa.8 Setting Chris Hani Baragwanath Hospital, a 2700-bed public
Ethics The study was approved by the Committee for Research on Human Subjects of the University of the Witwatersrand, Johannesburg.
RESULTS In Region D of Johannesburg, 110 patients aged 765 years were notified in 2004, representing 1.6% of adults notified. The case notification rate for the elderly was 262 per 100 000 population. The elderly comprised 5.8% of the adult population (Table 1). Of the 110 elderly patients studied, 67 were notified, while 43 patients with positive M. tuberculosis cultures had not been notified. Basic demographic and laboratory information was available for all, but only 83 had clinical records available (Table 2). Thirty-nine patients were from Soweto. The median age was 70 years (range 65–97). Human immunodeficiency virus (HIV) status was
Correspondence to: A S Karstaedt, Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, PO Box 128, Parklands, 2121 Johannesburg, South Africa. Tel: (þ27) 82 978 0585. Fax: (þ27) 11 938 1454. e-mail: [email protected] Article submitted 15 March 2014. Final version accepted 24 May 2014.
TB in the elderly in Soweto
Table 1 Notification rate (per 100 000 population) by age of adults with TB in Region D, Soweto, 2004 TB notifications
Age years
Population8 n
n
Rate/100 000
All 15–24 25–34 35–44 45–54 55–64 765
723 839 199 091 201 152 146 733 89 212 45 647 42 004
6068 757 2158 1860 898 285 110
838 380 1073 1268 1007 624 262
common in the HIV-infected (5 patients vs. 1; P ¼ 0.0128), as was hyponatraemia with serum sodium ,135 mmol/l (6 vs. 3; P ¼ 0.0497). Three patients had CD4 counts ranging from 43/ll to 122/ll.
DISCUSSION
TB ¼ tuberculosis.
known for 25 (23%) patients, with 10 (40% of those tested and 9% of the cohort) being HIV-infected. Twenty-two (48%) males smoked compared to 4 (11%) females. Alcohol was used by 14 (30%) men and one (3%) woman. No predisposing factor, comprising predisposing disease, mining history, smoking or alcohol use, was found in 32 (39%). Other comorbidities included hypertension (n ¼ 27), heart failure (n ¼ 5), stroke (n ¼ 4) and rheumatoid arthritis (n ¼ 2). Seven HIV-infected patients with clinical records were compared to 11 non-HIV-infected patients with records. Predisposing diseases (other than HIV infection) were found in 1 (14%) HIV-infected patient and in 4 (36%) non-infected patients. In HIV-infected patients, pulmonary TB occurred in 5 (71%) and extra-pulmonary TB (EPTB) was diagnosed in 4 (57%) patients compared to respectively 9 (81%) and 3 (27%) among the non-HIV-infected. Anaemia with haemoglobin ,10 g/dl was more
Table 2
The TB notification rate in Soweto followed the African pattern, with a peak in those aged 25–44 years. The rate among the elderly, of 262/100 000, was equivalent to that in the elderly in South Africa in 1977,9 and in Cape Town in 2009.10 It was similar to that in Japan among those aged 65–74 years and to the 60–69 year age group in Hong Kong, but was far higher than among the elderly in the United States.1,4,6 EPTB was diagnosed in 50% of the elderly (37% without concomitant pulmonary TB); this is higher than in most published series, where it is ,20%.3,6 Pleural TB was the most common form, unlike in the elderly in Europe in whom bone and joint, lymphatic and genitourinary TB were most common.11 Half of the males smoked, which is a wellrecognised risk factor for TB. A predisposing disease was present in 46%, higher than in Hong Kong (25– 29% by age category).3 A similar proportion of the elderly were tested for HIV infection in the United States, among whom 3% of those tested and 0.8% of the cohort were HIV-infected.6 In Cape Town, 78% were tested, of whom 10% of the cohort and 12% of those tested were HIV-positive.9 HIV infection was the third most common predisposing disease in Soweto, and it is likely that if more patients had been tested, it would have increased in significance. This may partially explain the high rate of EPTB.
Characteristics of 110 older adults with TB and 83 with clinical records
Older adults with TB (n ¼ 110) Characteristic Male Form of TB PTB alone PTB and EPTB EPTB alone Organ involved by EPTB Pleural TB TB meningitis TB lymphadenitis TB bacteraemia Renal TB Bone and joint TB Peritoneal TB TB abscess Microbiologically proven Smear-positive for acid-fast bacilli Culture positive PTB (n ¼ 69) EPTB (n ¼ 55)
Older adults with clinical records (n ¼ 83) n (%) 61 (55) 55 (50) 14 (13) 41 (37) 29 7 6 4 3 3 3 1 85 39 62 54 39
1221
(26) (6) (5) (4) (3) (3) (3) (1) (77) (35) (56) (78) (71)
Characteristic Male Previous TB Household contact Smoking Alcohol use Predisposing disease Asthma/COPD Diabetes mellitus HIV infection Chronic renal failure Immunosuppressive drugs Malignancy Gastrectomy Ex-miner Died
n (%) 46 12 6 26 15 38 13 9 8 5 4 4 1 3 18
(55) (14) (7) (31) (18) (46) (16) (11) (10) (6) (5) (5) (1) (4) (22)
TB ¼ tuberculosis; PTB ¼ pulmonary TB; EPTB ¼ extra-pulmonary TB; COPD ¼ chronic obstructive pulmonary disease; HIV ¼ human immunodeficiency virus.
1222
The International Journal of Tuberculosis and Lung Disease
The microbiological confirmation of TB in 77% of patients was similar to that documented in other countries. In Hong Kong, in patients aged 760 years, 59% were confirmed; this rate was 71% in Korea and 78% in the United States among those with pulmonary TB.3,5,6 The emphasis in South Africa at the time of the study was on sputum smear for diagnosis of pulmonary TB. There were a number of limitations in this study. The notification rate under-represents TB disease incidence, as not all cases are detected or notified. The patients studied were hospital-based and may not be representative of all elderly patients with TB in Soweto. The year 2004 was chosen to utilise the last published census before 2011 and to set a baseline before widespread provision of antiretroviral therapy. In conclusion, the rate of notified TB in the elderly in Soweto is similar to that in medium-burden countries where the elderly have the highest rates. HIV infection was an important predisposing disease. TB was microbiologically confirmed. Better rapid diagnostic tests are likely to have a further impact in this group with a high burden of TB. Acknowledgements The authors wish to thank A Barnard, N Beylis and M Edginton for assistance. Conflict of interest: none declared.
References 1 Mori T, Leung C C. Tuberculosis in the global aging population. Infect Dis Clin N Am 2010; 24: 751–768. 2 Schaaf H S, Collins A, Bekker A, Davies P D O. Tuberculosis at extremes of age. Respirology 2010; 15: 747–763. 3 Chan-Yeung M, Noertjojo K, Tan J, Chan S L, Tam C M. Tuberculosis in the elderly in Hong Kong. Int J Tuberc Lung Dis 2002; 6: 771–779. 4 Perez-Guzman C, Vargas M H, Torres-Cruz A, VillarrealVelarde H. Does aging modify pulmonary tuberculosis? A metaanalytical review. Chest 1999; 116: 961–967. 5 Lee J H, Han D H, Song J W, Chung H S. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci 2005; 20: 784–789. 6 Pratt R H, Winston C A, Kammerer J S, Armstrong L R. Tuberculosis in older adults in the United States, 1993–2008. J Am Geriatr Soc 2011; 59: 851–857. 7 Morris C D W. The radiology, haematology and biochemistry of pulmonary tuberculosis in the aged. Q J Med 1989; 71: 529– 535. 8 Statistics South Africa. Population of Soweto and Diepkloof Municipalities, Census 2001. Pretoria, South Africa: Statistics South Africa, 2001. www.statssa.gov.za Accessed July 2014. 9 Kustner H G V. Trends in four major communicable diseases. S Afr Med J 1979; 55: 460–473. 10 Wood R, Lawn S D, Caldwell J, Kaplan R, Middelkoop K, Bekker L-G. Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. PLOS ONE 2011; 6: e25098. 11 Zhang X, Andersen A B, Lillebaek T, et al. Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study. Am J Trop Med Hyg 2011; 85: 285– 290.
TB in the elderly in Soweto
i
RESUME
L’impact de la tuberculose (TB) sur les adultes ag´ ˆ es en Afrique du Sud est rarement soulign´e. La d´eclaration des cas de TB frappant les adultes ag´ ˆ es a` Soweto en 2004 a e´ t´e de 262 pour 100 000 habitants. Les personnes ag´ ˆ ees repr´esentaient 5,8% des adultes et seulement 1,6% des cas adultes d´eclar´es. Parmi 110 patients ag´ ˆ es e´ tudi´es, 50% avaient une TB pulmonaire, 37%, une TB extrapulmonaire et 13% les deux. Chez 46% d’entre eux, il existait un pathologie pr´edisposante. La TB a e´ t´e
prouv´ee microbiologiquement chez 77% des patients. Le statut du virus de l’immunod´eficience humaine (VIH) e´ tait connu chez 25 (23%) patients, dont 10 (9% de la cohorte des 110 patients e´ tudi´es) e´ taient infect´es par le VIH. Ces derniers avaient plus souvent une TB extrapulmonaire, une an´emie et une hyponatr´emie. Les adultes ag ˆ e´ s de Soweto supportent un plus lourd fardeau en mati`ere de TB.
RESUMEN
Con poca frecuencia se destacan las consecuencias de la ´ tuberculosis (TB) en los ancianos del sur de Africa. La tasa de notificacion ´ de TB en los ancianos de Soweto en el 2004 fue 262 para 100 000 habitantes. Los ancianos representan el 5,8% de los adultos y el 1,6% de los casos notificados en este grupo. En los 110 pacientes ancianos estudiados, el 50% presento´ TB pulmonar, el 37% TB extrapulmonar y el 13% ambas localizaciones. En 46% de los casos se observo´ una enfermedad predisponente.
Se obtuvo confirmacion ´ bacteriologica ´ de la TB en 77% de los casos. La situacion ´ frente al virus de la inmunodeficiencia humana (VIH) se conocio´ en 25 pacientes (23%), de los cuales 10 presentaban la infeccion ´ (9% de la cohorte). Los pacientes adultos con infeccion ´ por el VIH exhibieron con mayor frecuencia TB extrapulmonar, anemia e hiponatremia. Los adultos ancianos en Soweto soportan una alta carga de morbilidad por TB.
Tuberculosis in older adults in Soweto, South Africa A. S. Karstaedt, M. Bolhaar Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa SUMMARY
The impact of tuberculosis (TB) on older adults in Southern Africa is rarely emphasised. The case notification rate in 2004 among the elderly in Soweto was 262 per 100 000 population. The elderly comprised 5.8% of adults and 1.6% of adults notified. Among 110 elderly patients studied, 50% had pulmonary TB, 37% had extra-pulmonary TB (EPTB) and 13% had both. A
predisposing disease occurred in 46%. TB was microbiologically proven in 77%. Human immunodeficiency virus (HIV) status was known for 25 (23%) patients, with 10 (9% of the cohort) being HIV-infected. HIV-infected adults had more EPTB, anaemia and hyponatraemia. Older adults in Soweto bear a high burden of TB. K E Y W O R D S : Africa; epidemiology; HIV
TUBERCULOSIS (TB) in Africa as compared to the United States and Japan is epidemiologically different.1 In the United States and Japan, TB incidence rates rise with age, and are highest among the elderly. In Africa, peak incidence occurs in the 25–44 years age group and decreases steadily thereafter. In parallel, the elderly comprise a larger proportion of the general population in the industrialised world than in Africa. This leads to a downplay of the impact of TB on older adults in Africa.1,2 Predisposing conditions are more common in older patients.3,4 Pulmonary TB occurs in 75–89% of the elderly.3,5,6 Bacteriological confirmation varies in different geographic areas.3,6 No study on TB among the elderly in Southern Africa has been published since 1989.7 We aimed to describe the TB notification rate among the elderly in Soweto and to characterise the manifestations in a separate cohort seen at one hospital.
sector university hospital, is the main hospital serving Soweto. A retrospective cohort study was performed of patients aged 765 years notified with newly diagnosed TB from April 2003 to June 2004 at the hospital. Further patients had positive cultures for Mycobacterium tuberculosis but were not notified at the hospital. This retrospective cohort was not necessarily directly related to those notified in Soweto in 2004. Microbiological proof of TB was based on acid-fast smear or culture.
METHODS Notification rate The numerator was patients aged 765 years notified in 2004 in Region D of the Johannesburg metropolitan area. The denominator was the population of Region D abstracted from the 2001 Census of South Africa.8 Setting Chris Hani Baragwanath Hospital, a 2700-bed public
Ethics The study was approved by the Committee for Research on Human Subjects of the University of the Witwatersrand, Johannesburg.
RESULTS In Region D of Johannesburg, 110 patients aged 765 years were notified in 2004, representing 1.6% of adults notified. The case notification rate for the elderly was 262 per 100 000 population. The elderly comprised 5.8% of the adult population (Table 1). Of the 110 elderly patients studied, 67 were notified, while 43 patients with positive M. tuberculosis cultures had not been notified. Basic demographic and laboratory information was available for all, but only 83 had clinical records available (Table 2). Thirty-nine patients were from Soweto. The median age was 70 years (range 65–97). Human immunodeficiency virus (HIV) status was
Correspondence to: A S Karstaedt, Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, PO Box 128, Parklands, 2121 Johannesburg, South Africa. Tel: (þ27) 82 978 0585. Fax: (þ27) 11 938 1454. e-mail: [email protected] Article submitted 15 March 2014. Final version accepted 24 May 2014.
TB in the elderly in Soweto
Table 1 Notification rate (per 100 000 population) by age of adults with TB in Region D, Soweto, 2004 TB notifications
Age years
Population8 n
n
Rate/100 000
All 15–24 25–34 35–44 45–54 55–64 765
723 839 199 091 201 152 146 733 89 212 45 647 42 004
6068 757 2158 1860 898 285 110
838 380 1073 1268 1007 624 262
common in the HIV-infected (5 patients vs. 1; P ¼ 0.0128), as was hyponatraemia with serum sodium ,135 mmol/l (6 vs. 3; P ¼ 0.0497). Three patients had CD4 counts ranging from 43/ll to 122/ll.
DISCUSSION
TB ¼ tuberculosis.
known for 25 (23%) patients, with 10 (40% of those tested and 9% of the cohort) being HIV-infected. Twenty-two (48%) males smoked compared to 4 (11%) females. Alcohol was used by 14 (30%) men and one (3%) woman. No predisposing factor, comprising predisposing disease, mining history, smoking or alcohol use, was found in 32 (39%). Other comorbidities included hypertension (n ¼ 27), heart failure (n ¼ 5), stroke (n ¼ 4) and rheumatoid arthritis (n ¼ 2). Seven HIV-infected patients with clinical records were compared to 11 non-HIV-infected patients with records. Predisposing diseases (other than HIV infection) were found in 1 (14%) HIV-infected patient and in 4 (36%) non-infected patients. In HIV-infected patients, pulmonary TB occurred in 5 (71%) and extra-pulmonary TB (EPTB) was diagnosed in 4 (57%) patients compared to respectively 9 (81%) and 3 (27%) among the non-HIV-infected. Anaemia with haemoglobin ,10 g/dl was more
Table 2
The TB notification rate in Soweto followed the African pattern, with a peak in those aged 25–44 years. The rate among the elderly, of 262/100 000, was equivalent to that in the elderly in South Africa in 1977,9 and in Cape Town in 2009.10 It was similar to that in Japan among those aged 65–74 years and to the 60–69 year age group in Hong Kong, but was far higher than among the elderly in the United States.1,4,6 EPTB was diagnosed in 50% of the elderly (37% without concomitant pulmonary TB); this is higher than in most published series, where it is ,20%.3,6 Pleural TB was the most common form, unlike in the elderly in Europe in whom bone and joint, lymphatic and genitourinary TB were most common.11 Half of the males smoked, which is a wellrecognised risk factor for TB. A predisposing disease was present in 46%, higher than in Hong Kong (25– 29% by age category).3 A similar proportion of the elderly were tested for HIV infection in the United States, among whom 3% of those tested and 0.8% of the cohort were HIV-infected.6 In Cape Town, 78% were tested, of whom 10% of the cohort and 12% of those tested were HIV-positive.9 HIV infection was the third most common predisposing disease in Soweto, and it is likely that if more patients had been tested, it would have increased in significance. This may partially explain the high rate of EPTB.
Characteristics of 110 older adults with TB and 83 with clinical records
Older adults with TB (n ¼ 110) Characteristic Male Form of TB PTB alone PTB and EPTB EPTB alone Organ involved by EPTB Pleural TB TB meningitis TB lymphadenitis TB bacteraemia Renal TB Bone and joint TB Peritoneal TB TB abscess Microbiologically proven Smear-positive for acid-fast bacilli Culture positive PTB (n ¼ 69) EPTB (n ¼ 55)
Older adults with clinical records (n ¼ 83) n (%) 61 (55) 55 (50) 14 (13) 41 (37) 29 7 6 4 3 3 3 1 85 39 62 54 39
1221
(26) (6) (5) (4) (3) (3) (3) (1) (77) (35) (56) (78) (71)
Characteristic Male Previous TB Household contact Smoking Alcohol use Predisposing disease Asthma/COPD Diabetes mellitus HIV infection Chronic renal failure Immunosuppressive drugs Malignancy Gastrectomy Ex-miner Died
n (%) 46 12 6 26 15 38 13 9 8 5 4 4 1 3 18
(55) (14) (7) (31) (18) (46) (16) (11) (10) (6) (5) (5) (1) (4) (22)
TB ¼ tuberculosis; PTB ¼ pulmonary TB; EPTB ¼ extra-pulmonary TB; COPD ¼ chronic obstructive pulmonary disease; HIV ¼ human immunodeficiency virus.
1222
The International Journal of Tuberculosis and Lung Disease
The microbiological confirmation of TB in 77% of patients was similar to that documented in other countries. In Hong Kong, in patients aged 760 years, 59% were confirmed; this rate was 71% in Korea and 78% in the United States among those with pulmonary TB.3,5,6 The emphasis in South Africa at the time of the study was on sputum smear for diagnosis of pulmonary TB. There were a number of limitations in this study. The notification rate under-represents TB disease incidence, as not all cases are detected or notified. The patients studied were hospital-based and may not be representative of all elderly patients with TB in Soweto. The year 2004 was chosen to utilise the last published census before 2011 and to set a baseline before widespread provision of antiretroviral therapy. In conclusion, the rate of notified TB in the elderly in Soweto is similar to that in medium-burden countries where the elderly have the highest rates. HIV infection was an important predisposing disease. TB was microbiologically confirmed. Better rapid diagnostic tests are likely to have a further impact in this group with a high burden of TB. Acknowledgements The authors wish to thank A Barnard, N Beylis and M Edginton for assistance. Conflict of interest: none declared.
References 1 Mori T, Leung C C. Tuberculosis in the global aging population. Infect Dis Clin N Am 2010; 24: 751–768. 2 Schaaf H S, Collins A, Bekker A, Davies P D O. Tuberculosis at extremes of age. Respirology 2010; 15: 747–763. 3 Chan-Yeung M, Noertjojo K, Tan J, Chan S L, Tam C M. Tuberculosis in the elderly in Hong Kong. Int J Tuberc Lung Dis 2002; 6: 771–779. 4 Perez-Guzman C, Vargas M H, Torres-Cruz A, VillarrealVelarde H. Does aging modify pulmonary tuberculosis? A metaanalytical review. Chest 1999; 116: 961–967. 5 Lee J H, Han D H, Song J W, Chung H S. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci 2005; 20: 784–789. 6 Pratt R H, Winston C A, Kammerer J S, Armstrong L R. Tuberculosis in older adults in the United States, 1993–2008. J Am Geriatr Soc 2011; 59: 851–857. 7 Morris C D W. The radiology, haematology and biochemistry of pulmonary tuberculosis in the aged. Q J Med 1989; 71: 529– 535. 8 Statistics South Africa. Population of Soweto and Diepkloof Municipalities, Census 2001. Pretoria, South Africa: Statistics South Africa, 2001. www.statssa.gov.za Accessed July 2014. 9 Kustner H G V. Trends in four major communicable diseases. S Afr Med J 1979; 55: 460–473. 10 Wood R, Lawn S D, Caldwell J, Kaplan R, Middelkoop K, Bekker L-G. Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. PLOS ONE 2011; 6: e25098. 11 Zhang X, Andersen A B, Lillebaek T, et al. Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study. Am J Trop Med Hyg 2011; 85: 285– 290.
TB in the elderly in Soweto
i
RESUME
L’impact de la tuberculose (TB) sur les adultes ag´ ˆ es en Afrique du Sud est rarement soulign´e. La d´eclaration des cas de TB frappant les adultes ag´ ˆ es a` Soweto en 2004 a e´ t´e de 262 pour 100 000 habitants. Les personnes ag´ ˆ ees repr´esentaient 5,8% des adultes et seulement 1,6% des cas adultes d´eclar´es. Parmi 110 patients ag´ ˆ es e´ tudi´es, 50% avaient une TB pulmonaire, 37%, une TB extrapulmonaire et 13% les deux. Chez 46% d’entre eux, il existait un pathologie pr´edisposante. La TB a e´ t´e
prouv´ee microbiologiquement chez 77% des patients. Le statut du virus de l’immunod´eficience humaine (VIH) e´ tait connu chez 25 (23%) patients, dont 10 (9% de la cohorte des 110 patients e´ tudi´es) e´ taient infect´es par le VIH. Ces derniers avaient plus souvent une TB extrapulmonaire, une an´emie et une hyponatr´emie. Les adultes ag ˆ e´ s de Soweto supportent un plus lourd fardeau en mati`ere de TB.
RESUMEN
Con poca frecuencia se destacan las consecuencias de la ´ tuberculosis (TB) en los ancianos del sur de Africa. La tasa de notificacion ´ de TB en los ancianos de Soweto en el 2004 fue 262 para 100 000 habitantes. Los ancianos representan el 5,8% de los adultos y el 1,6% de los casos notificados en este grupo. En los 110 pacientes ancianos estudiados, el 50% presento´ TB pulmonar, el 37% TB extrapulmonar y el 13% ambas localizaciones. En 46% de los casos se observo´ una enfermedad predisponente.
Se obtuvo confirmacion ´ bacteriologica ´ de la TB en 77% de los casos. La situacion ´ frente al virus de la inmunodeficiencia humana (VIH) se conocio´ en 25 pacientes (23%), de los cuales 10 presentaban la infeccion ´ (9% de la cohorte). Los pacientes adultos con infeccion ´ por el VIH exhibieron con mayor frecuencia TB extrapulmonar, anemia e hiponatremia. Los adultos ancianos en Soweto soportan una alta carga de morbilidad por TB.
