Clinical, Radiological Features and Treatment Outcomes of Tuberculosis in Patients Aged 75 years and Older

doi:10.21203/rs.3.rs-4167985/v1

Introduction

Tuberculosis is a significant contributor of morbidity and mortality. With a progressively aging population, TB is increasingly encountered in older adults. Understanding the clinical presentation and optimal treatment strategies for TB in this population is essential.

Method

Clinical, radiological features, treatment and outcome of TB in patients aged 75 years or older was evaluated retrospectively.

Results

Among 92 elderly tuberculosis patients, most were male (76.1%) with a mean age of 82.5 years. Pulmonary TB was diagnosed in 52.2% of patients, Extra Pulmonary TB in 32.6%, and Disseminated TB in 15.2%. Comorbidities included Diabetes Mellitus (59.8%) and Congestive Heart Failure (41.3%). The most common presentation symptoms included cough (51.1%), fever (43.5%), dyspnea (39.1%), and weight loss (31.5%). Delay of TB diagnosis for up to 3 months was observed in 31.5% of patients. Weight loss and male gender were significant predictors of delayed diagnosis. Laboratory findings varied among TB types, with disseminated TB showing higher eosinophilia and thrombocytopenia. Completion of an initial RIPE treatment protocol achieved in 67.6% of patients. Mortality during treatment occurred in 23.9% of patients. Pulmonary TB was associated with higher mortality compared to extrapulmonary TB (p=0.007).

Conclusion

Tuberculosis is associated with high mortality in patients above age of 75. There is still a substantial delay in TB diagnosis in elderly. RIPE regimen is frequently changed due to side effect. Alternative regimen choices were quite variable. More studies on tuberculosis in this patient’s population is needed to define the best effective therapeutic approach.

Tuberculosis

Elderly

TB in Saudi

mortality

Disseminated Tuberculosis

Tuberculosis (TB) is a major public health concern despite the delegation efforts made by the World Health Organization (WHO) and partners to improve its control[1]. It is the 13th leading cause of death worldwide[2]. Multiple observational studies conducted in the Western Pacific, Eastern Mediterranean, and Southeast Asian regions, TB cases are rising among the elderly, particularly those who are 65 years and older [3–6]. Similar trends have been observed in European regions. For instance, in France in 2019, the reported percentage of TB cases was 17.5% among individuals aged over 65, 9.8% among those over 75, and 6.3% among those over 80[7].

Several investigators have indicated a direct link between age and the risk of mortality in patients with TB [2, 8, 9]. In a large TB treatment trial in the United States and Canada, mortality was highest with increased age [8]. Similarly, a study involving Taiwanese TB patients highlighted an elevated risk of mortality in the age group of ≥ 75 years [10].

In a Saudi Arabia, Aljadani et al reported an overall mortality rate of 22 per 1000/yeas among Saudi TB cases, with the highest mortality rates among the elderly, males, and patients with pulmonary TB [11].As the life expectancy is increasing worldwide, TB in older people will become a significant diagnostic and therapeutic challenges[12].

This study aims to describe the clinical characteristics of TB in patients above age of 75, identify the different anti-TB regimen received, and treatment outcomes.

We identified all cases of TB admitted or treated as an outpatient at King Abdulaziz Medical City, Riyadh, Saudi Arabia during the period from January 2015 to December 2021. A chart review was conducted including patients aged 75 years or older, diagnosed with Pulmonary Tuberculosis (PTB), Extra-Pulmonary Tuberculosis (EPT) or Disseminated Tuberculosis (DTB) based on a positive AFB culture, positive TB PCR from sputum, tissues or fluid or compatible histopathological changes, compatible clinical presentation with documented radiological response after starting on anti TB medications. Only patients who were initiated on anti-tuberculous medications were included.

Collected data included patients, age, gender, comorbidities history of TB or contact with active TB patients, use of immune suppressive medications, presenting complains and time interval from the onset of symptoms until confirmation of TB diagnosis (less than 30 days, between 31–90 days, and more than 90 days)

We also collected data on initial laboratory investigations, including complete blood count (CBC), inflammatory markers (ESR, CRP), liver function tests (LFT) and renal function tests. Radiological findings of chest x ray and CT chest were obtained from radiological reports.

Data pertaining to initial TB treatment was collected. Typical initial regimen is defined as initiating therapy with 4 drugs namely Isoniazid, Rifampicin, Pyrazinamide and Ethambutol (RIPE regimen). Atypical initial therapy regimen is defined as any modification of the previously mentioned drugs either by substitution or omission of one or more drugs. Any modification of the initial regimens was documented including the indication for the modification, nature of modification (omission, addition, or substitution of drugs). Outcome of TB therapy was documented.

The study received ethical approval from the Ethics Committee at King Abdullah International Medical Research Center (KAIMRC) under approval number IRB/2609/22.

Statistical analysis

A comprehensive statistical analysis was conducted on the dataset, encompassing both descriptive and inferential methodologies. Firstly, a descriptive analysis is conducted to summarize the demographic characteristics of the participants, which include age, gender, and other features. This provides an overview of the study population. Subsequently, inferential analyses such as Fisher’s Exact Test or ANOVA (for more than two groups) are employed to examine the significant difference between variables. Binary Logistic Regression is used to find out the predictors of delayed diagnosis and mortality as outcome. Statistical significance is established at a p-value of 0.05 or lower and a 95% Confidence Interval. All statistical analyses are executed using IBM's SPSS Software, version 29.0.0.

Demographic and presenting symptoms:

We identified 92 patients with TB, most were male, 40 patients (76.1%). The mean age was 82.5 ± 6.8 years. Forty-eight patients were diagnosed as PTB (52.2%), 30 patients as EPTB (32.6%) and 14 patients (15.2%) were diagnosed as DTB. Spinal tuberculosis was the most common extrapulmonary form of Tuberculosis occurring in 12 patients followed by TB lymphadenitis in 7 patients. (Table 1)

The most common presenting symptoms were cough in 47 patients (51.1%), fever in 40 patients (43.5%), dyspnea in 36 patients (39.1%), weight loss in 29 patients (31.5%), night sweats in 15 patients (16.3%), and hemoptysis in 9 patients (9.8%). Additionally, 55 patients (59.8%) exhibited other symptoms like poor oral intake and low back pain. (Table 1) The time interval from symptom onset to diagnosis varied. In 33 patients (35.9%), diagnosis of TB was established ≤ 30 days from start of symptoms, 30 patients (32.6%) diagnosis was confirmed 31–90 days from symptoms, and in 29 patients (31.5%) diagnosis was established after 3 months of symptoms. (Table 1)

The most prevalent comorbidity was Diabetes Mellitus (DM) in 55 patients (59.8%) and Congestive Heart Failure (CHF) in 38 patients (41.3%). Other comorbidities include chronic kidney disease (CKD) in 23 patients (25%), Hemodialysis in 10 patients (10.9%), Chronic Liver Disease (CLD) in 6 patients (6.5%) and chronic respiratory disease (Asthma and COPD) in 4 patients (4.3%). Seven patients were immunocompromised or on Immunosuppressive Therapy (7.6%). History of prior TB was present in 8 patients (8.7%). History of recent contact with TB was documented on 4 patients (4.3%). (Table 1)

Logistic regression analysis identifying adjusted predictors of delay in the diagnosis of tuberculosis (TB). Weight loss has a significant positive association with delay (B = 1.991, p = 0.003), with an odds ratio (Exp (B)) of 7.322, indicating that elderly individuals experiencing weight loss are approximately 7 times more likely to face delayed TB diagnosis. Furthermore, gender (male) also demonstrates significance (B=-1.379, p = 0.030), with an odds ratio of 0.252, suggesting that males have a lower likelihood of delayed diagnosis compared to females. Other symptoms and age did not show significant associations. (Table 2)

Initial Labs, and Radiological findings

Different Laboratory findings according to different types of TB shown in Table 2. Patients with DTB had significantly more eosinophilia (defined as eosinophil count more than ≥ 500cells/mcL) compared to those with PTB or EPTB (p = 0.026). Thrombocytopenia (defined as Platelet count of < 150 cells/mcL) was also significantly more prevalent in patients with DTB (p = 0.003). The mean C-reactive protein and Albumin levels were significantly lower in patients with PTB compared to patient with DTB or EPTB. (Table 3)

The most prevalent radiological findings in Tuberculosis in this group is shown in figure (1). Consolidation was present in 47 patients (51.1%), Upper Lung lobe involvement occurred in 46 patients (50%) while lower lobe involvement was present in 31 patients (33.7%). Middle lobe involvement was present in 17 patients (18.5%). Pleural Effusion was present in 46 patients (50%). Lymph node enlargement was present in 39 patients (42.4%). Other common findings include ground glass opacity in 20 patients (21.7%), and cavitation in 19 patients (20.7%) (Fig. 1).

Diagnosis, and Treatment

The diagnosis of TB was confirmed by a positive culture in 50 patients (54%), by PCR alone in 2 patients (2.2%), while diagnosis was based on a histological finding compatible with TB (granuloma) in 36 patients (39%). Clinical diagnosis of TB without confirmatory tests was made in 4 patients (4.3), all of whom were started on Anti-TB therapy and showed clinical and radiological response (Table 1)

Typical initial RIPE regimen was used in 82 patients (89.1%) while an initial modified regimen was used in 17 patients (28.3%). Treatment adjustment within the first 2 months occurred in 24 patients (26.1%). The most frequent reason to modify an initial typical 4 drug regimen was increase in liver enzymes (ALT) occurring in 18 patients (20.7%). Other adverse reactions include skin rashes and gastro-toxicity reported in 3, and 3 patients respectively (3.3%). Thrombocytopenia is the least frequently reported adverse effect, affecting one patient (1.1%) of patients. (Table 4)

PZA was the most common cause of altered liver enzymes, in 10 of the 18 patients (55.5%), followed by INH and Rifampicin, in 2 patients each. In the other 4 patients, both INH and PZA were stopped concomitantly and were never restarted again. Other causes of modifications were poor compliance in two patients and anaphylaxis reaction in one patient (PZA was blamed).

In two additional patients, same initial drugs were continued but more drugs were added because of worsening symptoms. Side effects

Pyrazinamide was the most frequently discontinued drug from initial regimen in 14 patients (15%) and Moxifloxacin was the most frequently introduced medication in 15 patients (16.3%) patients followed by Amikacin in 4 patients and Linezolid in one patient. INH and Rifampicin were replaced in 6 (6.5%) and 8 patients (8.7%) respectively. (Table 4)

Initial modified regimen was used in 17 patients. Two of the initial RIPE drugs were substituted in one patient and 3 drugs were all substituted in another 3 patients (3%). In two patients, the whole 4 drugs were stopped together for transaminases and then re-started again with no increase in liver enzymes with the re-challenge. In three patients, only omission of one drug was done and three drugs only were used in treatment for the initial two months of therapy.

The most frequent initial atypical TB treatment regimen was a 4-drug regimen with Ethambutol, Moxifloxacin, Rifampicin and Isoniazid in 3 patients, and a 3-drug regimen with Ethambutol, INH and wither Moxifloxacin or Rifampicin in 4 patients. Moxifloxacin was the most frequently used drug from the second line agents. Modification due to resistant strain only occurred in one patient (1.1%)

Outcome

Successful completion of intended TB therapy (cure) was achieved in 53 patients (67.6%). Twenty-two patients died during TB therapy (23.9) while follow up was lost during therapy in 17 patients (18.5%). Causes of death was respiratory failure in 8 patients (8.7%), septic shock with multi-organ failure in 7 patients (7.6%). No documented reason of death in 7 patient (7.6%). (Table 4)

Predictors of mortality in TB among elderly patients include the significant negative association of fever (B=-2.532, p = 0.032) and lower lobe involvement (B=-2.199, p = 0.036). Conversely, night sweats (B = 1.288, p = 0.428), hemoptysis (B = 1.750, p = 0.084) and Ground glass opacity (B=-2.521, p = 0.045) demonstrate positive associations with higher mortality (Table 5). Patients with pulmonary tuberculosis has higher mortality compared to those with extrapulmonary tuberculosis both during TB therapy and after completion of treatment (p = 0.007 and p = 0.019).

Despite a decreasing incidence of newly diagnosed TB cases in many parts of the world including Saudi Arabia, incidence of tuberculosis in older persons (aged ≥ 65 years) still constitute a significant proportion of all notified TB cases [13, 14]. In Japan and Korea, 69% and 51 of newly diagnosed TB cases were in patient aged 65 and older [15]. In Western Pacific Region, Tuberculosis in the elderly was 19.5%, the highest of the total TB incidence in that region [15]. Tuberculosis also remains a leading cause of death worldwide, with older age recognized as a major risk factor for TB-related death [16]. We aimed in this study to evaluate the profile and outcomes of TB in the elderly in Saudi Arabia, which is still considered a country with a moderate burden of Tuberculosis.

Tuberculosis in elderly is usually secondary to reactivation especially in countries with lower TB burden [17–19]. Progression of a primary TB infection or reactivation of TB may also occur in elderly due to age-associated immune dysfunction and associated comorbidities especially in countries with high TB burden and transmission [20–24]. In our study the majority of our patients had underlying comorbidities and we believe the reactivation is the most likely mechanism of TB disease in this group. Only 4 of our patients (4.3%) gave a history of recent exposure to confirmed TB cases.

Fifty-five of our patients (59.8%) presented with less specific symptoms such as fatigue, back pain, and low oral intake. The typical clinical presentation of tuberculosis like prolonged cough, hemoptysis and weight loss may be less prominent in elderly persons. The presenting symptoms and signs may also be confounded by concurrent comorbidities including structural lung disease like COPD, making TB more challenging to diagnose in older adults and leading to delay in diagnosis or even misdiagnosis with malignancies for example. Patients may also dismiss some of the symptoms like cough attributing it to other illness common in older people like COPD [6, 25–30]. More than two thirds of patients ultimately diagnosed with Tuberculosis were not recognized on initial hospitalization; the majority (64%) of those with initial missed diagnosis were aged > 60 years [31–33].

There was a delay of 3 months or more before the diagnosis was established in more than one third of our patients. In a study done in China, the median time from symptom onset to TB disease diagnosis was > 90 days among older adults [31]. Delay in diagnosis will result in more advanced disease at time of diagnosis, more likelihood of transmission and potentially higher mortality. This delay in diagnosis may be a factor contributing to high mortality observed in our study.

Some of the symptoms like weight loss may miss guide the physicians to malignancy. In our study, weight loss was significantly associated with delayed diagnosis. Inadequate TB awareness and knowledge about TB in elderly has been reported in some countries [34, 35]. Interventions designed to explore the awareness and knowledge about TB disease and its symptoms in older Saudi citizens is warranted.

Radiological features of TB in older people may be different than in younger population. Various studies reported less prevalence of typical lung cavitation, consolidation or pulmonary nodules [16, 36–39] In our study however, both cavity lung disease, upper lobe involvement and pleural effusion occurs in half of the patientsLower lobe involvement and nodular changes were less commonly present compared to other reports [9, 40, 41].

Selecting a regimen for treatment of TB in older people may also be challenging for many reasons. Polypharmacy and drug to drug interactions with TB medications is common in elderly due to multiple coexisting illness [54–56]. The two main first line medication, INH and in particular Rifampicin is associated with drug-to-drug interaction like with the anticoagulants DOAC and warfarin.

Older people with TB above age of 85 years have a higher risk of treatment failure and a higher rate of treatment interruption due to side effects [57, 58]. There was no documentation of treatment failure in our group, however modifications of initial regimens were due to worsening symptoms in two patients only.

Adverse effects of TB medication in elder are also a significant concern. All the three first line drug therapy for TB. INH, rifampicin and pyrazinamide are associated with hepatoxicity in elderly [42–44]. In elderly people, pyrazinamide omission from the initial regimen is suggested by some authors to avoid toxicity [45]. American guideline does not recommend the use of pyrazinamide during the intensive phase in elderly above 75 years with moderate disease and lower resistance risk [9]. Other studies, however, did not find an association between PZA containing regimens use and higher treatment discontinuation rates, liver toxicity, or death in older people [45–47]. WHO has not recommended any specific TB treatment regimen in the elderly.

PZA is not the only anti TB medication that pose a problem in eldest [48]. Although Elderlies are more likely to have vision related medical problems which increase potential toxicity of Ethambutol[49]. Ethambutol side effects were not reported frequently in our patients, significant side effects from this medication were common in elderly people in some other studies. There was no documentation of routine visual acuity assessment in patients taking this medication in our study. Two of the most commonly used (so called second line therapy) anti-TB agents are Moxifloxacin and Linezolid. Moxifloxacin is being increasingly incorporated as part of initial regimen. The drug has a high risk of hepatic toxicity, QT prolongation and tendinitis in older people[50, 51]. Safety of linezolid use in elderly in older people is not well known [52, 53]. Linezolid has been used in few of our patients.

Drug resistance in our population was very low. This was similarly shown in other parts of the world. In Germany, resistance rate of all anti TB medication was lower in older persons (6.5 vs. 13.9%) including those with multi resistant isolates (MDR) (0.6 vs. 3.1%) [59]. in another cohort of more than 3000 patients from China, primary TB cases in elderly had a lower rate of drug resistant TB, multi drug resistant TB, Rifampin resistance TB and streptomycin resistant TB. Resistance to INH and Ethambutol however was higher among elderly [54].

Limitation

This is a single center study and results may be limited to this geographical location. The large number of patients lost to follow could have affected the mortality rate. Many of the lost follow ups are likely dead. This conclusion is made because all of the patients in this group are Saudi citizens who have full eligibility in this tertiary center and are very unlikely to seek heath care elsewhere at their age. Loss of follow up is not uncommon in elderly with TB [53].

We also did not assess adherence to medications which was found to be a problem in some other studies [55–57].

The diagnosis and treatment of tuberculosis (TB) in elderly patients (over 75 years) presents a significant challenge. Nonspecific symptoms, delays in diagnosis, and frequent adverse reactions to medications all contribute to this complexity. A critical reevaluation of current diagnostic and therapeutic approaches is warranted. Existing literature suggests concerning trends: frequent modifications to initial drug regimens, often lacking robust evidence and potentially reflecting physician bias. While establishing a association between TB infection and mortality in elderly can be difficult, further targeted research is essential to define the most efficacious treatment strategies for this group of patients.

Ethics approval and consent to participate

The Institutional Review Board at King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia (IRB/2609/22), approved the study. Patient confidentiality was ensured, and the collected patients' data used by the research team only

Consent for publication: All authors agree for publication
Availability of data and materials: available
Competing interests : none
Funding : None
Acknowledgements : none

Author Contribution

SB: Supervision of the research Conception and design of Study, participate in writing the draft and final manuscriptAA :Collecting , Acquisition of data HR: Collecting , Acquisition of data HJ : Conception the study , participate in writing the final manuscriptLL : Analysis and interpretation of dataES: Literature review , review and reference updateAll authors have critically reviewed the manuscript for important intellectual contents, approved the final draft and are responsible for the content and similarity index of the manuscript

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Table 1: Sociodemographic parameters, prevalence of different TB types and presenting symptoms

^ TB peritonitis, Testicular TB and chest wall TB

* Decrease level of consciousness, confusion

** Fatigue, malaise, decrease oral intake.

*** Induced sputum, bronchoscopic lavage

Table 2: - Adjusted predictors of delay in diagnosis of TB (Logistic Regression Analysis)

	B	Sig.	Exp(B)	95% CI
	B	Sig.	Exp(B)	Lower	Upper
Age	.000	1.000	1.000	.933	1.072
Gender (Male)	-1.379	*.030*	.252	.073	.872
Dyspnea	.301	.644	1.352	.377	4.847
Cough	-.153	.817	.858	.235	3.133
Fever	-.044	.933	.957	.341	2.685
Night Sweat	.094	.912	1.099	.206	5.859
Hemoptysis	-.201	.818	.818	.148	4.527
Weight Loss	1.991	*.003*	7.322	1.924	27.858
Others	.806	.142	2.238	.764	6.559
Constant	.619	.836	1.856

Table 3: Different laboratory finding according to different type of TB (ANOVA)

	Pulmonary TB	Extra-Pulmonary TB	Disseminated TB‎	Overall	Sig. Value
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Sig. Value
White Blood Cell Count	10.96 (16.4)	8.17 (4.3)	5.30 (2.6)	9.15 (12.1)	0.275
Lymphocyte	17.34 (9.6)	22.70 (9.9)	18.71 (18.2)	19.12 (11.4)	0.257
Polymorph Neutrophils	65.21 (19.1)	60.73 (15.0)	55.69 (28.8)	62.46 (19.8)	0.377
Eosinophils	1.63 (4.9)	.80 (1.5)	13.93 (33.1)	3.28 (13.7)	*0.026*
Hemoglobin	115.52 (20.3)	118.13 (18.2)	103.57 (17.5)	114.53 (19.6)	0.063
Hematocrit	0.36 (0.06)	0.35 (0.06)	0.32 (0.05)	0.35 (0.06)	0.082
Platelets	299.78 (135.4)	315.55 (117.7)	176.57 (111.2)	285.54 (133.8)	*0.003*
Erythrocyte Sedimentation Rate	83.92 (29.2)	81.19 (28.3)	71.11 (42.7)	80.87 (30.8)	0.569
C reactive protein	95.22 (71.1)	48.86 (32.5)	109.53 (72.6)	80.09 (63.7)	*0.009*
Procalcitonin	0.17 (0.10)	2.52 (6.5)	0.38 (0.33)	1.39 (4.6)	0.574
Alkaline Phosphatase	154.89 (106.97)	162.03 (108.9)	161.29 (146.9)	158.22 (113.2)	0.960
Gamma-glutamyl transpeptidase	190.45 (157.1)	214.28 (229.4)	178.50 (123.2)	198.82 (183.9)	0.902
Aspartate Aminotransferase	33.57 (23.7)	35.86 (26.7)	38.79 (17.3)	35.13 (23.7)	0.760
Alanine Aminotransferase	24.85 (18.6)	30.66 (34.2)	24.93 (11.6)	26.75 (24.0)	0.574
Albumin	28.76 (7.9)	32.04 (5.8)	26.14 (4.6)	29.41 (7.1)	*0.026*
Total Bilirubin	12.68 (9.0)	11.32 (8.2)	14.46 (11.6)	12.51 (9.1)	0.573
Blood Urea Nitrogen	7.78 (5.3)	7.76 (5.1)	9.30 (4.9)	8.01 (5.2)	0.606
Uric Acid	294.35 (152.7)	308.64 (125.9)	311.33 (207.8)	301.63 (151.7)	0.903
Creatinine	126.56 (172.5)	139.47 (170.4)	142.07 (133.6)	133.35 (164.7)	0.926

Table 4: Treatment related Features of TB Patients

		Frequency (n=92)	Percent
Treatment Duration Patients who completed therapy Patients died during therapy	Months (Mean, SD)	7.1 (5.2)
	Days (Mean, SD)	12.1 (7.2)
Initial Regimen	Typical Regimen (Ethambutol/Pyrazinamide/Rifampin/Isoniazid)	82	89.1
Initial Regimen	Modified Regimen	10	10.9
Adjustment of Initial Treatment	Yes	24	26.1
Changes due to Resistance		1	1.1
Rechallenged Initial Regimen	Yes	13	14.1
Final Regimen	Typical Regimen (Ethambutol/Pyrazinamide/Rifampin/Isoniazid)	65	70.7
Final Regimen	Modified Regimen	27	29.3
Adverse Reaction due to Treatment	Yes	18	19.6
Outcome of Treatment	Complete therapy	53	57.6
	Died during before completion of therapy	22	23.9
	Died after completion of therapy	16	17.4
	Lost Follow-Up during treatment	17	18.5
	Lost follow up after treatment completion	16	17.4
Causes of death during therapy	Respiratory Failure	8	8.7
	Septic Shock with MOF	7	7.6
	Unknown	7	7.6
Causes of death after completion of therapy	Cardiovascular even Pneumonia (bacterial, Viral) Malignancy Liver cirrhosis Unknown	4 6 2 2 2	4.3 6.5 2.2 2.2 2.2

Table 5: - Adjusted predictors of poor outcome (Mortality) in TB (Logistic Regression Analysis)

	B	Sig.	Exp(B)	95% CI
	B	Sig.	Exp(B)	Lower	Upper
Age	.065	.246	1.067	.956	1.192
Gender (Male)	.317	.734	1.373	.221	8.523
Presenting Features
Cough	.952	.381	2.591	.308	21.790
Fever	-2.532	*.032*	.080	.008	.806
Dyspnea	-1.039	.229	.354	.065	1.925
Weight Loss	-1.059	.461	.347	.021	5.776
Night Sweats	1.288	.428	3.627	.150	87.636
Hemoptysis	1.750	.084	5.756	.793	41.799
Presence of Other Symptoms	-1.451	.127	.234	.036	1.512
Pathological Features
Consolidation	1.403	.206	4.069	.462	35.802
Upper Lung Lobe Involvement	.791	.440	2.207	.296	16.422
Pleural Effusion	1.128	.225	3.089	.500	19.100
Lymph Node Enlargement	-.455	.705	.634	.060	6.713
Lower Lobe Involvement	-2.199	*.036*	.111	.014	.869
Nodules	1.382	.267	3.984	.346	45.808
Ground Glass Opacity	-2.521	*.045*	.080	.007	.948
Cavitation	-.720	.463	.487	.071	3.328
Middle Lung Lobe Involvement	.233	.835	1.262	.141	11.315
Micronodules	1.732	.131	5.652	.598	53.408
Tree in Bud Appearance	.860	.498	2.363	.196	28.456
Mass	.674	.670	1.962	.088	43.578
Bronchiectasis	-.451	.601	.637	.118	3.451
Pleural Thickening	.198	.810	1.219	.243	6.126
Fibrotic Changes	-22.801	.998	.000	.000	.
Treatment
Treatment (Atypical)	.351	.634	1.421	.334	6.037
Constant	-5.575	.249	.004

No competing interests reported.

Clinical, Radiological Features and Treatment Outcomes of Tuberculosis in Patients Aged 75 years and Older

Status:

Version 1

Abstract

Figures

Introduction

Methods

Statistical analysis

Results

Demographic and presenting symptoms:

Initial Labs, and Radiological findings

Diagnosis, and Treatment

Outcome

Discussion

Limitation

Conclusion

Declarations

Author Contribution

References

Tables

Additional Declarations

Status:

Version 1