title: Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes.
abstract: BACKGROUND
  worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults.
  
  
  OBJECTIVE
  to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.
  
  
  METHODS
  we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.
  
  
  RESULTS
  eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; P<0.001) adjusting for sociodemographic and clinical variables.
  
  
  CONCLUSIONS
  community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.
authors.affiliation: Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca Morelos,  México.
authors.forename: Luis Pablo
authors.initials: LP
authors.lastname: Cruz-Hervert
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-García
authors.forename: Leticia
authors.initials: L
authors.lastname: Ferreyra-Reyes
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla-del-Valle
authors.forename: Bulmaro
authors.initials: B
authors.lastname: Cano-Arellano
authors.forename: Sergio
authors.initials: S
authors.lastname: Canizales-Quintero
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ferreira-Guerrero
authors.forename: Renata
authors.initials: R
authors.lastname: Báez-Saldaña
authors.forename: Norma
authors.initials: N
authors.lastname: Téllez-Vázquez
authors.forename: Ariadna
authors.initials: A
authors.lastname: Nava-Mercado
authors.forename: Luis
authors.initials: L
authors.lastname: Juárez-Sandino
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Delgado-Sánchez
authors.forename: César Alejandro
authors.initials: CA
authors.lastname: Fuentes-Leyra
authors.forename: Rogelio
authors.initials: R
authors.lastname: Montero-Campos
authors.forename: Rosa Areli
authors.initials: RA
authors.lastname: Martínez-Gamboa
authors.forename: Peter M
authors.initials: PM
authors.lastname: Small
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-de-León
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000375:Aging; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003371:Cough / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000635:transmission; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods; D008800:Mexico / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents